Desquamative interstitial pneumonia

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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

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

General

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

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:

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. 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.