Man is what he thinks he is

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Man is what he thinks he is
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Pathology of Tuberculosis

• Dr. Venkatesh M. Shashidhar
• Associate Professor of Pathology
• Fiji School of Medicine

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Introduction

• Infects one third of world population..!
• 3 million deaths due to TB every year
• Under privileged population -
• over crowding, malnutrition
• Since 1985 incidence is increasing in west
• AIDS, Diabetes, Immunosuppressed patients.
• Drug resistance

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Microbiology of TB

• M. tuberculosis (air) M. bovis (milk)
• Aerobic, no toxins, no spore, non motile
• Mycolic acid in bacterial wall - Acid Alcohol
  fast (AFB)
• M. avium, M.intracellulare in AIDS - Atypical
  tuberculosis.

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AFB - Ziehl-Nielson stain
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Pathogenesis of TB

• Type IV hypersensitivity - Granuloma
• Escape killing by macrophages
• Mycolic acid wax coat
• Cord Factor - surface glycolipid

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Tuberculous Granuloma

• Rounded outlines.
• Central Caseous necrosis.
• Transformed macrophages called epithelioid cells.
• Lymphocytes, plasma cells, and fibroblasts.
• Langhans giant cells.

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Tuberculous Granuloma
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Primary Tuberculosis

• In Non Immunized individuals (Children)
• Primary Tuberculosis
• Self Limited disease
• Ghons complex or Primary complex.
• Primary Progressive TB
• 10 of adults, Immunosuppressed individuals
• Common in malnourished children
• Miliary TB and Meningitis.

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Secondary Tuberculosis

• Post Primary in immunized individuals.
• Reactivation or Reinfection
• Apical lobes or upper part of lower lobes
• Caseation, cavity - soft granuloma
• Pulmonary or extra-pulmonary
• Local or systemic/Miliary

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Primary or Ghons Complex

• Primary tuberculosis is the pattern seen with
  initial infection with tuberculosis in children.
• Reactivation, or secondary tuberculosis, is more
  typically seen in adults.

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Ghon Complex
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Cavitary Tuberculosis

• When soft, necrotic center drain out leave behind
  a cavity.
• Cavitation is typical for large granulomas.
• Cavitation is more common in the reactivation
  tuberculosis seen in upper lobes.

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Tuberculous Granulomas
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Caseation Necrosis
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Epitheloid cells in Granuloma
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Systemic Miliary TB
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Adrenal TB - Addison Disease
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Spinal TB - Potts Disease
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Miliary Tuberculosis

• Extensive infection
• Hematogenous spread
• Low immunity
• Pulmonary or Systemic types.

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PPD Testing
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PPD Testing
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Lifes battles dont go always to the stronger
or faster man, But sooner or later,The
man who wins is the man who thinks he can.
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Lung Tumours

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

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Lung Cancer

• Most common visceral malignancy.
• Top public enemy in western world.
• 3rd of all cancer deaths due to lung cancer.
• Significant increase in incidence.
• Dramatic increase among females
• 90 of lung cancers are related to smoking..!
  (passive smoking in 5)

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Lung Cancer Smoking

• Depends on duration, amount of daily smoking
  deep inhaling.
• 10 fold greater risk than non smokers. 20 fold
  risk if gt40cigarettes per day
• Atypical cells in 96.7 of smokers compared to
  0.9 in non smokers.
• Significant proportion of over 1200 substances in
  smoke are carcinogenic. (not nicotine)
• Initiaters Benzoopyrenes
• Promoters Phenol derivatives
• Radioactive substances Polonium, C14, K40

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Classification (Bronchogenic Carcinoma)

• Squamous cell carcinoma 35
• Adenocarcinoma 30
• Brochial (acinar/papillary)
• Bronchioalveolar (1-9)
• Small cell carcinoma 22
• Oat cell carcinoma

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Bronchogenic Carcinoma
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Bronchogenic Carcinoma
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Bronchogenic Carcinoma
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Adeno- Carcinoma
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Direct Spread of carcinoma
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Oat cell Carcinoma
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LungMetastasis(Gross)
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Squamous Cell Carcinoma(CT)
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Normal Chest Radiograph
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LungMetastasis(Multiple coin shadows)
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Squamous Cell Carcinoma
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Adenocarcinoma
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Oat Cell Carcinoma (High power)
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Pleural effusion (Gross)
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Paraneoplastic Syndromes

• Hormone producing neoplasms.
• ADH - Hyponatremia
• ACTH Cushings syndrome
• Parathyroid hormone Hypercalcemia
• Gonadotrophins Gynecomastia

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Find the key to yourself.. and every door in
the world is open to you
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Thank You...

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine