Role of Surgical Lung Biopsy in Separating Chronic Hypersensitivity Pneumonia From Usual Interstitial Pneumonia/Idiopathic Pulmonary Fibrosis*: Analysis of 31 Biopsies From 15 Patients

Trahan, Syvain; Hanak, Viktor; Ryu, Jay H.; Myers, Jeffrey L.

doi:10.1378/chest.08-0033

Cited by 106 publications

(106 citation statements)

References 26 publications

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“…Fukuoka et al 34 reported PBM in 17 of 29 UIP cases (59%), 10 of 20 NSIP cases (50%), 3 of 6 desquamative interstitial pneumonia cases (50%), 9 of 18 HP cases (50%), and 2 of 18 respiratory bronchiolitis with interstitial lung disease cases (11%). Myers and colleagues 29,35 concluded that PBM was present in 50% of HP biopsies and in 100% of HP autopsies but noted that the frequency of PBM was similarly high in UIP/IPF biopsies, so that it was not diagnostically useful in that context.…”

Section: Peribronchiolar Metaplasiamentioning

confidence: 99%

“…Table 3 summarizes the literature using reports where outcome by specific pathologic pattern was indicated and standard definitions have been adhered to (the NSIP and ''typical'' patterns described by Gaxiola et al 43 are excluded because the authors indicated that they included cases with and without fibrosis in those categories). Four reports 27,32,33,43 indicated that CHP with a UIP pattern had a poor prognosis, with median survivals of 36 to 50 month, and Trahan et al 35 reported survivals of 9 months each for 2 patients whose biopsies showed only a UIP pattern. All those numbers were similar to the survival rates for UIP/IPF.…”

Section: Relationship Of Pathologic Findings In Chp Tomentioning

confidence: 99%

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Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care?

Churg

Bilawich

Wright

2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Chronic hypersensitivity pneumonitis (CHP) has emerged from obscurity during the past 15 years and is now recognized as a very common form of fibrosing interstitial pneumonia but one that is frequently misdiagnosed both clinically and on surgical lung biopsy as usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) or fibrotic nonspecific interstitial pneumonia. Objective.— To review the pathologic features of CHP. Data Sources.— Clinical, pathology, and radiology literature were used. Conclusions.— Upper lobe–predominant fibrosis and/or air-trapping on computed tomography scan are features of CHP but not UIP/IPF; however, radiologic separation is possible in only about 50% of cases. Morphologically, CHP sometimes mimics UIP/IPF, but CHP often shows isolated foci of peribronchiolar (centrilobular) fibrosis, frequently associated with fibroblast foci, and in CHP, fibrosis may bridge from the centrilobular region to another bronchiole, an interlobular septum, or the pleura (“bridging fibrosis”). This set of findings is uncommon in UIP/IPF. In addition, CHP may produce a picture of fibrotic nonspecific interstitial pneumonia. Although giant cells/granulomas are usually present in subacute hypersensitivity pneumonitis, they are much less frequently found in CHP, and their absence does not contradict the diagnosis. This diagnostic separation is clinically important because CHP is treated differently than UIP/IPF is (immunosuppressive agents versus antifibrotic agents); further, there are some data to suggest that removing the patient from antigen exposure improves outcome, and there is evidence that patients with CHP have a much better survival prognosis after lung transplantation than do patients with UIP/IPF. In most cases, accurate diagnosis of CHP requires consultation among clinicians, radiologists, and pathologists.

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Section: Peribronchiolar Metaplasiamentioning

confidence: 99%

Section: Relationship Of Pathologic Findings In Chp Tomentioning

confidence: 99%

Pathology of Chronic Hypersensitivity Pneumonitis What Is It? What Are the Diagnostic Criteria? Why Do We Care?

Churg

Bilawich

Wright

2017

Archives of Pathology &Amp; Laboratory Medicine

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“…Bronchiolitis was the most common finding in surgical lung biopsies reported by Trahan et al 37 and was a useful feature for distinguishing chronic hypersensitivity pneumonia from UIP. Peribronchiolar interstitium is expanded by the same lymphocyte-rich infiltrate that characterizes the previously described interstitial pneumonia, accompanied by variable numbers of epithelioid histiocytes.…”

Section: Commentmentioning

confidence: 93%

“…This triad includes a bronchiolocentric cellular chronic interstitial pneumonia, chronic bronchiolitis, and nonnecrotizing granulomatous inflammation largely confined to the peribronchiolar interstitium. 8,33,36,37,46,47 This classic combination of findings is often accompanied by other characteristic secondary features that may serve as supportive evidence in the proper setting.…”

Section: Commentmentioning

confidence: 99%

“…33 Retrospective studies published in the last decade and focusing on surgical lung biopsy findings show a collective mortality rate of 37%, which likely reflects a bias toward patients with fibrotic disease in whom the differential diagnosis is less easily resolved on the basis of clinical and radiologic findings alone. 8,[34][35][36][37] Indeed, in some patients fibrotic lung disease may be indistinguishable from UIP and is associated with the same poor prognosis seen in patients with idiopathic pulmonary fibrosis. 34 Antigen avoidance is the mainstay of therapy and is thought to prevent disease progression, although recovery with continued antigen exposure is well documented in patients with either pigeon breeder's or farmer's lung.…”

Section: Commentmentioning

confidence: 99%

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Hypersensitivity Pneumonia: Role of Surgical Lung Biopsy

Herbst

2012

Archives of Pathology &Amp; Laboratory Medicine

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Lung biopsy often plays a key role in identifying patients with hypersensitivity pneumonia, especially in the absence of a typical history. A 69-year-old woman with a 2-year history of unexplained dyspnea on exertion underwent surgical lung biopsy for diagnosis of diffuse lung disease thought to represent idiopathic pulmonary fibrosis. Her biopsy showed honeycomb change and fibroblast foci suggestive of usual interstitial pneumonia, but also showed areas of cellular interstitial pneumonia with chronic bronchiolitis and a pattern of granulomatous inflammation typical of hypersensitivity pneumonia. The classic features of hypersensitivity pneumonia in surgical lung biopsy are emphasized, including a bronchiolocentric cellular interstitial pneumonia, chronic bronchiolitis, and poorly formed nonnecrotizing granulomas. As illustrated in our patient, sometimes subtle histologic clues are key in separating hypersensitivity pneumonia from usual interstitial pneumonia and other forms of idiopathic interstitial pneumonia. Making the distinction is important given differences in treatment strategies and natural history.

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