Cigars are not as carcinogenic as cigarettes probably due to the fact that cigar smoke is not usually inhaled. In the early 1900’s cigar smoking was associated with elegance and currently portrays a sense of bravado as demonstrated in this image.
Courtesy Ashley Davidoff MD 13021g
TheCommonVein.net
From the series “People of Israel”
Ashley Davidoff MD
TheCommonVein.net
From the series “People of Israel”
Ashley Davidoff MD
TheCommonVein.net
Collage of cigarette advertisements of the early 20th century revealing a portrayal of elegance, feminism, and manhood. The advertising campaigns worked well for the cigarette companies but had a dismal result on health. The third image from the left in the top row shows a physician who states that “Luckies are less irritating”
The world war brought free cigarettes to the soldiers from the tobacco companies. The effect on the soldiers and the culture was a devastating rise in carcinoma 20 years after the event, with peaks in the incidence of carcinoma in the 1940’s and then in the 1960’s.
54458 code historical
Ashley Davidoff MD
The CommonVein.net
54457 code historical
These diseases are all about cigarettes and the garbage that they deposit in our lungs.
Courtesy Ashley Davidoff MD. 32646d The CommonVein.net
Polycyclic Aromatic Hydrocarbons (PAH’s) are by products of nicotine and are flat compounds that are similar to benzene in structure. Liver enzymes oxidize the PAH’s making their incorporation into DNA possible. The change in DNA structure leads to interference in function and a predisposition to carcinogenesis.
Image modified by Ashley Davidoff MD. 54460 The CommonVein.net
An alveolus subjected day and night for 20 years to black smog from a human chimney. It had no choice but to react.
Courtesy Ashley Davidoff MD. 32166f
The CommonVein.net
The acinus with its arborizations is shaped more like a bunch of grapes.
Courtesy of: Ashley Davidoff, M.D 42650
TheCommonVein.net
Image on the left shows normal size and appearance of terminal bronchioles and alveoli. On the right the image shows the effects on the respiratory bronchioles and when severe, on the alveoli as well
Ashley Davidoff MD
TheCommonVein.net
The CT scan through the chest of an 80 year old male shows a large lung mass in the posterior aspect of the right upper lobe (overlaid in green) and3 small nodules in the left upper lobe (overlaid in green). The patient is obviously a smoker and the incriminating pack of cigarettes is identified in his right shirt pocket containing 9 cigarettes. The lung cancer was shown to be an adenocarcinoma The pathology of the nodules may either represent metastatic disease or multicentric foci of bronchioloalveolar cell carcinoma. Associated finding of a thinned anterior junction line suggests hyperinflation and emphysema, and the thickened bronchial walls noted in the right lung suggest chronic bronchitis. Saber shaped trachea is also reminiscent of emphysema. The patient is emaciated, a finding that relates both to his chronic lung disease and his cancer.
Ashley Davidoff MD 87831c01b.8s
TheCommonVein.net
Ashley Davidoff MD
TheCommonVein.net
Langerhans Cell is a dendritic white cell with a wavy nucleus that creates granulomas and infiltrates the interstitium. It thus causes spiculated nodules that appear as spiculated nodules on CT
Ashley Davidoff
TheCommon Vein.net
The subsegmental medium sized airways give rise to the terminal bronchiole (tb) which gives rise to the membranous airways. These include in order, the respiratory bronchiole (rb), alveolar duct (ad) and alveolar sac (as)
Ashley Davidoff
TheCommonvein.net
Light brown granules in the macrophage is characteristic of the smokers macrophage
Ashley Davidoff
TheCommonVein.net
The Buck Ends Here
The alveolus is lined by a simple epithelium – one cell layer thick. There are two types of lining cells; Type 1 pneumocytes are squamous cells that cover 90% of the surface of the inner lining of the lung , and type II cuboidal pneumocytes that are in fact much more numerous than Type I. They are involved in the production of surfactant . In the lumen there are resident macrophages which play a crucial role in the immune system. The mucosa is grounded by a basement membrane and a lamina propria, and connected to the lamina propria and basement membrane of the surrounding capillary. The alveolus is lined by a thin layer of surfactant. (teal blue)
Ashley Davidoff
TheCommonVein.net
Light brown granules in the macrophage is characteristic of the smokers macrophage
Ashley Davidoff
TheCommonVein.net
Ashley Davidoff
TheCommonVein.net
Inhaled smoke contains between 2000-4000 toxic substances. The cancer producing properties are well known. The smoke causes inflammation of the medium sized airways resulting in activation of the resident macrophage in the lumen of the airway, hyperemia of the mucosa, activation of the neutrophils, monocytes, nonresident macrophages, and fibroblasts. Cytokines are released which also induce the secretion of proteases and elastases among many others. Structurally there is destruction of the cilia, hypersecretion of mucus, hypertrophy of the muscularis and mild fibrosis. These findings are the hallmark of chronic bronchitis
Ashley Davidoff
TheCommonVein.net
At the level of the membranous airways the effect is predominantly related to the loss of elasticity, and aberrant accumulation of smoking related macrophages.
The weakening and destruction results in emphysema and the abnormal accumulation of smoking related macrophages relates to DIP
Ashley Davidoff
TheCommonVein.net
The effect of the proteases and and elastases cause destruction of the alveoli and loss of elasticity, and therefore overall function. The destruction leads to bullous disease
The accumulation of smokers macrophage, and in the case of Langerhans cell histiocytosis leads to space occupation of the alveoli also reducing function
Ashley Davidoff
TheCommonVein.net
lungs-00687-lo res
The effect of the proteases and and elastases cause destruction of the alveoli and loss of elasticity, and therefore overall function. The destruction leads to bullous disease
The accumulation of smokers macrophage, and in the case of Langerhans cell histiocytosis leads to space occupation of the alveoli also reducing function
Ashley Davidoff
TheCommonVein.net
lungs-00687-lo res
At the level of the membranous airways the effect is predominantly related to the loss of elasticity, and aberrant accumulation of smoking related macrophages.
The weakening and destruction results in emphysema and the abnormal accumulation of smoking related macrophages relates to DIP
Ashley Davidoff
TheCommonVein.net
Inhaled smoke contains between 2000-4000 toxic substances. The cancer producing properties are well known. The smoke causes inflammation of the medium sized airways resulting in activation of the resident macrophage in the lumen of the airway, hyperemia of the mucosa, activation of the neutrophils, monocytes, nonresident macrophages, and fibroblasts. Cytokines are released which also induce the secretion of proteases and elastases among many others. Structurally there is destruction of the cilia, hypersecretion of mucus, hypertrophy of the muscularis and mild fibrosis. These findings are the hallmark of chronic bronchitis
Ashley Davidoff
TheCommonVein.net
Ashley Davidoff
TheCommonVein.net
November is COPD Awareness Month
Ashley Davidoff MD TheCommonVeein.net
This is a collage showing the evolution of a malignant cell (1) into a nodule restricted to the epithelium (2) which with time penetrates the basement membrane and progressively extends into the submucosa and muscularis (3). Subsequent extension into local lymph nodes and blood vessels occurs (4) as well as growth into the lumen. As it grows circumferentially, narrowing and eventually obstruction of the lumen complicates the process (5) Space in tubular systems is limited and malignant growth has no respect for this space nor for boundaries. By definition malignant disease is space occupying.
Ashley Davidoff
TheCommonVein.net
32336c
This is the story of lung cancer, (left top) from the tobacco leaves of Virginia, to the cigarette, a nicotine filled alveolus, repeated contact with epithelium, and malignant proliferation with compromise of the lumen. People of all types affected by the curse of smoke. The histology may be of the non small cell or the small cell type, but in either case malignant and space occupying. A cough is common with the clinical presentation and a mass frequent on CT. Biopsy follows with staging by PET scan, multidisciplinary conference, and therapeutic choices – surgery, radiation and or chemotherapy. Mortality is usually inevitable with this devastating disease, but there is always hope for a cure in early stages.
Ashley Davidoff
TheCommonVein.net
10296cc
keywords lung pulmonary disease introduction collage people grosspathology smoking
Ashley Davidoff MD
TheCommonvein.net