Respiratory Pathology — MCQs

A 40-year-old man presents with a two-week history of increasing cough and hemoptysis. He has no smoking history and is in good health. Physical examination reveals a temperature of 38.2°C. A chest radiograph shows consolidation in the right upper lobe. Despite antibiotic therapy, his cough and hemoptysis persist for an additional two weeks. A subsequent chest CT scan reveals right upper lobe atelectasis. Bronchoscopic examination demonstrates a tan, circumscribed obstructive mass filling a right upper lobe bronchus. Which of the following neoplasms is most likely to produce these findings?

Q98Easy

Which lung disease is associated with mesothelioma?

Q99Easy

Bronchogenic cysts occur commonly in which location?

Q100Medium

A 45-year-old man with cirrhosis due to alpha-1-antitrypsin deficiency receives a liver transplant. He is at increased risk of developing which of the following types of emphysema?

Respiratory Pathology Indian Medical PG Practice Questions and MCQs

Question 91: What is the most common type of lung carcinoma in women and children?

A. Small cell carcinoma
B. Adenocarcinoma (Correct Answer)
C. Squamous cell carcinoma
D. Large cell carcinoma

Explanation: **Explanation:** **Adenocarcinoma** is currently the most common histological subtype of lung cancer overall. It is specifically the most frequent type found in **women, non-smokers, and children**. Unlike other lung cancers, it typically arises in the **periphery** of the lung [1] and is associated with mutations in the **EGFR** gene (especially in non-smoking Asian women) or **ALK** rearrangements. In children, while primary lung epithelial tumors are rare, adenocarcinoma remains the most frequently reported subtype when they do occur. **Analysis of Incorrect Options:** * **Small Cell Carcinoma (SCLC):** This is a high-grade neuroendocrine tumor strongly associated with heavy smoking. It is usually central in location and is the most common type associated with paraneoplastic syndromes like SIADH or ACTH production. * **Squamous Cell Carcinoma (SCC):** Historically the most common type in men, it is characterized by "the 4 Cs": **C**entral location, **C**igarette smoking, **C**avitary lesions, and hyper**C**alcemia (due to PTHrP). * **Large Cell Carcinoma:** This is a diagnosis of exclusion (undifferentiated). It is less common and typically presents as a large peripheral mass with a poor prognosis. **NEET-PG High-Yield Pearls:** * **Most common lung cancer overall:** Adenocarcinoma. * **Most common lung cancer in non-smokers:** Adenocarcinoma. * **Scar Carcinoma:** Adenocarcinoma often arises in areas of previous lung scarring [1] (e.g., old TB foci). * **Driver Mutations:** EGFR (most common), KRAS (associated with smoking), and ALK are key targets for biological therapy in Adenocarcinoma [1]. * **Precursor lesion:** Atypical Adenomatous Hyperplasia (AAH) leads to Adenocarcinoma *in situ* (formerly Bronchioloalveolar carcinoma) [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-336.

Question 92: Which condition is associated with thymoma?

A. Myasthenia gravis (Correct Answer)
B. Polycythemia
C. Ectopic ACTH
D. Polyarteritis nodosa

Explanation: **Explanation:** **Thymoma** is the most common tumor of the anterior mediastinum, arising from thymic epithelial cells [2]. It is uniquely associated with various paraneoplastic syndromes, the most frequent being **Myasthenia Gravis (MG)** [1]. 1. **Why Myasthenia Gravis is correct:** Approximately 30–45% of patients with thymoma have MG, and conversely, about 10–15% of patients with MG are found to have a thymoma. The underlying mechanism involves the failure of self-tolerance; the tumor cells express acetylcholine receptor (AChR)-like epitopes, leading to the production of autoantibodies against the postsynaptic AChR at the neuromuscular junction [4]. 2. **Why other options are incorrect:** * **Polycythemia:** This is typically associated with Renal Cell Carcinoma, Hepatocellular Carcinoma, or Hemangioblastoma (due to ectopic Erythropoietin). Thymoma is actually associated with **Pure Red Cell Aplasia (PRCA)**. * **Ectopic ACTH:** This is a classic paraneoplastic syndrome of **Small Cell Carcinoma of the Lung** or bronchial carcinoids, leading to Cushing syndrome. * **Polyarteritis nodosa (PAN):** This systemic vasculitis is strongly associated with **Hepatitis B** infection, not thymic tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Most common association:** Myasthenia Gravis. * **Other associations:** Pure Red Cell Aplasia (PRCA) and Hypogammaglobulinemia (**Good Syndrome**) [1]. * **Morphology:** Look for "Mixed" patterns of epithelial cells and non-neoplastic T-lymphocytes [3]. * **Staging:** The **Masaoka Staging System** is used to determine the prognosis based on capsular invasion. * **Management:** Surgical resection is the treatment of choice; thymectomy often improves MG symptoms even in the absence of a tumor. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 572-574. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 571-572. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 634-635. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1237-1238.

Question 93: Which type of lung cancer is associated with neuromuscular disorders?

A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma (Correct Answer)
D. Bronchoalveolar carcinoma

Explanation: **Small cell carcinoma (SCLC)** is the correct answer because it is a neuroendocrine tumor derived from Kulchitsky cells [1]. These cells have the capacity to secrete various hormones and antibodies, leading to **Paraneoplastic Syndromes (PNS)** [1]. The specific neuromuscular disorder most strongly associated with SCLC is **Lambert-Eaton Myasthenic Syndrome (LEMS)**. In LEMS, the body produces autoantibodies against voltage-gated calcium channels at the neuromuscular junction, leading to progressive muscle weakness. SCLC is also associated with other neurological PNS, such as limbic encephalitis and cerebellar degeneration. **Analysis of Incorrect Options:** * **Adenocarcinoma:** The most common lung cancer in non-smokers and women [3]. It is typically associated with hypertrophic osteoarthropathy (digital clubbing) rather than neuromuscular disorders. * **Squamous Cell Carcinoma:** Classically associated with **hypercalcemia** due to the secretion of Parathyroid Hormone-related Protein (PTHrP) [2]. It is centrally located and strongly linked to smoking [3]. * **Bronchoalveolar Carcinoma (now Adenocarcinoma in situ):** A subtype of adenocarcinoma that grows along alveolar walls (lepidic growth). It typically presents as a pneumonia-like infiltrate and is not linked to neuromuscular PNS. **NEET-PG High-Yield Pearls:** * **SCLC "S" Rules:** **S**moking association, **S**entral location, and **S**yndromes (ACTH/Cushing’s, SIADH, and Lambert-Eaton) [1]. * **Histology of SCLC:** Look for "Oat cell" appearance, scant cytoplasm, and **Azzopardi effect** (DNA staining of vessel walls). * **Lambert-Eaton vs. Myasthenia Gravis:** In LEMS (associated with SCLC), muscle strength *improves* with repetitive use, whereas in Myasthenia Gravis, it *worsens*. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 725-727. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 338-339. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337.

Question 94: Which of the following lung cancers is associated with the worst prognosis?

A. Small cell carcinoma (Correct Answer)
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Oat cell carcinoma

Explanation: **Explanation:** **Small cell carcinoma (SCLC)** is associated with the worst prognosis among all lung cancers [2]. This is primarily due to its highly aggressive nature, rapid doubling time, and early tendency for widespread hematogenous metastasis [1]. By the time of diagnosis, most patients already have extensive-stage disease, making surgical resection impossible [2]. It is highly sensitive to chemotherapy and radiotherapy initially, but recurrence is almost universal [2]. **Analysis of Options:** * **Small cell carcinoma (Correct):** It is a neuroendocrine tumor strongly linked to smoking. It has the lowest 5-year survival rate (approx. 5-10%) compared to non-small cell lung cancers (NSCLC) [2]. * **Adenocarcinoma:** This is the most common type of lung cancer overall [3]. While serious, it generally has a better prognosis than SCLC as it often presents as a peripheral lesion that may be amenable to surgical resection or targeted therapies (e.g., EGFR inhibitors) [4]. * **Squamous cell carcinoma:** Typically presents as a central/hilar mass [3]. It tends to remain localized longer than SCLC and spreads via local invasion before distant metastasis, offering a better window for surgical intervention. * **Oat cell carcinoma:** This is actually a **subtype/synonym** for Small Cell Carcinoma [1]. In the context of a "single best answer" MCQ where both are listed, "Small cell carcinoma" is the preferred, broader clinical term used in modern WHO classifications. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** SCLC and Squamous cell carcinoma are **Central**; Adenocarcinoma and Large cell are **Peripheral** [3], [4]. * **Paraneoplastic Syndromes:** SCLC is classically associated with **SIADH** and **ACTH** (Cushing syndrome), and **Lambert-Eaton Myasthenic Syndrome** [2]. * **Microscopy:** Look for "Azzopardi effect" (DNA staining of vessel walls) and "Molding" of nuclei in SCLC [1]. * **Markers:** SCLC stains positive for neuroendocrine markers: **Chromogranin A, Synaptophysin, and CD56.** [1] **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 725-727. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 335-336.

Question 95: What is the predominant constituent of a hyaline membrane?

A. Albumin
B. Anthracotic pigment
C. Fibrin-rich exudates (Correct Answer)
D. None of the above

Explanation: **Explanation:** The formation of hyaline membranes is the hallmark histological feature of the **exudative phase** of **Acute Respiratory Distress Syndrome (ARDS)** and **Diffuse Alveolar Damage (DAD)** [1]. **Why Fibrin-rich exudates is correct:** When the alveolar-capillary membrane is damaged (due to sepsis, pneumonia, or shock), there is an increase in vascular permeability. This allows plasma proteins, particularly **fibrinogen**, to leak into the alveolar spaces [1]. Once in the alveoli, fibrinogen is converted into **fibrin**. This fibrin, combined with necrotic debris from Type I pneumocytes and other plasma proteins, condenses along the alveolar walls to form the characteristic waxy, eosinophilic (pink) "hyaline membranes" [1]. **Analysis of Incorrect Options:** * **A. Albumin:** While albumin is a plasma protein that leaks during injury, it is not the structural "backbone" of the membrane. Fibrin is the primary constituent that provides the membrane its distinct, polymerized consistency [2]. * **B. Anthracotic pigment:** This refers to inhaled carbon/dust particles commonly found in the lungs of smokers or city dwellers. It is stored in alveolar macrophages (dust cells) and is unrelated to the acute inflammatory process of hyaline membrane formation. **NEET-PG High-Yield Pearls:** * **ARDS/DAD:** Hyaline membranes typically appear within **1 to 7 days** of the initial insult (Exudative Phase) [1]. * **Neonatal RDS:** In newborns, hyaline membranes are caused by a **deficiency of surfactant**, leading to high surface tension, alveolar collapse, and subsequent endothelial damage. * **Microscopy:** On H&E stain, they appear as thick, pink, "ribbon-like" linings along the alveolar ducts and alveoli [1]. * **Progression:** If the patient survives the acute phase, these membranes are either resorbed or undergo organization by fibroblasts, leading to interstitial fibrosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 679-681. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 101-103.

Question 96: All of the following are seen in asbestosis except?

A. Diffuse alveolar damage (Correct Answer)
B. Calcified pleural plaques
C. Diffuse pulmonary interstitial fibrosis
D. Mesotheliomas

Explanation: **Explanation:** Asbestosis is a chronic fibrotic lung disease caused by the inhalation of asbestos fibers. The correct answer is **Diffuse Alveolar Damage (DAD)** because DAD is the pathological hallmark of **Acute Respiratory Distress Syndrome (ARDS)** and acute lung injury, not chronic pneumoconiosis like asbestosis. **Why the other options are characteristic of Asbestos exposure:** * **Diffuse pulmonary interstitial fibrosis (Option C):** This is the defining feature of asbestosis [1]. It typically begins in the lower lobes and subpleural areas, characterized by the presence of **asbestos bodies** (ferruginous bodies)—golden-brown, fusiform rods with a translucent center [1]. * **Calcified pleural plaques (Option B):** These are the **most common** manifestation of asbestos exposure [1]. They are well-circumscribed areas of dense collagen, often calcified, occurring most frequently on the anterior and posterolateral aspects of the parietal pleura and over the diaphragm [2]. * **Mesotheliomas (Option D):** Asbestos exposure is the primary risk factor for malignant mesothelioma of the pleura or peritoneum [2]. While lung carcinoma is more common in asbestos workers (especially smokers), mesothelioma is the most **specific** neoplasm associated with asbestos. **NEET-PG High-Yield Pearls:** 1. **Asbestos Bodies:** Detected using **Prussian Blue stain** (stains the iron coating). 2. **Location:** Unlike most inorganic dusts (Silica, Coal) which affect upper lobes, Asbestosis primarily affects the **lower lobes** [1]. 3. **Synergy:** Smoking does *not* increase the risk of mesothelioma, but it increases the risk of **bronchogenic carcinoma** in asbestos workers by ~55-fold. 4. **Pleural Effusion:** Benign asbestos pleural effusion is often the earliest clinical manifestation [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 698-699. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 699.

Question 97: A 40-year-old man presents with a two-week history of increasing cough and hemoptysis. He has no smoking history and is in good health. Physical examination reveals a temperature of 38.2°C. A chest radiograph shows consolidation in the right upper lobe. Despite antibiotic therapy, his cough and hemoptysis persist for an additional two weeks. A subsequent chest CT scan reveals right upper lobe atelectasis. Bronchoscopic examination demonstrates a tan, circumscribed obstructive mass filling a right upper lobe bronchus. Which of the following neoplasms is most likely to produce these findings?

A. Adenocarcinoma
B. Carcinoid tumor (Correct Answer)
C. Hamartoma
D. Kaposi sarcoma

Explanation: ### Explanation **Correct Answer: B. Carcinoid tumor** The clinical presentation describes a **central endobronchial mass** in a young, non-smoking patient. Bronchial carcinoids are neuroendocrine neoplasms that typically arise in the major bronchi [1]. Their **intraluminal growth** pattern leads to early bronchial obstruction, resulting in persistent cough, hemoptysis, and secondary complications like post-obstructive pneumonia (fever/consolidation) or atelectasis (collapse) [1]. On gross examination, they appear as well-circumscribed, fleshy, tan-to-pink masses covered by intact mucosa. **Analysis of Incorrect Options:** * **A. Adenocarcinoma:** This is the most common lung cancer in non-smokers, but it typically presents as a **peripheral** pulmonary nodule rather than a central, obstructive endobronchial mass [2]. * **C. Hamartoma:** While these are common benign lung tumors, they are usually asymptomatic "coin lesions" found incidentally on imaging. They are composed of cartilage, fat, and connective tissue and rarely cause significant bronchial obstruction or hemoptysis. * **D. Kaposi sarcoma:** In the lung, this typically presents as multifocal hemorrhagic nodules or perivascular infiltrates in immunocompromised (HIV+) patients, not as a solitary, circumscribed endobronchial mass in an otherwise healthy individual. **NEET-PG High-Yield Pearls:** * **Origin:** Derived from **Kulchitsky cells** (neuroendocrine cells) of the bronchial mucosa. * **Histology:** Characterized by "organoid" patterns (nests, chords, or trabeculae) of uniform cells with **"salt and pepper"** chromatin [1]. * **Markers:** Positive for **Chromogranin A, Synaptophysin,** and CD56 [1]. * **Clinical:** Carcinoid syndrome (flushing, diarrhea) is rare (<10%) in bronchial carcinoids unless there are extensive liver metastases. * **Age:** Often affects younger patients (mean age 40–45) compared to other bronchogenic carcinomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 727. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 336-337.

Question 98: Which lung disease is associated with mesothelioma?

A. Silicosis
B. Asbestosis (Correct Answer)
C. Bagassosis
D. Anthracosis

Explanation: **Explanation:** **Asbestosis (Option B)** is the correct answer because asbestos exposure is the only well-established environmental risk factor for **malignant mesothelioma** [1], [3], a rare neoplasm of the mesothelial cells (most commonly involving the pleura). While asbestos exposure is more frequently associated with bronchogenic carcinoma [1], it is the definitive precursor for mesothelioma, often with a long latent period of 25–40 years [3]. Crocidolite (blue asbestos) carries the highest risk. **Why other options are incorrect:** * **Silicosis (Option A):** Caused by inhalation of crystalline silica (quartz). It is characterized by "eggshell calcification" of hilar nodes and silicotic nodules. It increases the risk of **Tuberculosis (Silicotuberculosis)** and bronchogenic carcinoma, but not mesothelioma. * **Bagassosis (Option C):** A type of Hypersensitivity Pneumonitis caused by thermophilic actinomycetes found in moldy **sugar cane residue**. It leads to extrinsic allergic alveolitis, not malignancy. * **Anthracosis (Option D):** The simplest form of Coal Workers' Pneumoconiosis (CWP), caused by carbon pigment accumulation. It is generally asymptomatic and seen in urban dwellers and smokers; it does not predispose to mesothelioma. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cancer** associated with asbestos: **Bronchogenic Carcinoma** (not mesothelioma) [1]. * **Specific marker** for asbestos exposure: **Ferruginous bodies** (asbestos bodies) – golden-brown, fusiform/beaded rods with translucent centers [1]. * **Immunohistochemistry (IHC) for Mesothelioma:** Positive for **Calretinin**, Cytokeratin 5/6, and WT-1 [2]. * **Pleural Plaques:** The most common manifestation of asbestos exposure, usually involving the parietal pleura [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 698-699. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 731. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 339-340.

Question 99: Bronchogenic cysts occur commonly in which location?

A. Posterior mediastinum
B. Superior mediastinum
C. Carina (Correct Answer)
D. Periphery of lung

Explanation: **Explanation:** **Bronchogenic cysts** are congenital anomalies arising from abnormal budding of the primitive foregut during embryonic development. **Why Carina is the correct answer:** The most common location for bronchogenic cysts is the **middle mediastinum**, specifically near the **tracheal bifurcation (carina)** or the paratracheal region. Because they originate from the ventral foregut (which forms the respiratory tree), they are typically found in close proximity to the major airways. While they can occur within the lung parenchyma, the subcarinal location is the classic and most frequent site. **Analysis of Incorrect Options:** * **Posterior mediastinum:** This is the characteristic location for **neurogenic tumors** (e.g., Schwannomas, Neuroblastomas). Bronchogenic cysts are rarely found here. * **Superior mediastinum:** While the upper paratracheal region is possible, the subcarinal area (middle mediastinum) is statistically more common. The superior mediastinum is more frequently associated with thymic or thyroid masses. * **Periphery of lung:** Intrapulmonary bronchogenic cysts do occur (usually in the lower lobes), but they are less common than the mediastinal variety. Peripheral cystic lesions are more often associated with Congenital Pulmonary Airway Malformations (CPAM). **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** They are lined by **ciliated pseudostratified columnar epithelium** (respiratory epithelium) and often contain cartilage, smooth muscle, and mucous glands in the wall. * **Clinical Presentation:** Often asymptomatic in children but can cause compression of the airway or esophagus, leading to dyspnea, cough, or dysphagia. * **Imaging:** On CT, they appear as well-circumscribed, fluid-filled masses. They do not typically communicate with the tracheobronchial tree unless infected.

Question 100: A 45-year-old man with cirrhosis due to alpha-1-antitrypsin deficiency receives a liver transplant. He is at increased risk of developing which of the following types of emphysema?

A. Centriacinar
B. Paraseptal
C. Panacinar (Correct Answer)
D. Compensatory

Explanation: ### Explanation **Correct Answer: C. Panacinar** **Mechanism and Concept:** Alpha-1-antitrypsin (AAT) is a major protease inhibitor (Pi) synthesized in the liver [1,4]. Its primary role is to inhibit **neutrophil elastase**, an enzyme that breaks down elastin in the alveolar walls [2,4]. In AAT deficiency, the lack of this protective "anti-elastase" leads to unchecked destruction of the entire acinus (from the respiratory bronchiole to the terminal alveoli). This results in **Panacinar (Panlobular) emphysema** [1,2]. While the liver transplant corrects the cirrhosis (caused by the accumulation of misfolded proteins in hepatocytes) [4], the patient remains at high risk for lung disease because the underlying genetic predisposition and prior damage often manifest as panacinar changes, typically involving the **lower lobes** of the lungs. **Analysis of Incorrect Options:** * **A. Centriacinar:** This is the most common pattern in **smokers** [1]. It primarily affects the central or proximal parts of the acini (respiratory bronchioles) and is typically most severe in the **upper lobes** [3]. * **B. Paraseptal:** This involves the distal part of the acinus and occurs near the pleura or connective tissue septa [3]. It is a common cause of spontaneous pneumothorax in young adults (ruptured blebs) [3]. * **D. Compensatory:** This is not a true primary emphysema; it refers to the dilation of alveoli in response to the loss of lung substance elsewhere (e.g., post-lobectomy). **NEET-PG High-Yield Pearls:** * **Genetics:** Most common clinically significant mutation is the **PiZZ** phenotype [2]. * **Localization:** Panacinar = Lower lobes; Centriacinar = Upper lobes [3]. * **Histology:** Look for **PAS-positive, diastase-resistant globules** in the periportal hepatocytes (representing misfolded AAT). * **Clinical Clue:** Suspect AAT deficiency in a young, non-smoker presenting with emphysema or a patient with concurrent liver cirrhosis and lung disease [4]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 684-685. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 683-684. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 683. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 856-858.

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