Difference between revisions of "Diffuse lung diseases"

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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>
*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'''.
**Cannot count (distinct) granules.
*Inflammation of the terminal bronchioles.
 
Note:
*The histologic features of RBILD may be present peri-tumoural.
*Hemosiderin-laden macrophages have coarse granules - that one can count.
 
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 stain|PAS]] +ve.


=See also=
=See also=
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