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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

Exogenous lipoid pneumonia. The microscopic appearance of exogenous lipoid pneumonia is dependent on the composition of the aspirated material. (A) Exogenous lipoid pneumonia with histiocytes containing predominantly fine microvesicles. (B) Exogenous lipoid pneumonia with larger vacuoles and associated fibrosis. (A,B) H&E stain, 40× original magnification.
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CPT-62-05-0387-f22: Exogenous lipoid pneumonia. The microscopic appearance of exogenous lipoid pneumonia is dependent on the composition of the aspirated material. (A) Exogenous lipoid pneumonia with histiocytes containing predominantly fine microvesicles. (B) Exogenous lipoid pneumonia with larger vacuoles and associated fibrosis. (A,B) H&E stain, 40× original magnification.

Mentions: The cytological features of the macrophages in all of these conditions vary considerably and are helpful at times in pointing to a specific diagnosis. In RB-ILD, the macrophages are airway-centred and contain fine, light-brown, cytoplasmic pigmentation with delicate black punctation, findings characteristic of smokers’ macrophages. In amiodarone reactions, obstructive pneumonias, lipoid pneumonia and storage diseases, foamy or vacuolated histiocytes predominate. In hard metal disease (cobalt pneumoconiosis), distinctive multinucleated intra-alveolar histiocytes are the dominant finding.34 Chronic alveolar haemorrhage is associated with extensive haemosiderin-laden macrophages in the airspaces.14 The distinctive features of eosinophilic pneumonia are the presence of interstitial and airspace eosinophils, airspace fibrin, markedly reactive type II cells and dense alveolar macrophages.12 Birefringent material can be identified within the DIP-like reaction in many of the pneumoconioses. Large and small clear spaces, often engulfed by giant cells and associated with variable fibrosis, characterise exogenous lipoid pneumonia (fig 22).


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

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

Exogenous lipoid pneumonia. The microscopic appearance of exogenous lipoid pneumonia is dependent on the composition of the aspirated material. (A) Exogenous lipoid pneumonia with histiocytes containing predominantly fine microvesicles. (B) Exogenous lipoid pneumonia with larger vacuoles and associated fibrosis. (A,B) 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-f22: Exogenous lipoid pneumonia. The microscopic appearance of exogenous lipoid pneumonia is dependent on the composition of the aspirated material. (A) Exogenous lipoid pneumonia with histiocytes containing predominantly fine microvesicles. (B) Exogenous lipoid pneumonia with larger vacuoles and associated fibrosis. (A,B) H&E stain, 40× original magnification.
Mentions: The cytological features of the macrophages in all of these conditions vary considerably and are helpful at times in pointing to a specific diagnosis. In RB-ILD, the macrophages are airway-centred and contain fine, light-brown, cytoplasmic pigmentation with delicate black punctation, findings characteristic of smokers’ macrophages. In amiodarone reactions, obstructive pneumonias, lipoid pneumonia and storage diseases, foamy or vacuolated histiocytes predominate. In hard metal disease (cobalt pneumoconiosis), distinctive multinucleated intra-alveolar histiocytes are the dominant finding.34 Chronic alveolar haemorrhage is associated with extensive haemosiderin-laden macrophages in the airspaces.14 The distinctive features of eosinophilic pneumonia are the presence of interstitial and airspace eosinophils, airspace fibrin, markedly reactive type II cells and dense alveolar macrophages.12 Birefringent material can be identified within the DIP-like reaction in many of the pneumoconioses. Large and small clear spaces, often engulfed by giant cells and associated with variable fibrosis, characterise exogenous lipoid pneumonia (fig 22).

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