Difference between revisions of "Asthma"

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#redirect [[Medical_lung_diseases#Asthma]]
'''Asthma''' is a common respiratory disease. It occasionally can be fatal and may be seen in the context of [[forensic pathology]].
 
The [[cytopathology]] of asthma is dealt with in ''[[Pulmonary_cytopathology#Asthma|pulmonary cytopathology (asthma)]]''.
 
==General==
*The bread and butter of respirology.
*May be associated with atopy (allergies), medications (e.g. [[NSAID]]s), occupational exposures.<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref>
*[[Clinical diagnosis]] - diagnosis based on symtpoms/response to therapy<ref name=pmid20176271>{{Cite journal  | last1 = Lemanske | first1 = RF. | last2 = Busse | first2 = WW. | title = Asthma: clinical expression and molecular mechanisms. | journal = J Allergy Clin Immunol | volume = 125 | issue = 2 Suppl 2 | pages = S95-102 | month = Feb | year = 2010 | doi = 10.1016/j.jaci.2009.10.047 | PMID = 20176271 }}</ref> +/-methacholine challenge testing.<ref name=pmid25326695>{{Cite journal  | last1 = Lim | first1 = SY. | last2 = Jo | first2 = YJ. | last3 = Chun | first3 = EM. | title = The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma. | journal = BMC Pulm Med | volume = 14 | issue =  | pages = 161 | month =  | year = 2014 | doi = 10.1186/1471-2466-14-161 | PMID = 25326695 }}</ref>
 
Treatment:
*Bronchodilators.
*+/-Steroids.
 
===Pathogenesis===
*T-cell response T<sub>H</sub>2 dominant.
 
Sequence:<ref name=Ref_PCPBoD8_370-2>{{Ref PCPBoD8|370-2}}</ref>
*Antigen T<sub>H</sub>2 lymphocyte -> IgE B-cell -> [[mast cell]] IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling.
 
==Gross==
*Lung over-inflation.
*Mucous plugs.
*Focal resorption atelectasis,<ref name=Ref_PCPBoD8_363>{{Ref PCPBoD8|363}}</ref> i.e. collapse.
 
==Microscopic==
Features:<ref name=Ref_Klatt108>{{Ref Klatt|108}}</ref>
*Edema.
*Mucous (plugs).
*+/-Smooth muscle hypertrophy.
*+/-Inflammation - especially with [[eosinophil]]s.
*+/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product).
**Sharp edge, diamond shaped, pink on [[H&E]].
 
Notes:
*''Leyden'' in ''Charcot-Leyden'' is also seen written as ''Leiden''.
**Finding associated with hypereosinophilia<ref name=pmid6162378>{{Cite journal  | last1 = Dincsoy | first1 = HP. | last2 = Burton | first2 = TJ. | last3 = van der Bel-Kahn | first3 = JM. | title = Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome. | journal = Am J Clin Pathol | volume = 75 | issue = 2 | pages = 236-43 | month = Feb | year = 1981 | doi =  | PMID = 6162378 }}</ref> - ''not'' pathognomonic for asthma.
*[[Pulmonary cytopathology]]:
**''Curschmann's spirals'' =  spiral-shaped mucous plugs.<ref name=pmid9812228>{{cite journal |author=Cenci M, Giovagnoli MR, Alderisio M, Vecchione A |title=Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution |journal=Diagn. Cytopathol. |volume=19 |issue=5 |pages=349–51 |year=1998 |month=November |pmid=9812228 |doi= |url=}}</ref>
**''Creola bodies'' = clusters of (ciliated) bronchial epithelial cells.<ref name=pmid2818212>{{Cite journal  | last1 = Isohima | first1 = K. | last2 = Takahashi | first2 = K. | last3 = Soda | first3 = R. | last4 = Hukasaka | first4 = N. | last5 = Tanabe | first5 = K. | last6 = Ozaki | first6 = K. | last7 = Nakato | first7 = H. | last8 = Araki | first8 = M. | last9 = Tuzi | first9 = M. | title = [The clinical significance of Creola body in the sputum of asthmatic patients]. | journal = Arerugi | volume = 38 | issue = 7 | pages = 542-8 | month = Jul | year = 1989 | doi =  | PMID = 2818212 }}</ref>
 
DDx:
*Infection - fungal.
 
===Images===
<gallery>
Image:Charcot-Leyden_crystals,_HE_3.jpg | Charcot-Leyden crystals. (WC/Patho)
Image:Charcot-Leyden_crystals,_HE_2.jpg | Charcot-Leyden crystals. (WC/Patho)
</gallery>
www:
*[http://www.udel.edu/medtech/dlehman/medt372/Ch-lyd.html Charcot-Leyden crystals (udel.edu)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168024/figure/F1/ Charot-Leyden crystals (nih.gov)].
 
==Stains==
Features - crystals:
*PAS-D -ve.
*GMS -ve.
 
==Sign out==
<pre>
BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL:
- CHARCOT-LEYDEN CRYSTALS.
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS.
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE.
- NEGATIVE FOR MALIGNANCY.
 
COMMENT:
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific;
however, they would be compatible with asthma. Clinical and microbiological correlation
is required.
</pre>
 
==See also==
*[[Medical lung diseases]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Medical lung diseases]]

Latest revision as of 05:31, 13 March 2015

Asthma is a common respiratory disease. It occasionally can be fatal and may be seen in the context of forensic pathology.

The cytopathology of asthma is dealt with in pulmonary cytopathology (asthma).

General

  • The bread and butter of respirology.
  • May be associated with atopy (allergies), medications (e.g. NSAIDs), occupational exposures.[1]
  • Clinical diagnosis - diagnosis based on symtpoms/response to therapy[2] +/-methacholine challenge testing.[3]

Treatment:

  • Bronchodilators.
  • +/-Steroids.

Pathogenesis

  • T-cell response TH2 dominant.

Sequence:[4]

  • Antigen TH2 lymphocyte -> IgE B-cell -> mast cell IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling.

Gross

  • Lung over-inflation.
  • Mucous plugs.
  • Focal resorption atelectasis,[5] i.e. collapse.

Microscopic

Features:[6]

  • Edema.
  • Mucous (plugs).
  • +/-Smooth muscle hypertrophy.
  • +/-Inflammation - especially with eosinophils.
  • +/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product).
    • Sharp edge, diamond shaped, pink on H&E.

Notes:

  • Leyden in Charcot-Leyden is also seen written as Leiden.
    • Finding associated with hypereosinophilia[7] - not pathognomonic for asthma.
  • Pulmonary cytopathology:
    • Curschmann's spirals = spiral-shaped mucous plugs.[8]
    • Creola bodies = clusters of (ciliated) bronchial epithelial cells.[9]

DDx:

  • Infection - fungal.

Images

  • Charcot-Leyden crystals. (WC/Patho)

  • Charcot-Leyden crystals. (WC/Patho)

www:

Stains

Features - crystals:

  • PAS-D -ve.
  • GMS -ve.

Sign out

BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL:
- CHARCOT-LEYDEN CRYSTALS.
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS.
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE.
- NEGATIVE FOR MALIGNANCY.

COMMENT:
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific; 
however, they would be compatible with asthma. Clinical and microbiological correlation 
is required.

See also

References

  1. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 370. ISBN 978-1416054542.
  2. ↑ Lemanske, RF.; Busse, WW. (Feb 2010). "Asthma: clinical expression and molecular mechanisms.". J Allergy Clin Immunol 125 (2 Suppl 2): S95-102. doi:10.1016/j.jaci.2009.10.047. PMID 20176271.
  3. ↑ Lim, SY.; Jo, YJ.; Chun, EM. (2014). "The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma.". BMC Pulm Med 14: 161. doi:10.1186/1471-2466-14-161. PMID 25326695.
  4. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 370-2. ISBN 978-1416054542.
  5. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 363. ISBN 978-1416054542.
  6. ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 108. ISBN 978-1416002741.
  7. ↑ Dincsoy, HP.; Burton, TJ.; van der Bel-Kahn, JM. (Feb 1981). "Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome.". Am J Clin Pathol 75 (2): 236-43. PMID 6162378.
  8. ↑ Cenci M, Giovagnoli MR, Alderisio M, Vecchione A (November 1998). "Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution". Diagn. Cytopathol. 19 (5): 349–51. PMID 9812228.
  9. ↑ Isohima, K.; Takahashi, K.; Soda, R.; Hukasaka, N.; Tanabe, K.; Ozaki, K.; Nakato, H.; Araki, M. et al. (Jul 1989). "[The clinical significance of Creola body in the sputum of asthmatic patients].". Arerugi 38 (7): 542-8. PMID 2818212.
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