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| COMMENT: | | COMMENT: |
| The clinical findings are noted. The size and type of biopsy significant limit the | | The clinical findings are noted. The size and type of biopsy significantly limit the |
| interpretation. Suspected diffuse lung disease (interstitial lung disease) | | interpretation. Suspected diffuse lung disease (interstitial lung disease) |
| is best assessed on an open lung biopsy. | | is best assessed on an open lung biopsy. |
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| ====Micro==== | | ====Micro==== |
| The sections show small fragments of lung parenchyma. A very small amount of anthracotic | | The sections show small fragments of lung parenchyma. A very small amount of anthracotic |
| pigment is present. Interstitial fibrosis is not apparent. No granuloma are identified. | | pigment is present. Interstitial fibrosis is not apparent. No granulomata are identified. |
| No nuclear atypia is identified. Air-space macrophages show minimal pigmentation and are | | No nuclear atypia is identified. Air-space macrophages show minimal pigmentation and are |
| not present in large numbers. No significant airspace or interstitial inflammation is | | not present in large numbers. No significant airspace or interstitial inflammation is |
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| | [[Desquamative interstitial pneumonia]] (DIP) | | | [[Desquamative interstitial pneumonia]] (DIP) |
| | DIP | | | DIP |
| | Smoking | | | [[smoking]] |
| |- | | |- |
| | [[Diffuse alveolar damage]] (DAD) | | | [[Diffuse alveolar damage]] (DAD) |
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| | [[Respiratory bronchiolitis]] | | | [[Respiratory bronchiolitis]] |
| | [[Respiratory bronchiolitis-associated interstitial lung disease|RB-ILD]] | | | [[Respiratory bronchiolitis-associated interstitial lung disease|RB-ILD]] |
| | Smoking | | | smoking |
| |- | | |- |
| | [[Usual interstitial pneumonia]] (UIP) | | | [[Usual interstitial pneumonia]] (UIP) |
| | [[collagen vascular disease|CVD]], [[idiopathic pulmonary fibrosis|IPF]], [[drug toxicity]], [[pneumoconiosis]] | | | [[collagen vascular disease|CVD]], [[idiopathic pulmonary fibrosis|IPF]], [[drug toxicity]], [[pneumoconiosis]] |
| | Allergen (hypersensitivity pneumonitis), idiopathic, autoimmune | | | allergen (hypersensitivity pneumonitis), idiopathic, autoimmune |
| |- | | |- |
| | [[Organizing pneumonia]] | | | [[Organizing pneumonia]] |
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| | [[Lymphocytic interstitial pneumonia]] (LIP) | | | [[Lymphocytic interstitial pneumonia]] (LIP) |
| | LIP | | | LIP |
| | Viral/autoimmune | | | viral/autoimmune |
| |} | | |} |
| ARDS = adult respiratory distress syndrome, AIP = acute interstitial pneumonia, TRALI = transfusion related acute lung injury, CVD = [[collagen vascular disease]], IPF = idiopathic pulmonary fibrosis. | | ARDS = adult respiratory distress syndrome, AIP = acute interstitial pneumonia, TRALI = transfusion related acute lung injury, CVD = [[collagen vascular disease]], IPF = idiopathic pulmonary fibrosis. |
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| Notes: | | Notes: |
| *''Usual interstitial pneumonia'' is the most common type of ILD.<ref name="pmid16738196">{{cite journal |author=Visscher DW, Myers JL |title=Histologic spectrum of idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=322-9 |year=2006 |month=June |pmid=16738196 |doi=10.1513/pats.200602-019TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738196}}</ref> | | *''Usual interstitial pneumonia'' is the most common type of ILD.<ref name="pmid16738196">{{cite journal |author=Visscher DW, Myers JL |title=Histologic spectrum of idiopathic interstitial pneumonias |journal=Proc Am Thorac Soc |volume=3 |issue=4 |pages=322-9 |year=2006 |month=June |pmid=16738196 |doi=10.1513/pats.200602-019TK |url=http://pats.atsjournals.org/cgi/pmidlookup?view=long&pmid=16738196}}</ref> |
| | |
| | ==Gross pathologic DDx by location== |
| | Causes of upper lung fibrosis ''FASSTEN'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref> |
| | *[[Farmer's lung]]. |
| | *[[Ankylosing spondylitis]]. |
| | *[[Sarcoidosis]]. |
| | *[[Silicosis]]. |
| | *[[Tuberculosis]] (miliary). |
| | *[[Eosinophilic granuloma]]. |
| | *[[Neurofibromatosis]]. |
| | |
| | Causes of lower lung fibrosis ''BAD RASH'':<ref name=Ref_TN2005_R13>{{Ref TN2005| R13}}</ref> |
| | *[[Bronchiolitis obliterans organizing pneumonia]] (BOOP). |
| | *[[Asbestosis]]. |
| | *Drugs (nitrofurantoin, hydralazine, isoniazid (INH), amiodarone). |
| | *[[Rheumatologic disease]]. |
| | *[[aspiration pneumonia|Aspiration]]. |
| | *[[Scleroderma]]. |
| | *Hamman-Rich syndrome (really should be -- ''[[idiopathic pulmonary fibrosis]]''). |
| | |
| | Note: |
| | *''Hamman-Rich syndrome'' is another name for [[acute interstitial pneumonia]].<ref name=Ref_WMSP90>{{Ref WMSP|90}}</ref> |
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| =Specific diseases/pattterns= | | =Specific diseases/pattterns= |
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| ==Diffuse alveolar damage== | | ==Diffuse alveolar damage== |
| *Abbreviated ''DAD''. | | *Abbreviated ''DAD''. |
| ===General===
| | {{Main|Diffuse alveolar damage}} |
| Etiology:
| |
| *Abrupt hypoxemia with pulmonary infiltrates leading to epithelial cell and endothelial cell death not accompanied by cardiac failure.<ref name=Ref_PCPBoD8_364>{{Ref PCPBoD8|364}}</ref>
| |
| | |
| DAD is the histologic correlate of:
| |
| *Acute respiratory distress syndrome (ARDS).
| |
| **[[AKA]] adult respiratory distress syndrome (ARDS) to differentiate it from ''[[respiratory distress syndrome]]'' in infants.
| |
| *Acute interstitial pneumonia (AIP).
| |
| *Transfusion related acute lung injury (TRALI).
| |
| | |
| The DDx is broad:<ref>{{Ref WMSP|91}}</ref>
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| *Infection/sepsis.
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| *Toxic (smoke, oxygen).
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| *Drug (amiodarone, chemotherapy).
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| *Trauma/shock.
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| *Inflammatory.
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| *Idiopathic.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_Klatt103>{{Ref Klatt|103}}</ref><ref name=pmid16766248>{{Cite journal | last1 = Castro | first1 = CY. | title = ARDS and diffuse alveolar damage: a pathologist's perspective. | journal = Semin Thorac Cardiovasc Surg | volume = 18 | issue = 1 | pages = 13-9 | month = | year = 2006 | doi = 10.1053/j.semtcvs.2006.02.001 | PMID = 16766248 }}</ref>
| |
| #Exudative:
| |
| #*Hyaline membranes - '''key feature'''.
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| #**Debris (pink crap) lines the alveolar spaces.
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| #Proliferative:
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| #*Interstitial thickening.
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| #*Inflammation (lymphocytes).
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| #*Hobnailing of alveolar lining cells (type 2 pneumocyte hyperplasia<ref>URL: [http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm http://d3jonline.tripod.com/20-Pulmonary_II/Pathology_of_Interstitial_Lung_Diseases.htm]. Accessed on: 22 February 2012.</ref>).
| |
| #*Edema (link pink crap in the alveoli).
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| #*[[Masson bodies]] in the airway.
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| #*Hyaline material (usu. focal) - '''key feature'''.
| |
| #Fibrotic:
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| #*Interstitial inflammation.
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| #*Fibrosis.
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| | |
| DDx:<ref name=pmid16766248>{{Cite journal | last1 = Castro | first1 = CY. | title = ARDS and diffuse alveolar damage: a pathologist's perspective. | journal = Semin Thorac Cardiovasc Surg | volume = 18 | issue = 1 | pages = 13-9 | month = | year = 2006 | doi = 10.1053/j.semtcvs.2006.02.001 | PMID = 16766248 }}</ref>
| |
| *[[Cryptogenic organizing pneumonia]] - especially for ''proliferative phase DAD''.
| |
| *[[Bronchiolitis obliterans]].
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| | |
| ====Images====
| |
| <gallery>
| |
| Image:Hyaline membranes - low mag.jpg | Exudative phase DAD - low mag. (WC/Nephron)
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| Image:Hyaline membranes - intermed mag.jpg | Exudative phase DAD - intermed. mag. (WC/Nephron)
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| Image:Hyaline membranes - high mag.jpg | Exudative phase DAD - high mag. (WC/Nephron)
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| Image:Hyaline membranes - very high mag.jpg | Exudative phase DAD - very high mag. (WC/Nephron)
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| Image:ARDS.jpg | Exudative DAD (WC)
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| </gallery>
| |
| www:
| |
| *[http://www.flickr.com/photos/pulmonary_pathology/4710141110/in/photostream/ Proliferative phase DAD - intermed. mag. (flickr.com/Yale Rosen)].
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| *[http://www.flickr.com/photos/pulmonary_pathology/4709499629/in/photostream/ Proliferative phase DAD - high mag. (flickr.com/Yale Rosen)].
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| ==Usual interstitial pneumonia== | | ==Usual interstitial pneumonia== |
| *Abbreviated ''UIP''. | | *Abbreviated ''UIP''. |
| ===General===
| | {{Main|Usual interstitial pneumonia}} |
| *It is sometimes used incorrectly as a synonym for ''idiopathic pulmonary fibrosis''. It is a histomorphologic pattern and has a DDx (see below).
| |
| *UIP cannot be diagnosed via bronchoscopic or transbronchial biopsy,<ref name=Ref_PPP186>{{Ref PPP|186}}</ref> as it is peripheral.
| |
| | |
| ====Epidemiology====
| |
| *Disease of the old - rare in under 50 years old.<ref>AC UBC S.102.</ref>
| |
| *Dismal prognosis - mean survival after diagnosis ~ 2.8 years.<ref name=pmid9445300>{{Cite journal | last1 = Bjoraker | first1 = JA. | last2 = Ryu | first2 = JH. | last3 = Edwin | first3 = MK. | last4 = Myers | first4 = JL. | last5 = Tazelaar | first5 = HD. | last6 = Schroeder | first6 = DR. | last7 = Offord | first7 = KP. | title = Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. | journal = Am J Respir Crit Care Med | volume = 157 | issue = 1 | pages = 199-203 | month = Jan | year = 1998 | doi = | PMID = 9445300 }}</ref>
| |
| | |
| ===Radiology===
| |
| *Honeycombing - ''multiple'' defects that obliterate the normal lung architecture - multiple spherical voids in the lung parenchyma; radiologically these are seen as lucencies.<ref>[http://www.medcyclopaedia.com/library/topics/volume_v_1/h/honeycombing.aspx http://www.medcyclopaedia.com/library/topics/volume_v_1/h/honeycombing.aspx]</ref>
| |
| **Usually subplural, i.e. peripheral lung.
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| **Classically lower lobe predominant.
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| *Traction [[bronchiectasis]].
| |
| | |
| Note:
| |
| *Cysts - have thin walls (think of emphysema, [[lymphangioleiomyomatosis]] et cetera).
| |
| **Cysts may be isolated/not close to a neighbour.
| |
| **Medcyclopaedia defines it as: thin-walled, well-demarcated and >1 cm.<ref>[http://www.medcyclopaedia.com/library/topics/volume_v_1/l/lung_cyst.aspx http://www.medcyclopaedia.com/library/topics/volume_v_1/l/lung_cyst.aspx]</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PPP186-9>{{Ref PPP|186-9}}</ref>
| |
| *Fibroblast foci:
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| **"Crescent-shaped bulge" of fibroblasts -- a rounded projection of spindle cells into the airspace.
| |
| **Location: in the areas of transisition between active inflammation and old inflammation.<ref>[http://www.epler.com/IPFWhat%27sIPFDiseaseInformation2.htm http://www.epler.com/IPFWhat%27sIPFDiseaseInformation2.htm]</ref>
| |
| **Note: Technically, ''fibroblast foci'' are composed of myofibroblasts.<ref name=Ref_PPP189>{{Ref PPP|189}}</ref>
| |
| *Interstitial inflammation.
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| *Microscopic honeycombing.
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| **Typically peripheral - cysts lined by ciliated epithelium.
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| *Spatial heterogeneity - patchy lesional distribution (areas of abnormal and normal lung may appear beside one another).
| |
| *Temporal heterogeneity - lesions of differing age side-by-side.<ref name=Ref_WMSP92>{{Ref WMSP|92}}</ref>
| |
| | |
| Notes:
| |
| *Disease worse distant from large airways: lower lung field predominance, typically worse at periphery of lobule and lung.<ref>A. Churg. UBC S.103.</ref>
| |
| *Heterogeneity of inflammation: airspace macrophages & inflammation minimal in honeycombed foci.
| |
| | |
| DDx of UIP:<ref name=leslie>{{cite book |author=Wick, Mark R.; Leslie, Kevin |title=Practical pulmonary pathology: a diagnostic approach |publisher=Churchill Livingstone |location=Edinburgh |year=2005 |pages= |isbn=0-443-06631-0 |oclc= 156861539|doi= |accessdate=}}</ref>
| |
| *Idiopathic pulmonary fibrosis (UIP not otherwise specified).
| |
| *Asbestosis = UIP pattern + ferruginous bodies with asbestos fibers.
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| *Chronic hypersensitivity pneumonitis ([[AKA]] extrinsic allergic alveolitis) - classically centrilobular predominant +/- granulomas.
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| *Collagen vascular disease - includes [[systemic lupus erythematosus]], [[rheumatoid arthritis]], [[scleroderma]].<ref name=Ref_PCPBoD8_374>{{Ref PCPBoD8|374}}</ref>
| |
| *Chronic drug toxicity.<ref name=pmid10992015>{{cite journal |author=Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC |title=Pulmonary drug toxicity: radiologic and pathologic manifestations |journal=Radiographics : a review publication of the Radiological Society of North America, Inc |volume=20 |issue=5 |pages=1245-59 |year=2000 |pmid=10992015 |doi=}}</ref>
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|
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|
| ==Asbestosis== | | ==Asbestosis== |
| ===General===
| | {{Main|Asbestosis}} |
| Definition:
| |
| *Interstitial lung disease due to asbestos exposure.<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
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| **Important to diagnose... asbestosis = compensation.
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| | |
| Conditions associated with asbestos exposure (mnemonic ''PALM''):<ref name=Ref_PCPBoD8_375>{{Ref PCPBoD8|375}}</ref>
| |
| *[[Pleural plaques]].
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| *Asbestosis.
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| *[[Lung carcinoma]].
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| *[[Malignant mesothelioma]].
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| | |
| | |
| Possible association with asbestos exposure:
| |
| *[[Gestational trophoblastic disease]].<ref name=pmid19900938>{{Cite journal | last1 = Reid | first1 = A. | last2 = Heyworth | first2 = J. | last3 = de Klerk | first3 = N. | last4 = Musk | first4 = AW. | title = Asbestos exposure and gestational trophoblastic disease: a hypothesis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 18 | issue = 11 | pages = 2895-8 | month = Nov | year = 2009 | doi = 10.1158/1055-9965.EPI-09-0731 | PMID = 19900938 }}</ref>
| |
| | |
| Diagnosis:
| |
| *Rests on morphology with special techniques (e.g. polarization)<ref>{{Cite journal | last1 = Galateau-Salle | first1 = F. | title = [Anatomopathological tools for screening and medical surveillance of people exposed to asbestos]. | journal = Rev Mal Respir | volume = 16 | issue = 6 Pt 2 | pages = 1244-56 | month = Dec | year = 1999 | doi = | PMID = 10897845 }}</ref> and includes tunneling [[electron microscopy]] (TEM),<ref name=pmid21479897>{{Cite journal | last1 = Neumann | first1 = V. | last2 = Löseke | first2 = S. | last3 = Tannapfel | first3 = A. | title = Mesothelioma and analysis of tissue fiber content. | journal = Recent Results Cancer Res | volume = 189 | issue = | pages = 79-95 | month = | year = 2011 | doi = 10.1007/978-3-642-10862-4_6 | PMID = 21479897 }}</ref> as done at special centres.
| |
| **Tissue is typically digested prior to fibre counting.<ref name=pmid20196674>{{Cite journal | last1 = Roggli | first1 = VL. | last2 = Gibbs | first2 = AR. | last3 = Attanoos | first3 = R. | last4 = Churg | first4 = A. | last5 = Popper | first5 = H. | last6 = Cagle | first6 = P. | last7 = Corrin | first7 = B. | last8 = Franks | first8 = TJ. | last9 = Galateau-Salle | first9 = F. | title = Pathology of asbestosis- An update of the diagnostic criteria: Report of the asbestosis committee of the college of american pathologists and pulmonary pathology society. | journal = Arch Pathol Lab Med | volume = 134 | issue = 3 | pages = 462-80 | month = Mar | year = 2010 | doi = 10.1043/1543-2165-134.3.462 | PMID = 20196674 }}</ref>
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| | |
| ===Microscopic===
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| Features:<ref name=pmid20196674/>
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| #Interstitial fibrosis - similar to [[usual interstitial pneumonia]] (UIP).
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| #''Ferruginous bodies'' - '''key feature'''.
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| #*Segmented twirling baton with long slender fibre within.
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| | |
| ====Images====
| |
| <gallery>
| |
| Image:Ferruginous_body.jpg | Ferruginous bodies. (WC)
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| Image:Asbestosis_high_mag.jpg | Asbestosis. (WC)
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| </gallery>
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|
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|
| ==Non-specific interstitial pneumonia== | | ==Non-specific interstitial pneumonia== |
| *Abbreviated ''NSIP''. | | *Abbreviated ''NSIP''. |
| | | {{Main|Non-specific interstitial pneumonia}} |
| ===General===
| |
| *Better prognosis than [[UIP]].
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| *Some radiologists and pathologists don't believe in this entity.
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| | |
| Associations:<ref name=Ref_WMSP92>{{Ref WMSP|92}}</ref>
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| *Connective tissue disease.
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| *[[Rheumatoid arthritis]].
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| | |
| ===Gross/Radiology===
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| *No honeycombing.
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| *Fibrosis usually lower lung zone.
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| *Patchy ground glass.
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| | |
| ===Microscopic===
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| Features:<ref name=Ref_WMSP92>{{Ref WMSP|92}}</ref>
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| *Diffuse fibrosis:
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| **Uniform fibrosis (unlike [[UIP]]).
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| **"Linear fibrosis" has a good prognosis - should be mentioned in the report.
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| ***''Linear fibrosis'' = fibrosis that follows alveolar walls + no architectural distortion.
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| *+/-Lymphoid nodules - association with collagen vascular disease. (???)
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| *+/-Focal [[organizing pneumonia]].
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| | |
| Notes:
| |
| *Inflammation in NSIP usually more prominent than in UIP.
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| *No honeycombing - key difference between UIP and NSIP.
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| | |
| DDx:
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| *Collagen vascular disease.
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| *Drug reaction.
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| *[[Hypersensitivity pneumonitis]] (extrinic allergic alveolitis).
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| *[[Lymphocytic interstitial pneumonia]] (LIP) - much more inflammation.
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|
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| ==Organizing pneumonia== | | ==Organizing pneumonia== |
| ===General===
| | {{Main|Organizing pneumonia}} |
| *Multiple causes, e.g. transplant rejection, infection.
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| | |
| Clinical diagnoses:<ref name=Ref_WMSP91>{{Ref WMSP|91}}</ref>
| |
| *[[Lung transplant pathology|Transplant rejection]].
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| *Cryptogenic organizing pneumonia (COP), [[AKA]] (idiopathic) bronchiolitis obliterans organizing pneumonia (BOOP).
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| **Should '''not''' be confused with ''[[constrictive bronchiolitis]]'' (AKA ''[[bronchiolitis obliterans]]'').
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| *[[Collagen vascular disease]].
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| *Toxic injury.
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| *Infection.
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| *Peri-tumor - in proximity to a space-occupying lesion (abscess, neoplasm).
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| | |
| Note:
| |
| *BOOP is used as a synonym for ''organizing pneumonia'' which has the long differential diagnosis above.<ref name=Ref_WMSP91>{{Ref WMSP|91}}</ref>
| |
| **Confusingly, it may be used to refer to the idiopathic form of organizing pneumonia, now generally known as ''cryptogenic organizing pneumonia'' (COP).
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| ***In other words, strictly speaking, ''BOOP'' is '''not''' the same as ''COP''; idiopathic BOOP ''is'' COP.
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| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_Klatt110>{{Ref Klatt|110}}</ref>
| |
| *Distal airway disease -- airways plugged with organizing exudate ("[[Masson bodies]]").
| |
| **"Organized exudate" = fluffy light-staining paucicellular regions with stellate cells (fibroblasts & immature connective tissue).
| |
| *'''No''' hobnailing of pneumocytes.
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| **Type 2 pneumocytes hyperplasia is absent.
| |
| | |
| DDx:
| |
| *[[Diffuse alveolar damage]], proliferative phase - has type 2 pneumoncyte hyperplasia.
| |
| *[[Bronchiolitis obliterans]].
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Masson_body_-_intermed_mag.jpg | Masson body - intermed. mag. (WC/Nephron)
| |
| Image:Masson_body_-_very_high_mag.jpg | Masson body - very high mag. (WC/Nephron)
| |
| </gallery>
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| www:
| |
| *[http://150.59.224.157/pathology/system/data/image_data/11338411170518.jpg Masson body (150.59.224.157)].<ref>URL: [http://150.59.224.157/pathology/index.php?first_category_id=2&second_category_id=20 http://150.59.224.157/pathology/index.php?first_category_id=2&second_category_id=20]. Accessed on: 4 August 2011.</ref>
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| *[http://casereports.bmj.com/content/2011/bcr.11.2010.3483.full BOOP (bmj.com)].
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| *[http://www.flickr.com/photos/pulmonary_pathology/4733384977/ Masson body (flickr.com)].
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|
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|
| ==Hypersensitivity pneumonitis== | | ==Hypersensitivity pneumonitis== |
| *AKA ''extrinsic allergic alveolitis'' | | *AKA ''extrinsic allergic alveolitis'' |
| | | {{Main|Hypersensitivity pneumonitis}} |
| ===General===
| |
| *Exposure to stuffs... e.g. moldy hay - ''Farmer's lung'', atypical mycobacteria - ''hot tub lung''.
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| *Upper lung predominant disease.
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| **Mnemonic ''FASSTEN'' - upper lung field: [[Farmer's lung]], [[Ankylosing spondylitis]], [[Sarcoidosis]], [[Silicosis]], [[Tuberculosis]] (miliary), [[Eosinophilic granuloma]], [[Neurofibromatosis]].
| |
| *An immune complex-mediated [[hypersensitivity]]<ref name=pmid8279154>{{Cite journal | last1 = Kaltreider | first1 = HB. | title = Hypersensitivity pneumonitis. | journal = West J Med | volume = 159 | issue = 5 | pages = 570-8 | month = Nov | year = 1993 | doi = | PMID = 8279154 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/8279154/?tool=pubmed }}</ref> (Gell-Coombs classification type III).
| |
| **If chronic, may develop into a cell-mediated hypersensitivity (Gell-Coombs classification type IV).<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pufrm.html]. Accessed on: 4 December 2011.</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| * Lesions have centrilobular prominence - '''important feature'''. <ref name=pmid16061708/>
| |
| ** Allergens enter lung through airway which has a centrilobular location.
| |
| * [[Granulomata]] (not typically seen in UIP) - '''important feature'''.<ref name=pmid16061708>{{Cite journal | last1 = Ohtani | first1 = Y. | last2 = Saiki | first2 = S. | last3 = Kitaichi | first3 = M. | last4 = Usui | first4 = Y. | last5 = Inase | first5 = N. | last6 = Costabel | first6 = U. | last7 = Yoshizawa | first7 = Y. | title = Chronic bird fancier's lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. | journal = Thorax | volume = 60 | issue = 8 | pages = 665-71 | month = Aug | year = 2005 | doi = 10.1136/thx.2004.027326 | PMID = 16061708 }}</ref>
| |
| * Chronic interstitial inflammation consisting primarily of lymphocytes.
| |
| * Interstitial fibrosis.
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| * Air space involvement (alveolitis).
| |
| | |
| DDx:
| |
| *[[Usual interstitial pneumonia]].
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Hypersensitivity_pneumonitis_low_mag.jpg | Hypersensitivity pneumonitis - low mag. (WC/Nephron)
| |
| Image:Hypersensitivity_pneumonitis_intermed_mag.jpg | Hypersensitivity pneumonitis - intermed. mag. (WC/Nephron)
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| Image:Hypersensitivity_pneumonitis_high_mag.jpg | Hypersensitivity pneumonitis - high mag. (WC/Nephron)
| |
| </gallery>
| |
|
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|
| ==Lymphocytic interstitial pneumonia== | | ==Lymphocytic interstitial pneumonia== |
| *Often abbreviated '''''LIP'''''. | | *Often abbreviated '''''LIP'''''. |
| ===General===
| | {{Main|Lymphocytic interstitial pneumonia}} |
| *Associated with autoimmune disorders ([[rheumatoid arthritis]], [[pernicious anemia]], [[Sjoegren syndrome]])<ref>URL: [http://emedicine.medscape.com/article/299643-overview http://emedicine.medscape.com/article/299643-overview]. Accessed on: 2 June 2010.</ref> and immunodeficiency.<ref name=pmid16088689>{{cite journal |author=Nicholson AG |title=Lymphocytic interstitial pneumonia and other lymphoproliferative disorders in the lung |journal=Semin Respir Crit Care Med |volume=22 |issue=4 |pages=409–22 |year=2001 |month=August |pmid=16088689 |doi=10.1055/s-2001-17384 |url=}}</ref>
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| *Associated with viral infections ([[HIV]], EBV, human T-cell leukemia virus (HTLV) type 1).
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| **Considered an AIDS-defining diagnosis.<ref>{{Cite journal | last1 = Turner | first1 = BJ. | last2 = Eppes | first2 = S. | last3 = McKee | first3 = LJ. | last4 = Cosler | first4 = L. | last5 = Markson | first5 = LE. | title = A population-based comparison of the clinical course of children and adults with AIDS. | journal = AIDS | volume = 9 | issue = 1 | pages = 65-72 | month = Jan | year = 1995 | doi = | PMID = 7893443 }}</ref>
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| ===Gross===
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| *Location: basilar predominance.
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| *Increased interstitial markings.
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| ===Microscopic===
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| Features:<ref>URL: [http://emedicine.medscape.com/article/299643-diagnosis http://emedicine.medscape.com/article/299643-diagnosis]. Accessed on: 2 June 2010.</ref>
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| *Small mature lymphocytes (usually B cells)<ref name=afip_vol2_265>AFIP atlas of nontumour pathology. 2002. Vo. 2. P.265. ISBN 1-881041-79-4.</ref> in the interstitium of the lung.
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| *Plasma cells.
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| *+/-Lymphoid follicles.
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| Negatives:
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| *No [[vasculitis]].
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| *No [[necrosis]].
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| Images:
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| *[http://www.scielo.br/img/revistas/jbpneu/v34n2/en_a02fig01.jpg LIP (scielo.br)].
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| *[http://path.upmc.edu/cases/case176/micro.html LIP (upmc.edu)].
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| DDx:
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| *[[Lymphoma]].
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| *Follicular bronchitis/bronchiolitis.
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| *Nodular lymphoid hyperplasia.
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| **This is determined in part by radiology; it has nodules radiographically.
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| ===Stains===
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| To exclude infection:<ref>URL: [http://path.upmc.edu/cases/case176/dx.html http://path.upmc.edu/cases/case176/dx.html]. Accessed on: 8 January 2012.</ref>
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| *[[GMS stain]] -ve.
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| *[[Ziehl-Neelsen stain]] -ve.
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| ===IHC===
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| *May be done to exclude lymphoma.
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| ==Respiratory bronchiolitis-interstitial lung disease== | | ==Respiratory bronchiolitis-interstitial lung disease== |
| *Abbreviated ''RB-ILD'' or ''RBILD''. | | *Abbreviated ''RB-ILD'' or ''RBILD''. |
| *[[AKA]] ''respiratory bronchiolitis-associated interstitial lung disease''. | | *[[AKA]] ''respiratory bronchiolitis-associated interstitial lung disease''. |
| | | {{Main|Respiratory bronchiolitis-interstitial lung disease}} |
| ===General===
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| *May be an early version of ''[[DIP]]''.
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| *Associated with smoking.
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| ===Microscopic===
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| Features:<ref name=Ref_PPP197-8>{{Ref PPP|197-8}}</ref>
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| *Brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
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| *Inflammation of the terminal bronchioles.
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| Note:
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| *The histologic features of RBILD may be present peri-tumoural.
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| DDx:
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| *[[Desquamative interstitial pneumonia]].
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| Image:
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| *[http://www.nature.com/modpathol/journal/v19/n11/fig_tab/3800671f2.html RB-ILD (nature.com)].
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| ==Desquamative interstitial pneumonia== | | ==Desquamative interstitial pneumonia== |
| *Abbreviated ''DIP''. | | *Abbreviated ''DIP''. |
| ===General===
| | {{Main|Desquamative interstitial pneumonia}} |
| *Thought to be advanced ''[[RBILD]]''.
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| *Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref>
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| **Treatment: stop smoking.
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| ===Microscopic===
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| Features:
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| *Abundant brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
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| *Architecture preserved; "linear fibrosis".
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| Notes:
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| *Some fields of view may be indistinguishable from [[RBILD]].
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| DDx:
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| *Amiodarone toxicity.
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| *Fibrotic [[NSIP]].
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| Images:
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| *[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)].
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| ===Stains===
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| *Macrophages PAS +ve.
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| =See also= | | =See also= |