Usual interstitial pneumonia - Histologic study of biopsy and explant specimens

被引:154
作者
Katzenstein, ALA
Zisman, DA
Litzky, LA
Nguyen, BT
Kotloff, RM
机构
[1] SUNY Syracuse, Upstate Med Univ, Dept Pathol, Syracuse, NY USA
[2] Univ Penn, Sch Med, Div Pulm Allergy & Crit Care Med, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Med, Dept Pathol, Philadelphia, PA 19104 USA
[4] Univ Penn, Sch Med, Dept Radiol, Philadelphia, PA 19104 USA
[5] Crouse Hosp, Syracuse, NY USA
关键词
idiopathic pulmonary fibrosis; usual interstitial pneumonia; nonspecific interstitial pneumonia;
D O I
10.1097/00000478-200212000-00004
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
The pathologic findings in biopsy and subsequent explant specimens from 20 patients with usual interstitial pneumonia (UIP) were reviewed to refine histologic criteria for diagnosis, to identify factors that may confound diagnosis, and to assess the relationship of UIP and nonspecific interstitial pneumonia (NSIP). One case of NSIP was also identified and included for comparison. Surgical biopsies from 15 of the 20 UIP cases were diagnosed as UIP, whereas 5 showed only nondiagnostic changes. An important new observation is that areas resembling nonspecific interstitial pneumonia (NSIP-like areas) are present in the majority of UIP cases in both biopsy and explant specimens, and they are extensive in some. Ten of the 15 UIP biopsies were considered straightforward, with typical patchy interstitial fibrosis, honeycomb change, and fibroblast foci. Five cases were considered difficult because of prominent NSIP-like areas in two, extensive honeycomb change in one, superimposed diffuse alveolar damage in one, and superimposed bronchiolitis obliterans-organizing pneumonia in one. The most helpful feature for diagnosing UIP in difficult cases was the presence of a distinct patchwork appearance to the characteristic uneven or variegated parenchymal involvement along with evidence of architectural derangement. No explant showing UIP was preceded by biopsy findings of NSIP, and the one NSIP case appeared similar at biopsy and explant. NSIP or NSIP-like areas and UIP may reflect different mechanisms of fibrosis related either to different severity of injury or to different injuries.
引用
收藏
页码:1567 / 1577
页数:11
相关论文
共 13 条
[1]  
[Anonymous], 2002, AM J RESP CRIT CARE, V165, P277, DOI [DOI 10.1164/AJRCCM.165.2.ATS01, 10.1164/ajrccm.165.2.ats01]
[2]   Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis [J].
Bjoraker, JA ;
Ryu, JH ;
Edwin, MK ;
Myers, JL ;
Tazelaar, HD ;
Schroeder, DR ;
Offord, KP .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (01) :199-203
[3]   RAPID PROGRESSIVE BRONCHIOLITIS OBLITERANS WITH ORGANIZING PNEUMONIA [J].
COHEN, AJ ;
KING, TE ;
DOWNEY, GP .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (06) :1670-1675
[4]   Nonspecific interstitial pneumonia - Individualization of a clinicopathologic entity in a series of 12 patients [J].
Cottin, V ;
Donsbeck, AV ;
Revel, D ;
Loire, R ;
Cordier, JF .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 158 (04) :1286-1293
[5]   A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis [J].
Daniil, ZD ;
Gilchrist, FC ;
Nicholson, AG ;
Hansell, DM ;
Harris, J ;
Colby, TV ;
du Bois, RM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1999, 160 (03) :899-905
[6]   Histopathologic variability in usual and nonspecific interstitial pneumonias [J].
Flaherty, KR ;
Travis, WD ;
Colby, TV ;
Toews, GB ;
Kazerooni, EA ;
Gross, BH ;
Jain, A ;
Strawderman, RL ;
Flint, A ;
Lynch, JP ;
Martinez, FJ .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2001, 164 (09) :1722-1727
[7]   NONSPECIFIC INTERSTITIAL PNEUMONIA/FIBROSIS - HISTOLOGIC FEATURES AND CLINICAL-SIGNIFICANCE [J].
KATZENSTEIN, ALA ;
FIORELLI, RF .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1994, 18 (02) :136-147
[8]   Idiopathic pulmonary fibrosis - Clinical relevance of pathologic classification [J].
Katzenstein, ALA ;
Myers, JL .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (04) :1301-1315
[9]   Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP [J].
Nagai, S ;
Kitaichi, M ;
Itoh, H ;
Nishimura, K ;
Izumi, T ;
Colby, TV .
EUROPEAN RESPIRATORY JOURNAL, 1998, 12 (05) :1010-1019
[10]   The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis [J].
Nicholson, AC ;
Colby, TV ;
Dubois, RM ;
Hansell, DM ;
Wells, AU .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 162 (06) :2213-2217