|
|
(11 intermediate revisions by the same user not shown) |
Line 44: |
Line 44: |
| | [[Desquamative interstitial pneumonia]] (DIP) | | | [[Desquamative interstitial pneumonia]] (DIP) |
| | DIP | | | DIP |
| | Smoking | | | [[smoking]] |
| |- | | |- |
| | [[Diffuse alveolar damage]] (DAD) | | | [[Diffuse alveolar damage]] (DAD) |
Line 56: |
Line 56: |
| | [[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]] |
Line 68: |
Line 68: |
| | [[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. |
Line 112: |
Line 112: |
| ==Non-specific interstitial pneumonia== | | ==Non-specific interstitial pneumonia== |
| *Abbreviated ''NSIP''. | | *Abbreviated ''NSIP''. |
| | | {{Main|Non-specific interstitial pneumonia}} |
| ===General===
| |
| *Better prognosis than [[UIP]].
| |
| *Some radiologists and pathologists don't believe in this entity.
| |
| | |
| Associations:<ref name=Ref_WMSP92>{{Ref WMSP|92}}</ref>
| |
| *Connective tissue disease.
| |
| *[[Rheumatoid arthritis]].
| |
| | |
| ===Gross/Radiology===
| |
| *No honeycombing.
| |
| *Fibrosis usually lower lung zone.
| |
| *Patchy ground glass.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_WMSP92>{{Ref WMSP|92}}</ref>
| |
| *Diffuse fibrosis:
| |
| **Uniform fibrosis (unlike [[UIP]]).
| |
| **"Linear fibrosis" has a good prognosis - should be mentioned in the report.
| |
| ***''Linear fibrosis'' = fibrosis that follows alveolar walls + no architectural distortion.
| |
| *+/-Lymphoid nodules - association with collagen vascular disease. (???)
| |
| *+/-Focal [[organizing pneumonia]].
| |
| | |
| Notes:
| |
| *Inflammation in NSIP usually more prominent than in UIP.
| |
| *No honeycombing - key difference between UIP and NSIP.
| |
| | |
| DDx:
| |
| *Collagen vascular disease.
| |
| *Drug reaction.
| |
| *[[Hypersensitivity pneumonitis]] (extrinic allergic alveolitis).
| |
| *[[Lymphocytic interstitial pneumonia]] (LIP) - much more inflammation.
| |
|
| |
|
| ==Organizing pneumonia== | | ==Organizing pneumonia== |
| ===General===
| | {{Main|Organizing pneumonia}} |
| *Multiple causes, e.g. transplant rejection, infection.
| |
| | |
| Clinical diagnoses:<ref name=Ref_WMSP91>{{Ref WMSP|91}}</ref>
| |
| *[[Lung transplant pathology|Transplant rejection]].
| |
| *Cryptogenic organizing pneumonia (COP), [[AKA]] (idiopathic) bronchiolitis obliterans organizing pneumonia (BOOP).
| |
| **Should '''not''' be confused with ''[[constrictive bronchiolitis]]'' (AKA ''[[bronchiolitis obliterans]]'').
| |
| *[[Collagen vascular disease]].
| |
| *Toxic injury.
| |
| *Infection.
| |
| *Peri-tumor - in proximity to a space-occupying lesion (abscess, neoplasm).
| |
| | |
| 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).
| |
| ***In other words, strictly speaking, ''BOOP'' is '''not''' the same as ''COP''; idiopathic BOOP ''is'' COP.
| |
| | |
| ===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.
| |
| **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>
| |
| 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>
| |
| *[http://casereports.bmj.com/content/2011/bcr.11.2010.3483.full BOOP (bmj.com)].
| |
| *[http://www.flickr.com/photos/pulmonary_pathology/4733384977/ Masson body (flickr.com)].
| |
|
| |
|
| ==Hypersensitivity pneumonitis== | | ==Hypersensitivity pneumonitis== |
| *AKA ''extrinsic allergic alveolitis'' | | *AKA ''extrinsic allergic alveolitis'' |
| {{Main|Hypersensititivty pneumonitis}} | | {{Main|Hypersensitivity pneumonitis}} |
|
| |
|
| ==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>
| |
| *Associated with viral infections ([[HIV]], EBV, human T-cell leukemia virus (HTLV) type 1).
| |
| **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>
| |
| | |
| ===Gross===
| |
| *Location: basilar predominance.
| |
| *Increased interstitial markings.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>URL: [http://emedicine.medscape.com/article/299643-diagnosis http://emedicine.medscape.com/article/299643-diagnosis]. Accessed on: 2 June 2010.</ref>
| |
| *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.
| |
| *Plasma cells.
| |
| *+/-Lymphoid follicles.
| |
| | |
| Negatives:
| |
| *No [[vasculitis]].
| |
| *No [[necrosis]].
| |
| | |
| Images:
| |
| *[http://www.scielo.br/img/revistas/jbpneu/v34n2/en_a02fig01.jpg LIP (scielo.br)].
| |
| *[http://path.upmc.edu/cases/case176/micro.html LIP (upmc.edu)].
| |
| | |
| DDx:
| |
| *[[Lymphoma]].
| |
| *Follicular bronchitis/bronchiolitis.
| |
| *Nodular lymphoid hyperplasia.
| |
| **This is determined in part by radiology; it has nodules radiographically.
| |
| | |
| ===Stains===
| |
| 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>
| |
| *[[GMS stain]] -ve.
| |
| *[[Ziehl-Neelsen stain]] -ve.
| |
| | |
| ===IHC===
| |
| *May be done to exclude lymphoma.
| |
|
| |
|
| ==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===
| |
| *May be an early version of ''[[DIP]]''.
| |
| *Associated with smoking.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=Ref_PPP197-8>{{Ref PPP|197-8}}</ref>
| |
| *Brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
| |
| *Inflammation of the terminal bronchioles.
| |
| | |
| Note:
| |
| *The histologic features of RBILD may be present peri-tumoural.
| |
| | |
| DDx:
| |
| *[[Desquamative interstitial pneumonia]].
| |
| | |
| Image:
| |
| *[http://www.nature.com/modpathol/journal/v19/n11/fig_tab/3800671f2.html RB-ILD (nature.com)].
| |
|
| |
|
| ==Desquamative interstitial pneumonia== | | ==Desquamative interstitial pneumonia== |
| *Abbreviated ''DIP''. | | *Abbreviated ''DIP''. |
| ===General===
| | {{Main|Desquamative interstitial pneumonia}} |
| *Thought to be advanced ''[[RBILD]]''.
| |
| *Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref>
| |
| **Treatment: stop smoking.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Abundant brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
| |
| *Architecture preserved; "linear fibrosis".
| |
| | |
| Notes:
| |
| *Some fields of view may be indistinguishable from [[RBILD]].
| |
| | |
| DDx:
| |
| *Amiodarone toxicity.
| |
| *Fibrotic [[NSIP]].
| |
| | |
| Images:
| |
| *[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)].
| |
| | |
| ===Stains===
| |
| *Macrophages PAS +ve.
| |
|
| |
|
| =See also= | | =See also= |