hospital são paulo escola paulista de medicina 1933
TRANSCRIPT
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Hospital São PauloEscola Paulista de Medicina
1933
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VI Curso Nacional deVI Curso Nacional de
Doenças InterticiaisDoenças Interticiais
VI Curso Nacional deVI Curso Nacional de
Doenças InterticiaisDoenças Interticiais
Rimarcs G. FerreiraRimarcs G. Ferreira
Rimarcs G. FerreiraRimarcs G. Ferreira
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Granulomatoses PulmonaresGranulomatoses Pulmonares
causas comunscausas comuns
Granulomatoses PulmonaresGranulomatoses Pulmonares
causas comunscausas comuns
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causas comunscausas comunscausas comunscausas comuns
distribuição qualidade necrose infl.inters. pn.organização
sarcoidosesarcoidose linfangitica, acentuação axial (vasos, vias aéreas) ou pleura
Coalescência, bem formados, fibrose hialina, pouca inflamação
-/+ - -
InfecçõesInfecções Randômicos axial rara
Mais isolados, pouca coalescência, inflamação
+/- -/+ -/+
PHPH Vias aéreas e ductos alveolares
Isolados, frouxos, sem fibrose, inflamação
- + -/+
Hot tub Hot tub lunglung
Randômicos e axiais
Isolados com halo linfocitário
-/+ + -/+
aspectos gerais dos granulomasaspectos gerais dos granulomas
Cheung et al. Ann Diagn Pathol 7:127-138, 2003
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Processamento técnico da biópsia:
a. Cultura de tecido (área necrótica)
b. Colorações especiais (pesquisa de
agentes)
prata metenamina (fungos)
Ziehl-Neelsen (BAAR)
Gram
mucicarmin (se necessário)
imunoistoquímica, imunofluorescência
Processamento técnico da biópsia:
a. Cultura de tecido (área necrótica)
b. Colorações especiais (pesquisa de
agentes)
prata metenamina (fungos)
Ziehl-Neelsen (BAAR)
Gram
mucicarmin (se necessário)
imunoistoquímica, imunofluorescência
granulomatoses pulmonaresgranulomatoses pulmonaresgranulomatoses pulmonaresgranulomatoses pulmonares
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TuberculoseTuberculose
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. cicatriz (calcificação)
. nódulos (miliar)
. pn’ histiocítica DIP-like
. tuberculomas
. pn’ eosinofílica
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. cicatriz (calcificação)
. nódulos (miliar)
. pn’ histiocítica DIP-like
. tuberculomas
. pn’ eosinofílica
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courtesy: Samuel A. Yousem
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HistoplasmoseHistoplasmose
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. nódulo fibrocalcificado
. calcificação e fibrose (cicatriz)
. nódulos (miliar)
. histoplamoma
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. nódulo fibrocalcificado
. calcificação e fibrose (cicatriz)
. nódulos (miliar)
. histoplamoma
El-Zammar & Katzenstein; Histopathology 2007, 50:289-310El-Zammar & Katzenstein; Histopathology 2007, 50:289-310
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CriptococosCriptococos
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. BOOP com granuloma não necrosante
. pn’ mucóide
. pn’ granulomatosa necrosante
. granuloma necrosante solitário
. BOOP com granuloma não necrosante
. pn’ mucóide
El-Zammar & Katzenstein; Histopathology 2007, 50:289-310El-Zammar & Katzenstein; Histopathology 2007, 50:289-310
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ParacoccidioidomicoseParacoccidioidomicose
. pn’ granulomatosa necrosante
. granulomas solitários com neutrófilos
. pn’ eosinofílica
. pn’ granulomatosa necrosante
. granulomas solitários com neutrófilos
. pn’ eosinofílica
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AdiaspiromicoseAdiaspiromicose
. pn’ granulomatosa necrosante
. granulomas solitários com neutrófilos
. pn’ eosinofílica
. estruturas leveduriformes grandes
. pn’ granulomatosa necrosante
. granulomas solitários com neutrófilos
. pn’ eosinofílica
. estruturas leveduriformes grandes
El-Zammar & Katzenstein; Histopathology 2007, 50:289-310El-Zammar & Katzenstein; Histopathology 2007, 50:289-310
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Pneumonia de HipersensibilidadePneumonia de HipersensibilidadePneumonia de HipersensibilidadePneumonia de Hipersensibilidade
dados clínicos e radiológicos
cultura e pesquisas negativas
distribuição bronquiolocêntrica
granuloma frouxo, mal-formado
pneumonia intersticial granulomatosa
inflamação linfoplasmocitária
raros eosinófilos
bronquiolite obliterante
dados clínicos e radiológicos
cultura e pesquisas negativas
distribuição bronquiolocêntrica
granuloma frouxo, mal-formado
pneumonia intersticial granulomatosa
inflamação linfoplasmocitária
raros eosinófilos
bronquiolite obliterante
El-Zammar & Katzenstein; Histopathology 2007, 50:289-310El-Zammar & Katzenstein; Histopathology 2007, 50:289-310
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courtesy: Samuel A. Yousem
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coutesy: Samuel A. Yousem
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SarcoidoseSarcoidoseSarcoidoseSarcoidose
dados clínicos e radiológicos
cultura de tecido negativa
distrib’ peribroncovascular
(linfangítica) e pleural (75%)
dados clínicos e radiológicos
cultura de tecido negativa
distrib’ peribroncovascular
(linfangítica) e pleural (75%)
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SarcoidoseSarcoidoseSarcoidoseSarcoidose
Morfologia:
coalescência freqüente (granulomas)
prefere espaços alveolares
corpos de Shaumman (48% – 88%)
corpos asteróides (2% – 9%)
vasculite granulomatosa ocasional
ausência de necrose (94%)
Morfologia:
coalescência freqüente (granulomas)
prefere espaços alveolares
corpos de Shaumman (48% – 88%)
corpos asteróides (2% – 9%)
vasculite granulomatosa ocasional
ausência de necrose (94%)
Gal & Koss, Curr. Opin. Pulm. Med. 2002, 8:445-451El-Zammar & Katzenstein; Histopathology 2007, 50:289-310Gal & Koss, Curr. Opin. Pulm. Med. 2002, 8:445-451El-Zammar & Katzenstein; Histopathology 2007, 50:289-310
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Leslie & Wick, 2005
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Processamento técnico da biópsia:
a. Cultura de tecido (área necrótica)
b. Colorações especiais (pesquisa de agentes)
prata metenamina (fungos)
Ziehl-Neelsen (BAAR)
Gram
mucicarmin (se necessário)
imunoistoquímica, imunofluorescência
Processamento técnico da biópsia:
a. Cultura de tecido (área necrótica)
b. Colorações especiais (pesquisa de agentes)
prata metenamina (fungos)
Ziehl-Neelsen (BAAR)
Gram
mucicarmin (se necessário)
imunoistoquímica, imunofluorescência
granulomatosesgranulomatosesgranulomatosesgranulomatoses
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