159. Sarcoidosis of the lungs: definition, etiology, pathogenesis, macro- and microscopic changes in the lungs, complications, outcomes.

Lung sarcoidosis is a disease belonging to the group of benign systemic granulomatoses, occurring with damage to the mesenchymal and lymphatic tissues of various organs, but mainly the respiratory system.

The etiology remains unclear. They suggest the impact of a complex of causes, among which may be immunological, environmental and genetic factors.

Complications: bronchial stenosis, atelectasis, respiratory and cardiopulmonary insufficiency.

Outcomes: regression, stabilization, progression, relapse, death.

160. Lung cancer: classification, localization, morphological characteristics, features of metastasis, complications, causes of death in patients.

Lung cancer is a malignant formation that develops from the affected epithelium of the lungs

1. By localization: 1. Central - comes from the stem, lobe and initial part of the segmental bronchus 2. Peripheral - comes from the peripheral part of the segmental bronchus and its branches; from the alveolar epithelium 3. Mixed - massive 2. By the nature of growth: 1. Exophytic (endobrochial) 2. Endophytic (exobrochial, peribronchial)

3. In macroscopic form: 1. Plaque-shaped 2. Nodular 3. Polypous 4. Branched 5. Endobrochial diffuse

The morphogenesis of central lung cancer is associated with precancerous changes in the epithelium of large bronchi — basal cell hyperplasia, dysplasia and squamous cell metaplasia. The morphogenesis of peripheral lung cancer is different. This form of cancer occurs in the foci of pneumosclerosis after tuberculosis, pneumonia, lung infarction, around foreign bodies — "cancer in the scar".

Basal (central) cancer develops in the mucous membrane of the stem, lobe and initial part of the segmental bronchi initially in the form of a small nodule (plaque) or polyp. Later, depending on the nature of the growth (exophytic, endophytic), it takes the form of endobronchial diffuse, nodular, branched or nodularly branched cancer.

Peripheral cancer has been growing expansively for a long time in the form of a node, sometimes reaching large sizes (up to 5-7 cm in diameter). It does not manifest clinically until it is detected by a random examination.

Complications of lung cancer are metastases, which can equally be considered a manifestation of tumor progression and secondary pulmonary changes. Cancer metastases, both lymphogenic and hematogenic, are observed in 70% of patients. The first lymphogenic metastases occur in the peribronchial and bifurcation lymph nodes, then in the cervical ones. Among hematogenous metastases, the most characteristic are metastases in the liver, brain, bones (especially often in the vertebrae) and adrenal glands. Basal cancer often metastasizes lymphogenously, peripheral cancer — hematogenously. In patients with peripheral lung cancer, which is small in size and proceeds without symptoms, the first clinical signs are associated with hematogenous metastasis.

Lung cancer patients die from metastases, secondary pulmonary complications, or from cachexia.