Difference between revisions of "Desquamative interstitial pneumonia"

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==Microscopic==
==Microscopic==
Features:<ref name=pmid20854463>{{Cite journal  | last1 = Tazelaar | first1 = HD. | last2 = Wright | first2 = JL. | last3 = Churg | first3 = A. | title = Desquamative interstitial pneumonia. | journal = Histopathology | volume = 58 | issue = 4 | pages = 509-16 | month = Mar | year = 2011 | doi = 10.1111/j.1365-2559.2010.03649.x | PMID = 20854463 }}</ref>
Features:<ref name=pmid20854463>{{Cite journal  | last1 = Tazelaar | first1 = HD. | last2 = Wright | first2 = JL. | last3 = Churg | first3 = A. | title = Desquamative interstitial pneumonia. | journal = Histopathology | volume = 58 | issue = 4 | pages = 509-16 | month = Mar | year = 2011 | doi = 10.1111/j.1365-2559.2010.03649.x | PMID = 20854463 }}</ref>
*Abundant brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
*Abundant airspace macrophages - usually with brown pigment (so called ''smoker's macrophages'') - '''key feature'''.
*Interstitial inflammation ''or'' interstitial fibrosis with a preserved architecture - so called "linear fibrosis".
*Interstitial inflammation ''or'' interstitial fibrosis with a preserved architecture - so called "linear fibrosis".



Revision as of 04:27, 21 March 2016

Desquamative interstitial pneumonia
Diagnosis in short

LM abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis")
LM DDx amiodarone toxicity, fibrotic NSIP, RBILD
Site lung - see diffuse lung diseases

Associated Dx +/-smoking
Prevalence uncommon
Treatment stop smoking/remove insult

Desquamative interstitial pneumonia, abbreviated DIP, is a diffuse lung disease that is strongly associated with smoking.

General

  • Uncommon.
  • Strong association with smoking.[1][2]
    • Thought to be advanced RBILD.
  • May be seen in non-smokers (up to ~40% of cases) due to occupational exposures, drugs, viral illnesses and autoimmune diseases.[3]

Diagnosis:

  • Requires - surgical biopsy.[3]

Treatment:

  • Stop smoking/remove or manage underlying cause.

Microscopic

Features:[4]

  • Abundant airspace macrophages - usually with brown pigment (so called smoker's macrophages) - key feature.
  • Interstitial inflammation or interstitial fibrosis with a preserved architecture - so called "linear fibrosis".

Notes:

  • Some fields of view may be indistinguishable from RBILD.

DDx:

Images

Stains

  • Macrophages PAS +ve.

See also

References

  1. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 93. ISBN 978-0781765275.
  2. Margaritopoulos, GA.; Vasarmidi, E.; Jacob, J.; Wells, AU.; Antoniou, KM. (Sep 2015). "Smoking and interstitial lung diseases.". Eur Respir Rev 24 (137): 428-35. doi:10.1183/16000617.0050-2015. PMID 26324804.
  3. 3.0 3.1 Godbert, B.; Wissler, MP.; Vignaud, JM. (Jun 2013). "Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology.". Eur Respir Rev 22 (128): 117-23. doi:10.1183/09059180.00005812. PMID 23728865.
  4. Tazelaar, HD.; Wright, JL.; Churg, A. (Mar 2011). "Desquamative interstitial pneumonia.". Histopathology 58 (4): 509-16. doi:10.1111/j.1365-2559.2010.03649.x. PMID 20854463.