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My approach to interstitial lung disease using clinical, radiological and histopathological patterns.

Leslie KO - J. Clin. Pathol. (2009)

Bottom Line: The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting.The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis.A pattern-based histopathological approach to interstitial lung disease provides a "map" for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomic Pathology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA. leslie.kevin@mayo.edu

ABSTRACT
The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. A pattern-based histopathological approach to interstitial lung disease provides a "map" for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation.

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Related in: MedlinePlus

Granulomatous pneumonia from infection. This example of atypical mycobacterial infection (Mycobacterium avium complex) differs from hypersensitivity pneumonitis in having larger and better formed granulomas, along with more granulomas in the alveolar spaces and alveolar ducts. Necrosis in granulomas may be present (not in this image) and is a harbinger of infection. Sarcoidosis granulomas (fig 25) are better formed, have less associate inflammation, and consistently have more hyaline fibrosis around aggregated granulomas. H&E stain, 40× original magnification.
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CPT-62-05-0387-f18: Granulomatous pneumonia from infection. This example of atypical mycobacterial infection (Mycobacterium avium complex) differs from hypersensitivity pneumonitis in having larger and better formed granulomas, along with more granulomas in the alveolar spaces and alveolar ducts. Necrosis in granulomas may be present (not in this image) and is a harbinger of infection. Sarcoidosis granulomas (fig 25) are better formed, have less associate inflammation, and consistently have more hyaline fibrosis around aggregated granulomas. H&E stain, 40× original magnification.

Mentions: Infection dominates this pattern of cellular interstitial pneumonia, followed by subacute/chronic aspiration pneumonia, especially if the granulomas are present in alveoli or alveolar ducts (fig 18). Atypical mycobacteria dominate this diffuse lung disease presentation, including a form of bioaerosol exposure to atypical mycobacteria (so-called “hot tub lung”).30 When granulomas are interstitial and resemble those of sarcoidosis (see below), the presence of cellular infiltrates is best reconciled as a different disease process (eg, drug reaction and sarcoidosis).


My approach to interstitial lung disease using clinical, radiological and histopathological patterns.

Leslie KO - J. Clin. Pathol. (2009)

Granulomatous pneumonia from infection. This example of atypical mycobacterial infection (Mycobacterium avium complex) differs from hypersensitivity pneumonitis in having larger and better formed granulomas, along with more granulomas in the alveolar spaces and alveolar ducts. Necrosis in granulomas may be present (not in this image) and is a harbinger of infection. Sarcoidosis granulomas (fig 25) are better formed, have less associate inflammation, and consistently have more hyaline fibrosis around aggregated granulomas. H&E stain, 40× original magnification.
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2668105&req=5

CPT-62-05-0387-f18: Granulomatous pneumonia from infection. This example of atypical mycobacterial infection (Mycobacterium avium complex) differs from hypersensitivity pneumonitis in having larger and better formed granulomas, along with more granulomas in the alveolar spaces and alveolar ducts. Necrosis in granulomas may be present (not in this image) and is a harbinger of infection. Sarcoidosis granulomas (fig 25) are better formed, have less associate inflammation, and consistently have more hyaline fibrosis around aggregated granulomas. H&E stain, 40× original magnification.
Mentions: Infection dominates this pattern of cellular interstitial pneumonia, followed by subacute/chronic aspiration pneumonia, especially if the granulomas are present in alveoli or alveolar ducts (fig 18). Atypical mycobacteria dominate this diffuse lung disease presentation, including a form of bioaerosol exposure to atypical mycobacteria (so-called “hot tub lung”).30 When granulomas are interstitial and resemble those of sarcoidosis (see below), the presence of cellular infiltrates is best reconciled as a different disease process (eg, drug reaction and sarcoidosis).

Bottom Line: The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting.The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis.A pattern-based histopathological approach to interstitial lung disease provides a "map" for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation.

View Article: PubMed Central - PubMed

Affiliation: Division of Anatomic Pathology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA. leslie.kevin@mayo.edu

ABSTRACT
The complex world of interstitial lung disease presents nearly insurmountable challenges to the general surgical pathologist faced with a lung biopsy in this setting. The pathology is often inflammatory and always requires clinical and radiological context for a relevant and clinically useful histopathological diagnosis. A pattern-based histopathological approach to interstitial lung disease provides a "map" for the general pathologist to navigate this area successfully, especially so when used with aid of the clinical and radiological patterns of presentation.

Show MeSH
Related in: MedlinePlus