A 68-year-old woman with a history of heavy smoking and repeated bouts of pneumonia presents with a 2-week history of fever and productive cough. A chest X-ray reveals a right lower lobe infiltrate. A transbronchial biopsy confirms pneumonia and further demonstrates preneoplastic changes within the bronchial mucosa. Which of the following best characterizes the morphology of this bronchial mucosal lesion?
- Abnormal pattern of cellular maturation
- Increased numbers of otherwise normal cells
- Invasiveness through the basement membrane
- Transformation of one differentiated cell type to another
- Ulceration and necrosis of epithelial cells
Cells that compose an epithelium exhibit uniformity of size and shape, and they undergo maturation in an orderly fashion (e.g., from plump basal cells to flat superficial cells in a squamous epithelium). When we speak of dysplasia, we mean that this regular appearance is disturbed by (1) variations in the size and shape of the cells; (2) enlargement, irregularity, and hyperchromatism of the nuclei; and (3) disorderly arrangement of the cells within the epithelium. Dysplasia of the bronchial epithelium is a reaction of respiratory epithelium to carcinogens in tobacco smoke. It is potentially reversible if the patient stops smoking but is considered preneoplastic and may progress to carcinoma. Choices B, D, and E are not preneoplastic changes. Invasiveness (choice C) connotes malignant behavior.
Diagnosis: Pneumonia, dysplasia
Diagnosis: Pneumonia, dysplasia
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