Asthma
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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:
DDx:
- Infection - fungal.
Images
Charcot-Leyden crystals. (WC/Patho)
Charcot-Leyden crystals. (WC/Patho)
www:
Stains
Features - crystals:
- PAS-D -ve.
- GMS -ve.
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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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 108. ISBN 978-1416002741.
- ↑ 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.
- ↑ 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.
- ↑ 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.