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Toussie D, Finkelstein M, Mendoza D, Concepcion J, Stojanovska J, Azour L, Ko JP, Moore WH, Singh A, Sasson A, Bhattacharji P, Eber C. Incidental Apical Pleuroparenchymal Scarring on Computed Tomography: Diagnostic Yield, Progression, Morphologic Features and Clinical Significance. J Thorac Imaging 2024:00005382-990000000-00138. [PMID: 38798201 DOI: 10.1097/rti.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE Apical pleuroparenchymal scarring (APPS) is commonly seen on chest computed tomography (CT), though the imaging and clinical features, to the best of our knowledge, have never been studied. The purpose was to understand APPS's typical morphologic appearance and associated clinical features. PATIENTS AND METHODS A random generator selected 1000 adult patients from all 21516 chest CTs performed at urban outpatient centers from January 1, 2016 to December 31, 2016. Patients with obscuring apical diseases were excluded to eliminate confounding factors. After exclusions, 780 patients (median age: 64 y; interquartile range: 56 to 72 y; 55% males) were included for analysis. Two radiologists evaluated the lung apices of each CT for the extent of abnormality in the axial plane (mild: <5 mm, moderate: 5 to 10 mm, severe: >10 mm), craniocaudal plane (extension halfway to the aortic arch, more than halfway, vs below the arch), the predominant pattern (nodular vs reticular and symmetry), and progression. Cohen kappa coefficient was used to assess radiologists' agreement in scoring. Ordinal logistic regression was used to determine associations of clinical and imaging variables with APPS. RESULTS APPS was present on 65% (507/780) of chest CTs (54% mild axial; 80% mild craniocaudal). The predominant pattern was nodular and symmetric. Greater age, female sex, lower body mass index, greater height, and white race were associated with more extensive APPS. APPS was not found to be associated with lung cancer in this cohort. CONCLUSION Classifying APPS by the extent of disease in the axial or craniocaudal planes, in addition to the predominant pattern, enabled statistically significant associations to be determined, which may aid in understanding the pathophysiology of apical scarring and potential associated risks.
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Affiliation(s)
- Danielle Toussie
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | - Mark Finkelstein
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | - Dexter Mendoza
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Jose Concepcion
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | | | - Lea Azour
- Department of Radiology, David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA
| | - Jane P Ko
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | - William H Moore
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | - Ayushi Singh
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Arielle Sasson
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
| | - Priya Bhattacharji
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine
| | - Corey Eber
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY
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Shen Y, Li L, Yang Z, Wen Y, Qian L, He H. Prognostic significance of alveolar collapse in lung invasive adenocarcinoma and its relationship with tumor infiltrating lymphocytes. Pathol Res Pract 2024; 254:155149. [PMID: 38277751 DOI: 10.1016/j.prp.2024.155149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
This study aims to investigate the correlations between alveolar collapse, tumor size, and tumor infiltrating lymphocytes (TILs), while also evaluating the prognostic significance of alveolar collapse in invasive lung adenocarcinoma. 355 patients with solitary invasive lung adenocarcinoma were divided into two groups based on the maximum diameter of alveolar collapse: alveolar collapse ≤ 5 mm group and alveolar collapse > 5 mm group. Differences in clinicopathological characteristics, tumor size, TILs, and prognosis were compared between the two groups. The alveolar collapse > 5 mm group had a higher mean age, larger tumor diameter, and increased TILs levels compared to the alveolar collapse ≤ 5 mm group (P < 0.05). A moderate positive correlation was observed between alveolar collapse and tumor size (r = 0.646, P < 0.001). Lung adenocarcinoma with alveolar collapse > 5 mm demonstrated superior 5-year survival and acted as an independent prognostic indicator (HR=0.152, P = 0.004) in multivariate Cox regression analysis, alongside tumor size (HR=10.172, P = 0.034) and lymph node metastasis (HR=2.88, P = 0.017). The size of alveolar collapse is associated with TILs abundance, suggesting that the immune microenvironment may play a crucial role in alveolar collapse formation. Pathologists should take note of alveolar collapse in lung adenocarcinoma.
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Affiliation(s)
- Yuechuan Shen
- Department of Emergency, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
| | - Lue Li
- Department of Respiratory Medicine, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
| | - Zhiqiang Yang
- Department of Respiratory Medicine, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
| | - Yuanyuan Wen
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
| | - Liyong Qian
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
| | - Hui He
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhoushan City 316021, Zhejiang Province, China.
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Bankier AA, MacMahon H, Colby T, Gevenois PA, Goo JM, Leung AN, Lynch DA, Schaefer-Prokop CM, Tomiyama N, Travis WD, Verschakelen JA, White CS, Naidich DP. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2024; 310:e232558. [PMID: 38411514 PMCID: PMC10902601 DOI: 10.1148/radiol.232558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/17/2024] [Accepted: 01/31/2024] [Indexed: 02/28/2024]
Abstract
Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.
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Affiliation(s)
- Alexander A. Bankier
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Heber MacMahon
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Thomas Colby
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Pierre Alain Gevenois
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Jin Mo Goo
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Ann N.C. Leung
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David A. Lynch
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Cornelia M. Schaefer-Prokop
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Noriyuki Tomiyama
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - William D. Travis
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Johny A. Verschakelen
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - Charles S. White
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
| | - David P. Naidich
- From the Dept of Radiology, University of Massachusetts Memorial
Health and University of Massachusetts Chan Medical School, 55 Lake Ave N,
Worcester, MA 01655 (A.A.B.); Dept of Radiology, University of Chicago, Chicago,
Ill (H.M.); Dept of Pathology, Mayo Clinic Scottsdale, Scottsdale, Ariz (T.C.);
Dept of Pulmonology, Université Libre de Bruxelles, Brussels, Belgium
(P.A.G.); Dept of Radiology, Seoul National University Hospital, Seoul, Korea
(J.M.G.); Center for Academic Medicine, Dept of Radiology, Stanford University,
Palo Alto, Calif (A.N.C.L.); Dept of Radiology, National Jewish Medical and
Research Center, Denver, Colo (D.A.L.); Dept of Radiology, Meander Medical
Centre Amersfoort, Amersfoort, the Netherlands (C.M.S.P.); Dept of Radiology,
Osaka University Graduate School of Medicine, Suita, Japan (N.T.); Dept of
Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.); Dept
of Radiology, Catholic University Leuven, University Hospital Gasthuisberg,
Leuven, Belgium (J.A.V.); Dept of Diagnostic Radiology, University of Maryland
Hospital, Baltimore, Md (C.S.W.); and Dept of Radiology, NYU Langone Medical
Center/Tisch Hospital, New York, NY (D.P.N.)
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Gentili F, Di Martino V, Forestieri M, Mazzei F, Guerrini S, Bargagli E, Sisinni AG, Volterrani L, Mazzei MA. Pleuroparenchymal Fibroelastosis-like Lesions in Clinical Practice: A Rare Entity? Review of a Radiological Database. Diagnostics (Basel) 2023; 13:diagnostics13091627. [PMID: 37175018 PMCID: PMC10178180 DOI: 10.3390/diagnostics13091627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Pleuroparenchymal Fibroelastosis (PPFE) is a rare disease that consists of elastofibrosis that involves the pleura and subpleural lung parenchyma; it is an unusual pulmonary disease with unique clinical, radiological and pathological characteristics. According to recent studies, PPFE may not be a definite disease but a form of chronic lung injury. The aim of this retrospective study is to determine the incidence and to evaluate the distribution, severity and progression of this radiological entity on high-resolution CT (HRCT) exams of the chest, performed in routine clinical practice. In total, 1514 HRCT exams performed in the period January 2016-June 2018 were analyzed. For each exam, the presence of PPFE was evaluated and a quantitative score was assigned (from 0 to 7 points, based on the maximum depth of fibrotic involvement of the parenchyma). When available, two exams with a time interval of at least 6 months were compared for each patient in order to evaluate progression (defined as the increase in the disease score). Patients were divided into different groups according to exposure and their associated diseases. Statistical analysis was performed by using the Wilcoxon test and Kruskal-Wallis test. Results: PPFE was detected in 174 out of 1514 patients (11.6%), with a mean score of 6.1 ± 3.9 (range 1-14). In 106 out of 174 patients (60.9%), a previous CT scan was available and an evolution of PPFE was detected in 19 of these (11.5%). Among these 19 patients with worsening PPFE, 4 had isolated PPFE that was associated with chronic exposure or connective tissue disorders, and the other 15 had an associated lung disease and/or a chronic exposure. In this group, it was found that the ventral segments of the upper lobes, fissures and apical segments of the lower lobes had a greater statistically significant involvement in the progression of the disease compared to the non-progressive group. In 16 of 174 patients (9.2%, 7 of which belonged to the radiological progression group) a biopsy through video-assisted thoracoscopic surgery or apicoectomy confirmed PPFE. Conclusion: PPFE-like lesions are not uncommon on HRCT exams in routine clinical practice, and are frequently found in patients with different forms of chronic lung injury. Further studies are necessary to explain why the disease progresses in some cases, while in most, it remains stationary over time.
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Affiliation(s)
- Francesco Gentili
- Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Vito Di Martino
- Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | | | - Francesco Mazzei
- Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Susanna Guerrini
- Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Luca Volterrani
- Department of Radiological Sciences, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Radiological Sciences, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
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Suster D, Ronen N, Pierce DC, Suster S. Pulmonary nodular elastosis: The intraparenchymal counterpart of pulmonary apical caps? Ann Diagn Pathol 2023; 63:152107. [PMID: 36638602 DOI: 10.1016/j.anndiagpath.2023.152107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
We have studied six cases in which focal consolidative pulmonary opacities observed on imaging studies led to surgical resection due to the suspicion of malignancy and showed on histopathologic examination a benign process characterized by an expansile tumor-like nodular accumulation of elastotic material. The patients were five women and one man aged 46 to 67 years (mean: 61 years). All lesions were found incidentally on imaging studies done for a variety of reasons, including surveillance for metastatic carcinoma in four patients. The lesions presented as solid nodules within lung parenchyma with irregular borders and spiculated margins and measured between 0.6 and 4.6 cm in diameter. Histological examination showed dense deposits of elastic tissue without evidence of malignancy, similar to those seen in pulmonary apical caps. Clinical follow-up between 5 and 16 years (mean: 10 years) showed that all patients were alive and well without evidence of disease. Pulmonary nodular elastosis is a localized intraparenchymatous process that may be confused clinically and radiographically for a malignant neoplasm and needs to be distinguished from other nodular lesions of the lung. To the best of our knowledge, tumor-forming lesions within lung parenchyma that are predominantly or almost exclusively composed of accumulation of elastic fibers have not been previously described.
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Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University School of Medicine, Newark, NJ, United States of America.
| | - Natali Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Douglas C Pierce
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
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6
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Samhouri BF, Vassallo R, Achenbach SJ, Kronzer VL, Davis JM, Myasoedova E, Crowson CS. Incidence, Risk Factors, and Mortality of Clinical and Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Population-Based Cohort. Arthritis Care Res (Hoboken) 2022; 74:2042-2049. [PMID: 34995017 PMCID: PMC9272096 DOI: 10.1002/acr.24856] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/18/2021] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify the incidence, risk factors, and outcomes of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to assess time trends in the incidence and mortality in RA-ILD. METHODS We included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014. Subjects were followed until death, emigration, or April 30, 2019. ILD was defined as the presence of a radiologist-defined pattern consistent with ILD on chest computed tomography (CT). When chest CT was absent, the combination of chest radiograph abnormalities compatible with ILD and restrictive pattern on pulmonary function testing was considered consistent with ILD. Potential risk factors included age, sex, smoking, obesity, seropositivity, extraarticular manifestations (EAMs), and medications. For survival analysis, we matched RA-ILD patients to RA-non-ILD comparators. The frequency and mortality from clinician-diagnosed RA-ILD from 1999 to 2014 was compared against a cohort from 1955 to 1994. RESULTS During the 1999-2014 time period, 645 individuals (70% women) had incident RA, were a median age of 55.3 years, and 53% never smoked. Twenty-two patients had ILD before RA, and 51 (67% women) developed ILD during follow-up. The 20-year cumulative incidence of RA-ILD was 15.3%. Ever-smoking (hazard ratio [HR] 1.92), age at RA onset (HR 1.89 per 10-year increase), and severe EAMs (HR 2.29) were associated with incident RA-ILD. The RA-ILD cases had higher mortality than their matched RA comparators (HR 2.42). Incidence of RA-ILD was non-significantly lower from 1999 to 2014 than from 1955 to1994, but mortality was improved. CONCLUSIONS RA-ILD occurs in nearly 1 in 6 patients with RA within 20 years and is associated with shorter survival. Lack of significant change in RA-ILD incidence over 6 decades deserves further investigation.
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Franquet T, Giménez Palleiro A. Idiopathic pleuroparenchymal fibroelastosis. RADIOLOGIA 2022; 64 Suppl 3:301-307. [PMID: 36737168 DOI: 10.1016/j.rxeng.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/12/2022] [Indexed: 02/05/2023]
Abstract
The term idiopathic pleuroparenchymal fibroelastosis refers to a rare interstitial lung disease that predominantly involves the upper lobes. It has been considered a rare subtype of interstitial lung disease since 2013, when it was included in the joint consensus statement on the diagnosis of interstitial lung diseases published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Currently, two distinct types of pleuroparenchymal fibroelastosis are recognized: the idiopathic type for cases in which it has not been possible to establish a specific etiology and a secondary type associated with a variety of different causes. The diagnosis of pleuroparenchymal fibroelastosis must be managed from a combined clinical and radiological perspective. High-resolution computed tomography (HRCT) is the imaging method of choice for the evaluation and diagnosis of pleuroparenchymal fibroelastosis. In many cases, the diagnosis will be based exclusively on the HRCT findings and histologic confirmation will be unnecessary. This article describes the clinical, radiological, and histological characteristics of pleuroparenchymal fibroelastosis, discussing the different associations with this entity and its differential diagnosis.
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Affiliation(s)
- T Franquet
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - A Giménez Palleiro
- Servicio de Radiodiagnóstico, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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8
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Fibroelastosis pleuroparenquimatosa idiopática (FEPPI). RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Inafuku K, Sekine A, Arai H, Hagiwara E, Komatsu S, Iwasawa T, Misumi T, Kikunishi N, Tajiri M, Okudela K, Rino Y, Ogura T. Radiological unilateral pleuroparenchymal fibroelastosis as a notable late complication after lung cancer surgery: incidence and perioperative associated factors. Interact Cardiovasc Thorac Surg 2022; 35:6673152. [PMID: 35993903 PMCID: PMC9487195 DOI: 10.1093/icvts/ivac223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Pleuroparenchymal fibroelastosis (PPFE) is a rare idiopathic interstitial pneumonia characterized by pleural-parenchymal involvement, predominantly in the upper lobes. Unilateral upper lung field pulmonary fibrosis (upper-PF) that is radiologically consistent with PPFE reportedly develops after lung cancer surgery in the operated side and presents many clinical characteristics in common with PPFE. However, the incidence and perioperative associated factors remain unclear.
METHODS
All consecutive patients with lung cancer resected completely from 2008 to 2016 were investigated retrospectively. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated using competing risk analysis.
RESULTS
Among the 587 included patients, 25 patients (4.3%) were diagnosed as unilateral upper-PF. The 3-, 5- and 10-year cumulative incidence of unilateral upper-PF was 2.3%, 3.3% and 5.3%, respectively. In multivariable analysis, male sex, presence of a pulmonary apical cap, lobar resection and low % vital capacity (%VC < 80%) were independent perioperative associated factors. The 10-year cumulative incidence was 6.3% in patients treated with lobar resection, 8.0% in male patients, 10.3% in patients with pulmonary apical cap and 14.5% in patients with low %VC. Postoperative pleural effusion at 6 months after surgery was much more common in the patients who later developed unilateral upper-PF (96.0% vs 24.2%). This pleural effusion persisted and was accompanied thereafter by pleural thickening and subpleural pulmonary fibrosis. During the clinical courses of 25 patients with unilateral upper-PF, 18 patients presented symptoms related to upper-PF and 6 patients died.
CONCLUSIONS
Unilateral upper-PF is an occasional but under-recognized late complication after lung cancer surgery.
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Affiliation(s)
- Kenji Inafuku
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Hiromasa Arai
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, Yokohama City University School of Medicine , Yokohama, Japan
| | - Noritake Kikunishi
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Michihiko Tajiri
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
| | - Koji Okudela
- Department of pathology, Yokohama City University School of Medicine , Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University School of Medicine , Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center , Yokohama, Japan
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Miyamura T, Kinoshita Y, Kushima H, Mukae H, Ishii H. Lung involvement during the prediagnostic phase of idiopathic pleuroparenchymal fibroelastosis. ERJ Open Res 2022; 8:00548-2021. [PMID: 35539440 PMCID: PMC9081544 DOI: 10.1183/23120541.00548-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare interstitial pneumonia that predominantly affects the upper lung fields [1, 2]. A pulmonary apical cap (PAC) is an imaging finding resembling that for PPFE that does not show symptoms or progression [3, 4]. Some patients with PPFE have recognised lung involvement at the lung apex long before the diagnosis is actually made, findings that are indistinguishable from PAC based on temporal imaging data [5]. Clinically, it takes months to years from the first recognition of lung involvement to the diagnosis of PPFE [6, 7]. However, no study has yet focused on the progression of lung involvement or the clinical course before the diagnosis of IPPFE. The present study evaluated the prediagnostic clinical course in patients with IPPFE. Patients with PPFE sometimes have lung involvement at the lung apex long before the diagnosis. The prediagnostic phase with apical fibrosis is much longer than the postdiagnostic phase in patients with PPFE.https://bit.ly/32X1iXi
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11
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Marinescu DC, English J, Sedlic T, Kliber A, Ryerson CJ, Wong AW. Pulmonary Apical Cap as a Potential Risk Factor for Pleuroparenchymal Fibroelastosis. Chest 2021; 159:e365-e370. [PMID: 34099151 DOI: 10.1016/j.chest.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/19/2020] [Accepted: 01/01/2021] [Indexed: 11/19/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a progressive and frequently fatal interstitial lung disease that involves the upper lobes. Although its cause remains unknown, the histopathologic evidence underlying PPFE bears striking resemblance to that of the pulmonary apical cap (PAC), a relatively common and benign entity. We describe the case of a patient with PAC that evolved into distinctly asymmetric PPFE over 6 years after unilateral surgical lung injury. Given the histologic similarity between these two conditions, we propose that these two entities underlie common biologic pathways of abnormal response to lung injury, with the presence of a PAC increasing susceptibility to the development of PPFE in the face of ongoing inflammatory insults. This case describes the histopathologic evolution of PAC to PPFE before and after an inciting injury.
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Affiliation(s)
- Daniel-Costin Marinescu
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - John English
- Department of Pathology, Thoracic Service, University of British Columbia, Vancouver, BC, Canada
| | - Tony Sedlic
- Department of Diagnostic Medical Imaging, Thoracic Service, University of British Columbia, Vancouver, BC, Canada
| | - Agnes Kliber
- Department of Medicine, Mount St Joseph Hospital, Vancouver, BC, Canada
| | - Christopher J Ryerson
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, Thoracic Service, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
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12
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Alveolar Epithelial Denudation Is a Major Factor in the Pathogenesis of Pleuroparenchymal Fibroelastosis. J Clin Med 2021; 10:jcm10050895. [PMID: 33668178 PMCID: PMC7956653 DOI: 10.3390/jcm10050895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 01/22/2023] Open
Abstract
The pathogenesis of pleuroparenchymal fibroelastosis (PPFE), a rare interstitial lung disease, remains unclear. Based on previous reports and our experience, we hypothesized that alveolar epithelial denudation (AED) was involved in the pathogenesis of PPFE. This multicenter retrospective study investigated the percentage of AED and the features of the denudated areas in 26 PPFE cases, 30 idiopathic pulmonary fibrosis (IPF) cases, and 29 controls. PPFE patients had lower forced vital capacities and higher residual volume/total lung capacities in pulmonary function tests compared to IPF and control patients. Histopathologically, subpleural fibroelastosis was observed in PPFE, and AED was observed in 12.01% of cases in the subpleural or interlobular septa regardless of fibroelastosis. The percentage of AED in the PPFE group was significantly higher than that in the IPF group (6.84%; p = 0.03) and the normal group (1.19%; p < 0.001). In the IPF group, the percentage of AED and the presence of PPFE-like lesions in the upper lobes were examined radiologically, but no correlation was found. We showed that AED frequently occurred in PPFE. AED was less frequent in IPF, which, in combination with imaging data, suggests that PPFE may have a different pathogenesis from IPF.
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13
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Werlein C, Ackermann M, Hoffmann TL, Laenger F, Jonigk D. [Fibrotic remodeling of the lung following lung and stem-cell transplantation]. DER PATHOLOGE 2021; 42:17-24. [PMID: 33416936 DOI: 10.1007/s00292-020-00898-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Transplantation of solid organs and hematopoietic stem cells represents an important therapeutic option for a variety of end-stage pulmonary diseases, aggressive hematopoietic neoplasms, or severe immunodeficiencies. Although the overall survival following transplantation has generally improved over recent decades, long-time survival of lung and stem-cell transplant recipients is still alarmingly low with an average 5‑year survival rate of only 50-60%. Chronic allo-immunoreactions in general and pulmonary allo-immunoreactions with subsequent fibrosis in particular are major reasons for this poor outcome. Comparable patterns of fibrotic lung remodeling are observed following both lung and hematopoietic stem-cell transplantation. Besides the meanwhile well-established obliterative and functionally obstructive remodeling of the small airways - obliterative bronchiolitis - a specific restrictive subform of fibrosis, namely alveolar fibroelastosis, has been identified. Despite their crucial impact on patient outcome, both entities can be very challenging to detect by conventional histopathological analysis. Their underlying mechanisms are considered overreaching aberrant repair attempts to acute lung injuries with overactivation of (myo-) fibroblasts and excessive and irreversible deposition of extracellular matrix. Of note, the underlying molecular mechanisms are widely divergent between these two morphological entities and are independent of the underlying clinical setting.Further comprehensive investigations of these fibrotic alterations are key to the development of much-needed predictive diagnostics and curative concepts, considering the high mortality of pulmonary fibrosis following transplantation.
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Affiliation(s)
- Christopher Werlein
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland
| | - Max Ackermann
- Institut für Pathologie und Molekularpathologie, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Wuppertal, Deutschland.,Institut für Funktionelle und Klinische Anatomie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Thia Leandra Hoffmann
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland
| | - Florian Laenger
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Standort Hannover, Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, OE 5110, 30625, Hannover, Deutschland. .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Standort Hannover, Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland.
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14
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Kinoshita Y, Ishii H, Nabeshima K, Watanabe K. The pathogenesis and pathology of idiopathic pleuroparenchymal fibroelastosis. Histol Histopathol 2020; 36:291-303. [PMID: 33315234 DOI: 10.14670/hh-18-289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare subtype of idiopathic interstitial pneumonias that consists of elastofibrosis involving the lung parenchyma and pleural collagenous fibrosis predominantly located in the upper lobes. IPPFE has various distinct clinical and physiological characteristics, including platythorax and a marked decrease of forced vital capacity with an increased residual volume on a respiratory function test. The concept of IPPFE is now widely recognized and some diagnostic criteria have been proposed. In addition, the accumulation of cases has revealed the pathological features of IPPFE. However, little is known about the pathogenesis or the process of disease formation in IPPFE. This review article will provide a summary of the pathological features and previously reported hypotheses on disease formation in IPPFE, to discuss the potential etiologies and pathogenesis of IPPFE.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kentato Watanabe
- Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan
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15
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Trejo Bittar HE, Jerome JA, Hartman D, Pantanowitz L, Mehrad M, Dacic S. Prognostic significance of microscopic size in peripherally located scar-associated clinical stage I lung carcinomas. Lung Cancer 2020; 143:12-18. [PMID: 32200136 DOI: 10.1016/j.lungcan.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/09/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Staging of non-small cell lung carcinoma associated with scar is not discussed in detail in the current American Joint Committee on Cancer staging manual. The recommendation is to include the scar area in the tumor size measurement unless the tumor represents a small focus at the edge of the scar. The aim of this study is to investigate if subtraction of the size of the central scar from the total gross size of surgically resected peripheral clinical stage I non-small cell lung carcinoma improves patient stratification into more accurate prognostic groups. MATERIALS AND METHODS Hematoxylin and eosin sections of 148 non-small cell lung carcinomas (98 adenocarcinomas and 50 squamous cell carcinomas) were reviewed, including 44 adenocarcinomas and 9 squamous cell carcinomas with scar and 54 adenocarcinomas and 41 squamous cell carcinomas without scar. The microscopic size of the invasive tumor component was determined after the average percentage of scar tissue was subtracted from the grossly measured tumor diameter. Manual results were compared to digital image analysis. RESULTS Adenocarcinoma with scar were associated with better overall (80.5 % vs. 63.2 %, p = 0.026) and cancer specific survival (95.2 % vs. 73.3 %, p = 0.0053) when compared to adenocarcinoma without scar. Better cancer specific survival was observed in acinar and papillary predominant adenocarcinoma (95.8 % with scar vs. 67.8 % without scar, p = 0.01); while similar trend although not statistically significant was observed in adenocarcinomas with solid or micropapillary component. Using microscopic size, pathologic T stage was down-staged in 21 adenocarcinomas. Squamous cell carcinoma with or without scar did not show a difference in survival. Manual and quantitative image analysis showed strong correlation (r = 0.9769, p < 0.0001). CONCLUSION Our study suggests that microscopic size of the invasive component in acinar and papillary predominant adenocarcinoma with scar might be a better predictor of survival than the total gross size.
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Affiliation(s)
- Humberto E Trejo Bittar
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA.
| | - Jacob A Jerome
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Douglas Hartman
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | - Liron Pantanowitz
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | - Mitra Mehrad
- Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology, Nashville, Tennessee, USA
| | - Sanja Dacic
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
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16
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Travis WD, Dacic S, Wistuba I, Sholl L, Adusumilli P, Bubendorf L, Bunn P, Cascone T, Chaft J, Chen G, Chou TY, Cooper W, Erasmus JJ, Ferreira CG, Goo JM, Heymach J, Hirsch FR, Horinouchi H, Kerr K, Kris M, Jain D, Kim YT, Lopez-Rios F, Lu S, Mitsudomi T, Moreira A, Motoi N, Nicholson AG, Oliveira R, Papotti M, Pastorino U, Paz-Ares L, Pelosi G, Poleri C, Provencio M, Roden AC, Scagliotti G, Swisher SG, Thunnissen E, Tsao MS, Vansteenkiste J, Weder W, Yatabe Y. IASLC Multidisciplinary Recommendations for Pathologic Assessment of Lung Cancer Resection Specimens After Neoadjuvant Therapy. J Thorac Oncol 2020; 15:709-740. [PMID: 32004713 DOI: 10.1016/j.jtho.2020.01.005] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/25/2019] [Accepted: 01/04/2020] [Indexed: 12/14/2022]
Abstract
Currently, there is no established guidance on how to process and evaluate resected lung cancer specimens after neoadjuvant therapy in the setting of clinical trials and clinical practice. There is also a lack of precise definitions on the degree of pathologic response, including major pathologic response or complete pathologic response. For other cancers such as osteosarcoma and colorectal, breast, and esophageal carcinomas, there have been multiple studies investigating pathologic assessment of the effects of neoadjuvant therapy, including some detailed recommendations on how to handle these specimens. A comprehensive mapping approach to gross and histologic processing of osteosarcomas after induction therapy has been used for over 40 years. The purpose of this article is to outline detailed recommendations on how to process lung cancer resection specimens and to define pathologic response, including major pathologic response or complete pathologic response after neoadjuvant therapy. A standardized approach is recommended to assess the percentages of (1) viable tumor, (2) necrosis, and (3) stroma (including inflammation and fibrosis) with a total adding up to 100%. This is recommended for all systemic therapies, including chemotherapy, chemoradiation, molecular-targeted therapy, immunotherapy, or any future novel therapies yet to be discovered, whether administered alone or in combination. Specific issues may differ for certain therapies such as immunotherapy, but the grossing process should be similar, and the histologic evaluation should contain these basic elements. Standard pathologic response assessment should allow for comparisons between different therapies and correlations with disease-free survival and overall survival in ongoing and future trials. The International Association for the Study of Lung Cancer has an effort to collect such data from existing and future clinical trials. These recommendations are intended as guidance for clinical trials, although it is hoped they can be viewed as suggestion for good clinical practice outside of clinical trials, to improve consistency of pathologic assessment of treatment response.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ignacio Wistuba
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Prasad Adusumilli
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lukas Bubendorf
- Department of Pathology, University of Basel, Basel, Switzerland
| | - Paul Bunn
- Medical Oncology, Colorado University School of Medicine, Aurora, Colorado
| | - Tina Cascone
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Jamie Chaft
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | | | - Wendy Cooper
- Department of Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jeremy J Erasmus
- Department of Radiology, MD Anderson Cancer Center, Houston, Texas
| | | | - Jin-Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute at Mount Sinai, New York, New York
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keith Kerr
- Department of Pathology, Aberdeen University Medical School, Aberdeen, Scotland
| | - Mark Kris
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Young T Kim
- Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Fernando Lopez-Rios
- Laboratorio de Dianas Terapeuticas, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai, China
| | - Tetsuya Mitsudomi
- Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Andre Moreira
- Department of Pathology, New York University School of Medicine, New York, New York
| | - Noriko Motoi
- Department of Pathology, Mational Cancer Center, Tokyo, Japan
| | - Andrew G Nicholson
- Department of Pathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Mauro Papotti
- Department of Pathology, University of Turin, Torino, Italy
| | - Ugo Pastorino
- Thoracic Surgery Division, Istituto Nazionale Tumor, Milan, Italy
| | - Luis Paz-Ares
- Medical Oncology, National Oncology Research Center, Madrid, Spain
| | | | - Claudia Poleri
- Office of Pathology Consultants, Buenos Aries, Argentina
| | - Mariano Provencio
- Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Anja C Roden
- Department of Pathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ming S Tsao
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | | | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Yasushi Yatabe
- Department of Pathology, Mational Cancer Center, Tokyo, Japan
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17
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Abstract
This review discusses diagnostic pathology in idiopathic interstitial pneumonias (IIPs). Accurate understanding of basic structure of lung lobules is critical because the location of abnormalities inside the lobule is an important effector of pathology diagnosis. Depending on the method of obtaining tissue, recognition of the location may be difficult or impossible. Cryobiopsy is a new technology and its coverage of lung lobules is limited. This article discusses fundamental anatomy and approach to interstitial pneumonia. In addition, most histologic types of IIPs are covered, but the focus is on diagnosis of usual interstitial pneumonia because of its clinical importance.
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Affiliation(s)
- Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki 852-8501, Japan; Department of Pathology, Kameda Medical Center, 929 Higashi-machi, Kamogawa, Chiba 296-8602, Japan.
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18
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Saito A, Hakamata Y, Yamada Y, Sunohara M, Tarui M, Murano Y, Mitani A, Tanaka K, Nagase T, Yanagimoto S. Pleural thickening on screening chest X-rays: a single institutional study. Respir Res 2019; 20:138. [PMID: 31277661 PMCID: PMC6612134 DOI: 10.1186/s12931-019-1116-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/28/2019] [Indexed: 12/26/2022] Open
Abstract
Although pleural thickening is a common finding on routine chest X-rays, its radiological and clinical features remain poorly characterized. Our investigation of 28,727 chest X-rays obtained from annual health examinations confirmed that pleural thickening was the most common abnormal radiological finding. In most cases (92.2%), pleural thickening involved the apex of the lung, particularly on the right side; thus, it was defined as a pulmonary apical cap. Pleural thickening was more common in males than in females and in current smokers or ex-smokers than in never smokers. The prevalence increased with age, ranging from 1.8% in teenagers to 9.8% in adults aged 60 years and older. Moreover, pleural thickening was clearly associated with greater height and lower body weight and body mass index, suggesting that a tall, thin body shape may predispose to pleural thickening. These observations allowed us to speculate about the causative mechanisms of pleural thickening that are attributable to disproportionate perfusion, ventilation, or mechanical forces in the lungs.
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Affiliation(s)
- Akira Saito
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Yukichika Hakamata
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yukiko Yamada
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mitsuhiro Sunohara
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Megumi Tarui
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yoko Murano
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Akihisa Mitani
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kimie Tanaka
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shintaro Yanagimoto
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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19
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Tanaka T, Ishida K. Update on Rare Idiopathic Interstitial Pneumonias and Rare Histologic Patterns. Arch Pathol Lab Med 2019; 142:1069-1079. [PMID: 30141991 DOI: 10.5858/arpa.2017-0534-ra] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - In 2013, the revised American Thoracic Society and European Respiratory Society classification of idiopathic interstitial pneumonias (IIPs) described 2 rare IIPs and 2 rare histologic patterns. Because of the rarity of the disease, there is limited evidence related to the histology. Because the rare histologic patterns are provisional criteria, no unanimous consensus on histologic diagnostic criteria has yet been reached. OBJECTIVE - To review the histologic features for rare IIPs and rare histologic patterns, and to provide diagnostic aids and discuss the differential diagnosis. DATA SOURCES - Published peer-reviewed literature and the authors' personal experience. CONCLUSIONS - Following the publication of the international consensus classification, evidence regarding rare IIPs and rare histologic patterns has accumulated to some extent, although to date the amount remains insufficient and further evidence is required. Because the diagnosis is sometimes challenging, a multidisciplinary approach represents the gold standard in reaching an accurate diagnosis for these rare disorders.
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Affiliation(s)
| | - Kaori Ishida
- From the Department of Pathology, Faculty of Medicine, Kindai University, Osaka, Japan (Dr Tanaka); and the Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan (Dr Ishida)
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20
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Watanabe K, Ishii H, Kiyomi F, Terasaki Y, Hebisawa A, Kawabata Y, Johkoh T, Sakai F, Kondoh Y, Inoue Y, Azuma A, Suda T, Ogura T, Inase N, Homma S. Criteria for the diagnosis of idiopathic pleuroparenchymal fibroelastosis: A proposal. Respir Investig 2019; 57:312-320. [PMID: 30981683 DOI: 10.1016/j.resinv.2019.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Physicians have few opportunities to perform surgical lung biopsy (SLB) to diagnose idiopathic pleuroparenchymal fibroelastosis (IPPFE). Therefore, diagnostic criteria for IPPFE that do not require SLB must be established. Herein, we propose diagnostic criteria for IPPFE with and without SLB. METHODS AND RESULTS The diagnostic criteria for IPPFE with SLB are histological, based on computed tomography (CT) lesions compatible with PPFE, predominantly in the upper lobes. The three diagnostic criteria for IPPFE without SLB are as follows: (1) radiologically possible IPPFE (a radiological criterion confirming CT lesions in both lung apexes, regardless of the lower lobe lesions); (2) radiologically probable IPPFE (also a radiological criterion, but mandatory to confirm chest radiograph findings of bilateral upward shift of the hilar structures and/or CT findings of volume loss of the upper lobes); (3) radiologically and physiologically probable IPPFE. Our data from 41 patients with IPPFE and 97 with idiopathic pulmonary fibrosis (IPF) showed that the percentage of the predicted values of the ratio of residual volume to total lung capacity (RV/TLC %pred.) ≥115% and body mass index (BMI) ≤20 kg/m2 plus RV/TLC %pred. ≥80% performed well for discriminating IPPFE from IPF. These parameters were thus added to criterion (3). CONCLUSIONS We have proposed diagnostic criteria for IPPFE in patients with and without SLB. Both imaging criteria and physiological criteria using RV/TLC and BMI successfully discriminate IPPFE from chronic IIPs when SLB cannot be performed.
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Affiliation(s)
- Kentaro Watanabe
- General Medical Research Center, Fukuoka University School of Medicine, 814-0180 Fukuoka, Japan.
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akira Hebisawa
- Department of Clinical Research, National Hospital Organization Tokyo National Hospital, Japan
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School, Tokyo, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Japan
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21
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Sumikawa H, Johkoh T, Iwasawa T, Nakanishi K, Tomiyama N. Pleuroparenchymal fibroelastosis-like lesions on chest computed tomography in routine clinical practice. Jpn J Radiol 2019; 37:230-236. [DOI: 10.1007/s11604-018-0805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
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22
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Kinoshita Y, Watanabe K, Ishii H, Kushima H, Fujita M, Nabeshima K. Significant increases in the density and number of lymphatic vessels in pleuroparenchymal fibroelastosis. Histopathology 2018; 73:417-427. [PMID: 29675827 DOI: 10.1111/his.13634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/13/2018] [Indexed: 01/08/2023]
Abstract
AIMS Some investigators have detected fibrinous exudate or immature organisation in the alveolar spaces prior to the development of subpleural elastofibrosis in patients with pleuroparenchymal fibroelastosis (PPFE). We hypothesised that PPFE progress is associated with an impaired lymphatic drainage system, resulting in the failed resolution of intra-alveolar exudate. The aim of this study is to investigate the pulmonary lymphatic vessels in PPFE, histologically. METHODS AND RESULTS We retrospectively reviewed our medical records from 1995 to 2017, and selected autopsied or surgically biopsied patients with PPFE (n = 18), pulmonary apical cap (n = 18), and IPF (n = 26). We detected lymphatic endothelial cells by using immunostained specimens, calculating the percentage of lymphatic vessel area in the non-aerated area (lymphatic vessel density) and the number of lymphatic vessels per non-aerated area (per mm2 ) (lymphatic vessel number). These parameters in PPFE were compared with those in apical cap, IPF, and normal lung tissue. The lymphatic vessel density in PPFE patients [2.97%; interquartile range (IQR) 2.61-3.86] was significantly higher than that in normal lung (0.91%; IQR 0.84-1.07), pulmonary apical cap (0.67%; IQR 0.58-0.83), and IPF (0.91%; IQR 0.68-1.25) (P < 0.01 in any comparison). The lymphatic vessel number in PPFE was also significantly higher than that in normal lung, pulmonary apical cap, and IPF. Among PPFE patients, the increase in lymphatic vessel density was found to be correlated with the characteristic physiology of PPFE, such as a flattened chest cage on computed tomography and high residual volume/total lung capacity ratio on spirometry. CONCLUSIONS Significant increase in the density and number of lymphatic vessels is a supportive characteristic that enables the differentiation of PPFE from IPF and apical cap.
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Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
| | - Kentaro Watanabe
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan.,General Medical Research Centre, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
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23
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Enomoto Y, Matsushima S, Meguro S, Kawasaki H, Kosugi I, Fujisawa T, Enomoto N, Inui N, Nakamura Y, Suda T, Iwashita T. Podoplanin-positive myofibroblasts: a pathological hallmark of pleuroparenchymal fibroelastosis. Histopathology 2018; 72:1209-1215. [PMID: 29468722 DOI: 10.1111/his.13494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/15/2018] [Indexed: 01/28/2023]
Abstract
Pathological differential diagnoses of pleuroparenchymal fibroelastosis (PPFE) include usual interstitial pneumonia (UIP) and pulmonary apical cap (PAC); however, there are no specific immunostaining makers to distinguish between these diseases. We performed immunohistochemistry using several pleural mesothelial cell-related markers, including cytokeratin-5/6, CAM5.2, WT-1, calretinin, desmin and podoplanin, for PPFE (n = 4), UIP (n = 10) and PAC (n = 3) lung sections. Among the examined markers, in PPFE and PAC lungs podoplanin commonly showed positivity for spindle cells both in thickened pleura and subpleural fibroelastosis lesions; these cells were also stained with α-smooth muscle actin, a marker of myofibroblasts. However, even in elastic fibre-rich cases, UIP lungs did not show such podoplanin-positive myofibroblasts in pleura/subpleura and fibroblastic foci. These findings were also verified using immunofluorescence. By contrast, immunohistochemically as well as morphologically, the difference between PPFE and PAC was not apparent. The presence of podoplanin-positive myofibroblasts could be a pathological hallmark of PPFE, suggesting a pathogenic process distinct from UIP but common to PAC.
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Affiliation(s)
- Yasunori Enomoto
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan.,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Sayomi Matsushima
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan.,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shiori Meguro
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hideya Kawasaki
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Isao Kosugi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
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24
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Clinical diagnosis of idiopathic pleuroparenchymal fibroelastosis: A retrospective multicenter study. Respir Med 2017; 133:1-5. [PMID: 29173442 DOI: 10.1016/j.rmed.2017.11.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/11/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although the accurate diagnosis of pleuroparenchymal fibroelastosis (PPFE) requires pathologic evaluation, this diagnosis is often suggested when the radiologic findings are consistent with typical PPFE and when pulmonary apical cap, which radiologically and pathologically mimics PPFE, can be excluded by confirming disease progression. The aim of this study was to evaluate the validity of the clinical diagnosis of idiopathic PPFE. METHODS We recruited 44 patients with idiopathic PPFE according to our modified diagnostic criteria: 1) a radiologic PPFE pattern (i.e., bilateral subpleural dense consolidation with or without pleural thickening in the upper lobes and less marked or absent involvement of the lower lobes), 2) radiologic confirmation of disease progression, and 3) exclusion of other lung diseases with identifiable etiologies. The patients' baseline characteristics and clinical course were reviewed. RESULTS The median age was 70 years, and 28 patients were males. The majority revealed emaciation, hypercapnia, and a high ratio of residual volume to total lung capacity. On chest computed tomography, 39 patients showed abnormal shadows in the lower lobes; more than half were classified as having usual interstitial pneumonia (UIP)/possible UIP pattern. Pneumothorax was the most frequent complication (33/44). The median overall survival time after diagnosis was 35.3 months. The presence of lower lobe UIP/possible UIP pattern did not show a significant prognostic impact. CONCLUSIONS Using our diagnostic criteria, we could recruit relatively many patients with similar characteristics to those of idiopathic PPFE patients in the literature. The possibility of clinical diagnosis of idiopathic PPFE should be further discussed.
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25
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Kobayashi NS, Nambu A, Kawamoto M, Hayashi TY, Watanabe M, Okumura T, Fujino S, Aso T, Takahashi M, Okabe Y, Koyama H, Kohyama T, Tago M. Pulmonary Apical Opacities on Thin-Section Computed Tomography: Relationship to Primary Spontaneous Pneumothorax in Young Male Patients and Corresponding Histopathologic Findings. J Comput Assist Tomogr 2017; 42:33-38. [PMID: 28708718 DOI: 10.1097/rct.0000000000000649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to test the hypothesis that apical opacities on computed tomography (CT) are related to occurrence of primary spontaneous pneumothorax (PSP) in young male patients. METHODS We compared the frequency of apical opacities on thin-section CT between 70 male patients with PSP (PSP group) and 74 male patients without a history of PSP (non-PSP group). We also evaluated histopathologic findings of 39 specimens from 37 surgical cases in the PSP group. RESULTS Apical opacities were significantly more frequent in the PSP group than in the non-PSP group (right side, P = 0.01; left side, P = 0.005). Histopathologically, subpleural band-like alveolar collapse was seen in 35 specimens (89.7%), which was always accompanied by fibroelastosis and fibroblastic foci. CONCLUSIONS Apical opacities on CT were significantly associated with PSP in young male patients. These apical opacities histopathologically correspond to fibrotic pleural thickening with subpleural alveolar collapse.
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26
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Enomoto Y, Nakamura Y, Colby TV, Johkoh T, Sumikawa H, Nishimoto K, Yoshimura K, Matsushima S, Oyama Y, Hozumi H, Kono M, Fujisawa T, Enomoto N, Inui N, Iwashita T, Suda T. Radiologic pleuroparenchymal fibroelastosis-like lesion in connective tissue disease-related interstitial lung disease. PLoS One 2017; 12:e0180283. [PMID: 28666014 PMCID: PMC5493376 DOI: 10.1371/journal.pone.0180283] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Radiologic pleuroparenchymal fibroelastosis (PPFE)-like lesion including pulmonary apical cap can be occasionally observed in clinical settings. However, the significance of radiologic PPFE-like lesion is unclear in connective tissue disease (CTD)-related interstitial lung disease (ILD). MATERIALS AND METHODS A total of 113 patients with CTD-related ILD were enrolled and assessed for radiologic PPFE-like lesion, which was defined as bilateral, upper lobe, and subpleural dense consolidations with or without pleural thickening on chest high-resolution computed tomography. The clinical, radiologic, and pathologic characteristics were evaluated. RESULTS Radiologic PPFE-like lesion was found in 21 patients (19%) and were relatively frequent in those with systemic sclerosis (6/14: 43%) and primary Sjögren's syndrome (4/14: 29%). Patients with PPFE-like lesion were significantly older, had lower body mass index, higher ratio of residual volume to total lung capacity, and higher complication rate of pneumothorax and/or pneumomediastinum than those without. Twelve of the 21 patients were diagnosed radiologically as usual interstitial pneumonia (UIP) or possible UIP pattern. Two of three patients who underwent surgical lung biopsy of the upper lobes showed UIP on histopathology. Another patient was confirmed to have upper lobe PPFE on autopsy. During the clinical course, progression of the radiologic PPFE-like lesions was observed in 13 of 21 patients. Six patients died (mortality rate: 29%) and their PPFE-like lesions were commonly progressive. In the total cohort, our multivariate analysis identified the presence of PPFE-like lesion as a significant risk factor for respiratory death (hazard ratio: 4.10, 95% confidence interval: 1.33-12.65, p = 0.01). CONCLUSION In patients with CTD-related ILD, radiologic PPFE-like lesion, which may present as not only PPFE but also apical cap and upper lobe subpleural fibrosis commonly due to UIP, was not uncommon and was associated with poor prognosis. Clinicians should be cautious with this radiologic finding, particularly when it is progressive.
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Affiliation(s)
- Yasunori Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
- * E-mail: (YE); (YN)
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
- * E-mail: (YE); (YN)
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic Arizona, Scottsdale, AZ, United States of America
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Teachers, Hyogo, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Koji Nishimoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Katsuhiro Yoshimura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Sayomi Matsushima
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshiyuki Oyama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masato Kono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
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27
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Nunes H, Jeny F, Bouvry D, Picard C, Bernaudin JF, Ménard C, Brillet PY, Kannengiesser C, Valeyre D, Kambouchner M. Pleuroparenchymal fibroelastosis associated with telomerase reverse transcriptase mutations. Eur Respir J 2017; 49:49/5/1602022. [DOI: 10.1183/13993003.02022-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/19/2017] [Indexed: 11/05/2022]
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28
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Hayashi H, Nei T, Abe S, Saito Y, Kokuho N, Atsumi K, Fujita K, Saito T, Tanaka T, Gemma A, Azuma A. Body Mass Index and arterial blood oxygenation as prognostic factors in patients with idiopathic pleuroparenchymal fibroelastosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:35-40. [PMID: 32476820 DOI: 10.36141/svdld.v34i1.5172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/01/2016] [Indexed: 11/02/2022]
Abstract
Background: Idiopathic pleuroparenchymal fibroelastosis (IPPFE) was recently proposed as an entity to be included among rare idiopathic interstitial pneumonias (IIPs). However, the cause, clinical features and prognosis of this rare entity have not been elucidated. Objectives: We aimed to examine the clinical features, outcomes and prognostic factors for IPPFE in comparison to those of idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively analyzed 20 patients with IPPFE and 71 with IPF. We compared clinical features, blood examination data, and respiratory functions at the time of diagnosis. Results: The IPPFE group had a significantly lower body mass index (BMI), percent forced vital capacity (%FVC), total lung capacity (%TLC) and expiratory reserve volume (%ERV), as well as a higher residual volume to TLC (RV/TLC) ratio than the IPF group. The annual FVC changes in the IPPFE group (-326ml/year) were significantly larger than those in the IPF group (-142ml/year). Survival was significantly poorer in the IPPFE than in the IPF group (P = 0.021). BMI and the partial pressure of oxygen in arterial blood (PaO2) were significantly related to the outcome of IPPFE. Conclusions: Our present results indicate the prognosis of IPPFE patients to be poorer than that of IPF patients. We advocate that BMI and arterial blood PaO2 be determined at the first visit as these parameters are closely related to patients' outcomes. Prospective evaluation of IPPFE starting in the subclinical phase is necessary to assure that appropriate measures are taken before progression. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 35-40).
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Affiliation(s)
- Hiroki Hayashi
- Department of Respiratory Medicine, Nippon Medical School
| | - Takahito Nei
- Department of Respiratory Medicine, Nippon Medical School
| | - Shinji Abe
- Department of Respiratory Medicine, Nippon Medical School
| | | | - Nariaki Kokuho
- Department of Respiratory Medicine, Nippon Medical School
| | | | - Kazue Fujita
- Department of Respiratory Medicine, Nippon Medical School
| | - Takefumi Saito
- Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital
| | - Takahiro Tanaka
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital
| | - Akihiko Gemma
- Department of Respiratory Medicine, Nippon Medical School
| | - Arata Azuma
- Department of Respiratory Medicine, Nippon Medical School
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29
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Montero MA, Osadolor T, Khiroya R, Salcedo MT, Robertus JL, Rice A, Nicholson AG, Roman A, Monforte V. Restrictive allograft syndrome and idiopathic pleuroparenchymal fibroelastosis: do they really have the same histology? Histopathology 2017; 70:1107-1113. [DOI: 10.1111/his.13171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Maria A Montero
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Respiratory Unit; Imperial College London; London UK
| | - Tina Osadolor
- Biomedical Respiratory Unit; Imperial College London; London UK
| | - Reena Khiroya
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | | | - Jan L Robertus
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Alexandra Rice
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Andrew G Nicholson
- Histopathology Department; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Antonio Roman
- Respiratory Medicine; Vall d'Hebron University Hospitals; Barcelona Spain
| | - Victor Monforte
- Respiratory Medicine; Vall d'Hebron University Hospitals; Barcelona Spain
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30
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Wormanns D. Chest radiography: performance, indications and interpretation. IMAGING 2016. [DOI: 10.1183/2312508x.10002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
The pulmonary apical cap (PAC) is a morphologically distinct type of unilateral or bilateral fibroelastotic scar involving the lung apices. Despite being relatively common and having been described more than a hundred years ago, it remains underappreciated as a unique diagnostic entity by clinicians, radiologists, and pathologists alike. Given the centrality of modern chest imaging in the workup of diseases of the lungs, it may be expected that the PAC will be biopsied with increasing frequency. As such, pathologists should be familiar with its presentation, appearance, and differential diagnosis. This article serves as a short overview of PAC and as a practical aid in its diagnosis for surgical pathologists.
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Affiliation(s)
- Amir Lagstein
- From the Department of Pathology, University of Michigan Hospital and Health Systems, Ann Arbor
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32
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Kokosi MA, Nicholson AG, Hansell DM, Wells AU. Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP. Respirology 2015; 21:600-14. [DOI: 10.1111/resp.12693] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/22/2015] [Accepted: 10/24/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Maria A. Kokosi
- Interstitial Lung Disease Unit; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - Andrew G. Nicholson
- Department of Histopathology; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
| | - David M. Hansell
- Department of Radiology; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
| | - Athol U. Wells
- Interstitial Lung Disease Unit; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust; London UK
- National Heart and Lung Institute; Imperial College; London UK
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33
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Shea BS, Sharma A, Mark EJ. Case records of the Massachusetts General Hospital. Case 14-2015. A 58-year-old woman with shortness of breath. N Engl J Med 2015; 372:1749-58. [PMID: 25923555 DOI: 10.1056/nejmcpc1415200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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34
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Oda T, Ogura T, Kitamura H, Hagiwara E, Baba T, Enomoto Y, Iwasawa T, Okudela K, Takemura T, Sakai F, Hasegawa Y. Distinct characteristics of pleuroparenchymal fibroelastosis with usual interstitial pneumonia compared with idiopathic pulmonary fibrosis. Chest 2015; 146:1248-1255. [PMID: 25367470 DOI: 10.1378/chest.13-2866] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pleuroparenchymal fibroelastosis (PPFE) is a rare form of interstitial pneumonia and sometimes coexists with a histologic usual interstitial pneumonia (UIP) pattern. This study aimed to describe the distinct clinical features of PPFE with UIP pattern compared with idiopathic pulmonary fibrosis (IPF). METHODS We conducted a retrospective review of the medical records of 110 consecutive patients with IPF with a histologic UIP pattern on surgical lung biopsy specimen. Patients meeting radiologic criteria for the diagnosis of PPFE based on high-resolution CT scan and with a histologic UIP pattern were included. RESULTS Nine of eleven patients meeting radiologic criteria for the diagnosis of PPFE were histologically confirmed as having PPFE with UIP pattern. The PPFE with UIP pattern group showed a significantly higher residual volume (1.8 L vs 1.3 L, P < .01), higher Paco2 (44.6 mm Hg vs 41.7 mm Hg, P = .04), and higher complication rate of pneumothorax and pneumomediastinum than the 99 patients with IPF/UIP. The ratio of anteroposterior to transthoracic diameter in patients with PPFE with UIP pattern was significantly lower than that in patients with IPF/UIP (P = .04). Survival time tended to be shorter in patients with PPFE with UIP pattern. CONCLUSIONS The results support the view that PPFE with UIP pattern is a disease entity distinct from IPF/UIP and may well be classified as PPFE.
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Affiliation(s)
- Tsuneyuki Oda
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Ogura
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Hideya Kitamura
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Eri Hagiwara
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tomohisa Baba
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yasunori Enomoto
- From the Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Koji Okudela
- Department of Pathobiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tamiko Takemura
- Department of Pathology, Japan Red Cross Medical Center, Tokyo, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, International Medical Center of Saitama Medical University, Saitama, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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35
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Sauter JL, Butnor KJ. Pathological findings in spontaneous pneumothorax specimens: does the incidence of unexpected clinically significant findings justify routine histological examination? Histopathology 2014; 66:675-84. [DOI: 10.1111/his.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Jennifer L Sauter
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
| | - Kelly J Butnor
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
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36
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von der Thüsen JH. Pleuroparenchymal Fibroelastosis: Its Pathological Characteristics. CURRENT RESPIRATORY MEDICINE REVIEWS 2014; 9:238-247. [PMID: 24634642 PMCID: PMC3949414 DOI: 10.2174/1573398x113096660025] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/14/2013] [Accepted: 11/05/2013] [Indexed: 02/02/2023]
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a distinct pattern of pulmonary fibrosis which often runs a rapidly progressive course with a poor prognosis, and it is likely to be introduced as a separate entity in the new classification scheme of idiopathic interstitial pneumonias. It is characterised by pleural fibrosis and subpleural fibroelastosis, with an upper lobe predominance. In addition to cases following lung and bone marrow transplantation, familial and idiopathic cases have been described. The literature on PPFE is fragmented, however, and primarily consists of small case series, lacking a uniform methodology of clinical, radiological and histopathological description. In this review article, most previously published reports of PPFE in the English-language literature will be discussed and the salient clinical and histopathological data analysed to arrive at a working definition of PPFE in daily histopathological practice, and to aid the generation of a unifying hypothesis regarding its potential aetiologies and pathogenesis.
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37
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Fabre A, Borie R, Debray MP, Crestani B, Danel C. Distinguishing the histological and radiological features of cystic lung disease in Birt-Hogg-Dubé syndrome from those of tobacco-related spontaneous pneumothorax. Histopathology 2013; 64:741-9. [PMID: 24168179 DOI: 10.1111/his.12318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/24/2013] [Indexed: 01/12/2023]
Abstract
AIMS Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominantly inherited genodermatosis that predisposes to cystic lung disease, leading to spontaneous pneumothoraces. This retrospective analysis of five BHD cases (two men, three women) compared lung histology and computed tomography (CT) imaging to a matched cohort of non-BHD patients with spontaneous pneumothoraces (SPN). METHODS AND RESULTS Lung was sampled during pleurodesis to resect bullae. Recurrent pneumothoraces was seen in two patients. Fourteen sets of histological slides (seven in each group) and 10 CT scans (five in each group) were reviewed. CT scans in BHD showed multiple cysts with a basal predominance and intraparenchymal/peribronchial distribution. On histological examination, BHD lungs showed punch-out cysts with no inflammation, and lacked subpleural fibroelastotic scars and smoking changes. In contrast, all SPN cases showed respiratory bronchiolitis and subpleural fibroelastotic scars. CONCLUSIONS This study emphasizes the importance of smoking history and topography of the lesions in assessing cystic lung disease. Pathologists need to remain alert to the possibility of BHD in the setting of recurrent pneumothoraces in a non-smoker, in particular in a woman, at any age, and should take part in a multidisciplinary approach to the diagnosis of cystic lung disease to obtain clinical and CT scan details.
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Affiliation(s)
- Aurelie Fabre
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
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38
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Abstract
While most lung neoplasms are malignant, a subset of true neoplasms are benign, the most common of which are pulmonary hamartomas. In addition, a substantial proportion of lung mass lesions are nonneoplastic; granulomas are among the commonly encountered nonneoplastic masses. There is also a group of relatively rare, mainly inflammatory and fibrous tumor-like lesions that are encountered on core biopsy and excisions of lung tissue.
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Affiliation(s)
- Alain C Borczuk
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168th St., VC14-215, New York, NY 10032, USA.
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39
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Roeder HA, Cramer SF, Leppert PC. A Look at Uterine Wound Healing Through a Histopathological Study of Uterine Scars. Reprod Sci 2012; 19:463-73. [DOI: 10.1177/1933719111426603] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Stewart F. Cramer
- University of Rochester, Rochester General Hospital, Rochester, NY, USA
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40
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von der Thüsen JH, Hansell DM, Tominaga M, Veys PA, Ashworth MT, Owens CM, Nicholson AG. Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation. Mod Pathol 2011; 24:1633-9. [PMID: 21822205 DOI: 10.1038/modpathol.2011.114] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study presents four patients who underwent bone marrow transplantation and subsequently developed pleuroparenchymal fibroelastosis, hitherto reported as an idiopathic condition. All presented clinically with pneumothorax and subpleural fibrosis on high-resolution computed tomography. In addition to the expected obliterative bronchiolitis, histopathology showed coexistent subpleural changes, and the relationship of pathology in multiple anatomic compartments in post bone marrow transplantation pulmonary disease is discussed.
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Affiliation(s)
- Jan H von der Thüsen
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
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41
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CAGLE PHILIPT, ALLEN TIMOTHYCRAIG. Pathology of the pleura: What the pulmonologists need to know. Respirology 2011; 16:430-8. [DOI: 10.1111/j.1440-1843.2011.01957.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
CONTEXT Not uncommonly, a surgical pathologist will be requested to review excised material, with a clinical diagnosis of cancer, in which no malignancy can be identified. Often, sampling may be the issue. However, different nonneoplastic processes may mimic cancer clinically and not be recognized histologically. These are commonly referred to as pseudoneoplasms and can involve the lung, pleura, and mediastinum. OBJECTIVE To review the most commonly encountered pseudoneoplasms of the thoracic cavity in surgical pathology and discuss the main differential diagnosis. DATA SOURCES Literature and personal review of cases with focus on inflammatory pseudotumors of the lung, organizing pneumonia, nodular lymphoid hyperplasia, apical cap, round atelectasis, and sclerosing mediastinitis with its pulmonary counterpart, hyalinizing granuloma. CONCLUSIONS When reviewing specimens that appear nondiagnostic for malignancy, it is important to consider one of these pseudoneoplasms in the differential diagnosis as they may explain the clinical and radiologic information.
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Affiliation(s)
- Eunhee Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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44
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Kaneko Y, Kikuchi N, Ishii Y, Kawabata Y, Moriyama H, Terada M, Suzuki E, Kobayashi M, Watanabe K, Hizawa N. Upper lobe-dominant pulmonary fibrosis showing deposits of hard metal component in the fibrotic lesions. Intern Med 2010; 49:2143-5. [PMID: 20930444 DOI: 10.2169/internalmedicine.49.3801] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present a 54-year-old man employed in the field of hard metal manufacturing who complained of progressive dyspnea and weight loss. His chest radiograph showed bilateral fibrosis predominantly distributed in the upper lobes with bilateral pleural effusions, and a strong reduction in lung volume. Lung histopathology showed apical cap-like fibrosis but no giant cell interstitial pneumonia. Electron probe microanalysis detected tungsten deposits in the fibrotic region: we therefore considered this to be a case of hard metal disease. Hard metal disease should be considered as one possibility in the differential diagnosis of upper lobe-dominant pulmonary fibrosis.
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Affiliation(s)
- Yoshiko Kaneko
- Department of Respiratory Medicine, University of Tsukuba.
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45
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Borczuk AC. Benign Tumors and Tumorlike Conditions of the Lung. Arch Pathol Lab Med 2008; 132:1133-48. [DOI: 10.5858/2008-132-1133-btatco] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Benign tumors and tumorlike conditions of the lung are encountered in the pathologic evaluation of asymptomatic and symptomatic lung nodules. Since many of these lesions are uncommon, they can be diagnostically challenging.
Objective.—To review the current classification of benign lung tumors, with emphasis on histopathology and useful ancillary studies.
Data Sources.—The current World Health Organization classification system for lung neoplasms and review of relevant publications.
Conclusions.—Despite improved imaging techniques, benign lung nodules are encountered in wedge biopsy and resection specimens. Histopathology, immunohistochemistry, and molecular techniques ensure accurate pathologic diagnosis and have shed light on the histogenesis of these unusual lesions.
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Affiliation(s)
- Alain C. Borczuk
- From the Department of Surgical Pathology, Columbia University Medical Center, New York, NY
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46
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Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of Terms for Thoracic Imaging. Radiology 2008; 246:697-722. [DOI: 10.1148/radiol.2462070712] [Citation(s) in RCA: 2674] [Impact Index Per Article: 167.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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48
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Gal AA, Staton GW. Current concepts in the classification of interstitial lung disease. Am J Clin Pathol 2005; 123 Suppl:S67-81. [PMID: 16100869 DOI: 10.1309/562df88vc6g6qju1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The diagnosis and classification of idiopathic interstitial pneumonias continue to be problematic areas for pathologists. The recently proposed American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias defines specific clinical, radiologic, and pathologic criteria for each of the pulmonary disorders that encompass the idiopathic interstitial pneumonias. In this review, the highlights of this classification are presented, along with recommended guidelines for handling lung biopsy specimens and diagnosing interstitial lung diseases.
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Affiliation(s)
- Anthony A Gal
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
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49
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Mugler K. Pathologic quiz case: bilateral apical lung masses in an autopsy patient. Pulmonary apical cap. Arch Pathol Lab Med 2004; 128:e35-6. [PMID: 14736264 DOI: 10.5858/2004-128-e35-pqcbal] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kimberly Mugler
- Department of Pathology, University of Colorado Health Sciences Center, Denver, USA.
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