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Thomas V Colby - One of the best experts on this subject based on the ideXlab platform.
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lung tumors masquerading as Desquamative Interstitial Pneumonia dip report of 7 cases and review of the literature
The American Journal of Surgical Pathology, 2014Co-Authors: Kirtee Raparia, Thomas V Colby, James Ketterer, Mercedes Dalurzo, Yu Hui Chang, Kevin O LeslieAbstract:Abstract Malignant tumors in the lung (both primary and metastatic) rarely may be associated with markedly discohesive tumor cells, resulting in airspace filling reminiscent of "Desquamative Interstitial Pneumonia" (DIP) on histopathology evaluation. A peculiar aspect of this growth pattern is the relatively bland appearance of the tumor cells, in many cases simulating benign alveolar macrophages at scanning magnification. We searched the Charles Carrington Memorial consultation files in the Department of Laboratory Medicine and Pathology at Mayo Clinic Arizona for instances of malignant tumors in lung simulating DIP, from 1992 to 2011. We identified 7 cases involving transbronchial biopsies, needle core samples, or resected lung specimens. Clinical, histopathologic, and immunohistochemical analyses of these 7 patients were performed, including detailed morphometric analysis of the individual tumor cells using calibrated measurement tools on digital images. We compared the results with those of a control group of 4 patients with benign DIP-macrophage reactions in smoking-related lung disease. The study group comprised 5 male and 2 female patients, 48 to 86 years in age (median: 67 y). The radiologic findings included lobar consolidation, localized ground-glass opacities, and 1 or more nodules. None of the patients had typical bilateral infiltrates of DIP. Microscopically, the lung parenchyma was dominated by the presence of prominent tumor cells filling alveolar spaces. Four patients had primary lung carcinoma (adenocarcinoma), whereas 3 had metastases from other sites, including a melanoma. Immunohistochemical staining studies were performed on 6 of 7 cases to establish the diagnosis. Nuclear diameter, cytoplasmic diameter, and nuclear/cytoplasmic (N/C) ratios in patient and control groups were compared using the Wilcoxon rank sum test. No significant difference in the diameters of nucleus and cytoplasm between cases and control groups (P=0.3447 and 0.7055, respectively) was seen, and only a marginally significant difference in N/C ratios (P=0.0890) was seen. A more complex analysis, generalized estimating equation analysis, showed a significant difference in N/C ratio between the 2 groups (P=0.0278). A "DIP-growth pattern" of malignant tumors in the lung is presented. Although the N/C ratio differences approached statistical significance when compared with controls, the key to diagnosis is the recognition of the malignant cytology of the tumor nuclei. Immunohistochemical studies (keratin or other markers) are helpful in establishing an accurate diagnosis in this setting.
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Desquamative Interstitial Pneumonia may progress to lung fibrosis as characterized radiologically
Respirology, 2012Co-Authors: Yoshinori Kawabata, Tamiko Takemura, Akira Hebisawa, Yutaka Sugita, Takashi Ogura, Sonoko Nagai, Fumikazu Sakai, Tetsu Kanauchi, Thomas V ColbyAbstract:Background and objective: In some patients, Desquamative Interstitial Pneumonia may progress to lung fibrosis. The aim of this study was to assess the long-term radiological follow-up results in patients with Desquamative Interstitial Pneumonia. Methods: Among 75 patients suspected of having Desquamative Interstitial Pneumonia, 31 who fulfilled the criteria were included in this study. Clinical characteristics at presentation, responses to treatment and long-term follow-up were evaluated. Results: The 31 patients were predominantly males (94%), and the mean age was 55 years; 93% (28/30) had a history of smoking. The clinical findings included high serum levels of lactate dehydrogenase and immunoglobulin G. Bronchoalveolar lavage (26 patients, 84% of cases) frequently showed an increased percentage of eosinophils (mean 17%). Computed tomography (CT) or high resolution (HR) CT at presentation showed ground glass opacities and/or consolidation in all patients, with one third of patients also showing thin-walled cysts within the ground glass opacities. There was no honeycombing on CT or HRCT scans at presentation. Corticosteroid therapy was effective early in the course of the disease; long-term follow-up (mean 99 months) of 31 patients showed only one death due to progression of the disease, but long-term follow-up of 14 patients (mean 125 months) by HRCT showed the development of new thin-walled cysts and honeycombing in five and lung cancer in four patients, respectively. Conclusions: In a proportion of patients, Desquamative Interstitial Pneumonia may progress to lung fibrosis with honeycombing on HRCT, despite therapy.
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Desquamative Interstitial Pneumonia, respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P
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Desquamative Interstitial Pneumonia respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P < 0.001) and eosinophilic infiltration (P < 0.0001) in patients with DIP compared with RB. In addition, the extents of these three parameters were significantly interrelated. Patients with DIP had a lower incidence of smoking (60%) when compared with patients with RB-ILD (93%) (P < 0.005). Further analysis of smokers versus never-smokers with DIP showed no difference in histological parameters, extent of haemosiderin deposition or the number of CD1a+ macrophages between the two groups, nor were there any differences in clinical data to suggest other aetiologies. Follow-up high-resolution computed tomography data from patients with DIP suggested that a pattern of fibrotic non-specific Interstitial Pneumonia (NSIP) may develop in the long term in both smokers and never-smokers. Conclusion : There are significant differences in the extent of Interstitial fibrosis, lymphoid follicles and eosinophilic infiltration between DIP and RB, as well as a much lower incidence of smoking in patients with DIP. Whether the lower reported incidence of smoking in DIP reflects referral bias or conservatism in giving a history of smoking remains uncertain, as neither histological parameters nor clinical data indicate a difference between smokers and never-smokers with DIP. Nevertheless, some cases of DIP are likely to remain idiopathic and unrelated to RB, though still have a good prognosis. Furthermore, they may evolve into a pattern resembling fibrotic NSIP. Therefore, whilst SR-ILD is appropriate in the correct clinical setting, the distinction between the histological patterns of RB and DIP remains appropriate.
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the overlap between respiratory bronchiolitis and Desquamative Interstitial Pneumonia in pulmonary langerhans cell histiocytosis high resolution ct histologic and functional correlations
Chest, 2003Co-Authors: Robert Vassallo, Thomas V Colby, T E Hartman, William W Douglas, Eric A Jensen, Andrew Harold LimperAbstract:Objectives To characterize the histologic, high-resolution CT (HRCT), and functional correlates of respiratory bronchiolitis (RB)/Desquamative Interstitial Pneumonia (DIP)-like changes in biopsy specimens of adults with pulmonary Langerhans cell histiocytosis (PLCH). Methods We retrospectively identified 14 adult patients with histologically proven PLCH (all smokers) in whom both biopsy specimens and HRCT were available for review. The presence and extent of RB/DIP-like changes on lung biopsy specimens of patients with PLCH were correlated with total pack-years of smoking, lung function variables, and the presence of ground-glass attenuation on HRCT. Results Varying degrees of RB/DIP-like changes were identified in all biopsy specimens. The extent of involvement with RB/DIP-like changes correlated with the cumulative exposure to cigarettes smoked at the time of biopsy ( r = 0.61, p=0.03). Ground-glass attenuation was detected in three HRCTs, two of which had extensive RB/DIP-like changes (≥ 70% involvement) on histology, suggesting that substantial smoking-induced RB/DIP-like changes may be the cause of ground-glass attenuation on the HRCT of patients with PLCH. No correlation was found between the extent of RB/DIP-like changes and total lung capacity, FEV 1 , or diffusion capacity of the lung for carbon monoxide. Conclusions RB/DIP-like changes are exceedingly common in PLCH, may be sufficiently severe to cause the appearance of ground-glass attenuation on HRCT, and correlate with the cumulative exposure to cigarettes smoked. This study provides additional evidence that PLCH, RB, and DIP form a spectrum of Interstitial patterns of lung injury to cigarette smoke.
Ron M Du Bois - One of the best experts on this subject based on the ideXlab platform.
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respiratory bronchiolitis associated with Interstitial lung disease and Desquamative Interstitial Pneumonia
Clinics in Chest Medicine, 2004Co-Authors: Gary Davies, Athol U Wells, Ron M Du BoisAbstract:This article explores issues of the diagnosis and management of respiratory bronchiolitis, respiratory bronchiolitis-associated Interstitial lung disease, and Desquamative Interstitial Pneumonia. These three diseases have common and overlapping features and sometimes are viewed as a continuum of smoking-induced disease, rather than as distinct and separate entities.
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Desquamative Interstitial Pneumonia, respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P
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Desquamative Interstitial Pneumonia respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P < 0.001) and eosinophilic infiltration (P < 0.0001) in patients with DIP compared with RB. In addition, the extents of these three parameters were significantly interrelated. Patients with DIP had a lower incidence of smoking (60%) when compared with patients with RB-ILD (93%) (P < 0.005). Further analysis of smokers versus never-smokers with DIP showed no difference in histological parameters, extent of haemosiderin deposition or the number of CD1a+ macrophages between the two groups, nor were there any differences in clinical data to suggest other aetiologies. Follow-up high-resolution computed tomography data from patients with DIP suggested that a pattern of fibrotic non-specific Interstitial Pneumonia (NSIP) may develop in the long term in both smokers and never-smokers. Conclusion : There are significant differences in the extent of Interstitial fibrosis, lymphoid follicles and eosinophilic infiltration between DIP and RB, as well as a much lower incidence of smoking in patients with DIP. Whether the lower reported incidence of smoking in DIP reflects referral bias or conservatism in giving a history of smoking remains uncertain, as neither histological parameters nor clinical data indicate a difference between smokers and never-smokers with DIP. Nevertheless, some cases of DIP are likely to remain idiopathic and unrelated to RB, though still have a good prognosis. Furthermore, they may evolve into a pattern resembling fibrotic NSIP. Therefore, whilst SR-ILD is appropriate in the correct clinical setting, the distinction between the histological patterns of RB and DIP remains appropriate.
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Desquamative Interstitial Pneumonia and respiratory bronchiolitis associated Interstitial lung disease
Seminars in Respiratory and Critical Care Medicine, 2001Co-Authors: S L Elkin, Andrew G. Nicholson, Ron M Du BoisAbstract:Our understanding of the various types and patterns of diffuse lung disease that might result in fibrosis has evolved considerably over the last 50 years. Many entities now regarded as distinct had been previously "lumped'' together as a single disease, "lung fibrosis,'' and more recently misdiagnosed as idiopathic pulmonary fibrosis (IPF, synonymous with cryptogenic fibrosing alveolitis). In 1965 Desquamative Interstitial Pneumonia (DIP) was first described, and later it was clearly demonstrated that the clinical and pathological features of DIP and IPF were different, particularly in terms of survival and response to therapy. They are not part of the same disease spectrum nor does DIP evolve into usual Interstitial Pneumonia (UIP). Later, in the mid-1980s, RBILD was described as a distinct clinicopathologic syndrome with features consistent with an Interstitial lung disease among current or former smokers. In the recent histopathological classification of idiopathic Interstitial Pneumonia (IIP), DIP and RBILD have been included as separate entities, although there is some evidence that suggests they may lie at the two ends of a single spectrum. The debate bears similarities with the debate about DIP and UIP and is as yet unresolved. This article will give a broad and current overview of these two rarer forms of IIP, including issues that relate to diagnosis, imaging, histopathology, treatment, and prognosis.
Robert Vassallo - One of the best experts on this subject based on the ideXlab platform.
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Desquamative Interstitial Pneumonia and respiratory bronchiolitis associated Interstitial lung disease
Chest, 2005Co-Authors: Jeffrey L Myers, Stephen A Capizzi, William W Douglas, Robert Vassallo, Paul A DeckerAbstract:Background Desquamative Interstitial Pneumonia (DIP) and respiratory bronchiolitis-associated Interstitial lung disease (RB-ILD) are uncommon forms of Interstitial lung disease and have been incompletely characterized. Study objectives To further characterize the clinical features and course of subjects with DIP and RB-ILD. Design Retrospective study. Setting Tertiary care, referral medical center. Patients Twenty-three subjects with DIP and 12 subjects with RB-ILD seen over a 12-year period between 1990 and 2001. Interventions None. Results The study population included 19 men (54%) and 16 women (46%). The mean (± SD) age at diagnosis was 46 ± 10 and 43 ± 7 years, respectively, for patients with DIP and RB-ILD. All subjects were either current or previous smokers except for three subjects with DIP. The diagnosis was confirmed in all cases by surgical lung biopsy. Bronchoscopy with transbronchial lung biopsy had been performed in 12 patients and was nondiagnostic in all. The most common pulmonary function abnormality was a reduced diffusing capacity of the lung for carbon monoxide. A CT scan of the chest revealed ground-glass opacities bilaterally in most patients who had DIP and RB-ILD. No differences were observed between subjects with DIP and RB-ILD with respect to clinical features, radiologic findings, or pulmonary function test results. The clinical course was characterized by relative stability in the majority of patients in both groups and a partial response to corticosteroid therapy. Five deaths were observed, including three resulting from progressive diffuse lung disease, all in subjects with DIP. Conclusions We concluded that DIP and RB-ILD are chronic disease processes that in most patients are related to smoking. Persistent abnormalities can be seen on pulmonary function testing and radiologic studies despite smoking cessation and corticosteroid therapy. Corticosteroid therapy appeared to be associated with modest clinical benefit but usually not with resolution of disease. Progressive disease with eventual death can occur in subjects with DIP, especially with continued cigarette smoking.
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the overlap between respiratory bronchiolitis and Desquamative Interstitial Pneumonia in pulmonary langerhans cell histiocytosis high resolution ct histologic and functional correlations
Chest, 2003Co-Authors: Robert Vassallo, Thomas V Colby, T E Hartman, William W Douglas, Eric A Jensen, Andrew Harold LimperAbstract:Objectives To characterize the histologic, high-resolution CT (HRCT), and functional correlates of respiratory bronchiolitis (RB)/Desquamative Interstitial Pneumonia (DIP)-like changes in biopsy specimens of adults with pulmonary Langerhans cell histiocytosis (PLCH). Methods We retrospectively identified 14 adult patients with histologically proven PLCH (all smokers) in whom both biopsy specimens and HRCT were available for review. The presence and extent of RB/DIP-like changes on lung biopsy specimens of patients with PLCH were correlated with total pack-years of smoking, lung function variables, and the presence of ground-glass attenuation on HRCT. Results Varying degrees of RB/DIP-like changes were identified in all biopsy specimens. The extent of involvement with RB/DIP-like changes correlated with the cumulative exposure to cigarettes smoked at the time of biopsy ( r = 0.61, p=0.03). Ground-glass attenuation was detected in three HRCTs, two of which had extensive RB/DIP-like changes (≥ 70% involvement) on histology, suggesting that substantial smoking-induced RB/DIP-like changes may be the cause of ground-glass attenuation on the HRCT of patients with PLCH. No correlation was found between the extent of RB/DIP-like changes and total lung capacity, FEV 1 , or diffusion capacity of the lung for carbon monoxide. Conclusions RB/DIP-like changes are exceedingly common in PLCH, may be sufficiently severe to cause the appearance of ground-glass attenuation on HRCT, and correlate with the cumulative exposure to cigarettes smoked. This study provides additional evidence that PLCH, RB, and DIP form a spectrum of Interstitial patterns of lung injury to cigarette smoke.
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Smoking-related Interstitial lung diseases: a concise review
European Respiratory Journal, 2001Co-Authors: Thomas V Colby, T. E. Hartman, Robert VassalloAbstract:Interstitial lung diseases (also known as diffuse infiltrative lung diseases) are a heterogeneous group of parenchymal lung disorders of known or unknown cause. These disorders are usually associated with dyspnoea, diffuse lung infiltrates, and impaired gas exchange. The majority of Interstitial lung diseases are of unknown cause. Known causes of Interstitial lung disease include inhalation of organic and inorganic dusts as well as gases or fumes, drugs, radiation, and infections. This review summarizes the clinical, radiological, and histopathological features of four Interstitial lung disorders that have been linked to smoking. These disorders include Desquamative Interstitial Pneumonia, respiratory bronchiolitis-associated Interstitial lung disease, pulmonary Langerhans' cell histiocytosis, and idiopathic pulmonary fibrosis. Available evidence suggests most cases of Desquamative Interstitial Pneumonia, respiratory bronchiolitis-associated Interstitial lung disease, and pulmonary Langerhans' cell histiocytosis are caused by cigarette smoking in susceptible individuals. Smoking cessation should be a main component in the initial therapeutic approach to smokers with these Interstitial lung diseases. In addition, smoking appears to be a risk factor for the development of idiopathic pulmonary fibrosis.
Jeffrey L Myers - One of the best experts on this subject based on the ideXlab platform.
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a review of smoking related Interstitial fibrosis respiratory bronchiolitis and Desquamative Interstitial Pneumonia overlapping histology and confusing terminology
Archives of Pathology & Laboratory Medicine, 2018Co-Authors: Kristine E Konopka, Jeffrey L MyersAbstract:Smoking-related lung diseases traverse a spectrum of clinicopathologic entities, with cases often comprising a complex mixture of findings. The complexity of the diagnostic process extends beyond the histologic findings to the nomenclature, which is murky from a seemingly unending expansion of terms being applied to a handful of pathologic changes. Here, we focus our review on smoking-related Interstitial fibrosis, respiratory bronchiolitis, and Desquamative Interstitial Pneumonia, 3 entities that perhaps show the most histologic overlap and suffer from competing terminology.
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Desquamative Interstitial Pneumonia and respiratory bronchiolitis associated Interstitial lung disease
Chest, 2005Co-Authors: Jeffrey L Myers, Stephen A Capizzi, William W Douglas, Robert Vassallo, Paul A DeckerAbstract:Background Desquamative Interstitial Pneumonia (DIP) and respiratory bronchiolitis-associated Interstitial lung disease (RB-ILD) are uncommon forms of Interstitial lung disease and have been incompletely characterized. Study objectives To further characterize the clinical features and course of subjects with DIP and RB-ILD. Design Retrospective study. Setting Tertiary care, referral medical center. Patients Twenty-three subjects with DIP and 12 subjects with RB-ILD seen over a 12-year period between 1990 and 2001. Interventions None. Results The study population included 19 men (54%) and 16 women (46%). The mean (± SD) age at diagnosis was 46 ± 10 and 43 ± 7 years, respectively, for patients with DIP and RB-ILD. All subjects were either current or previous smokers except for three subjects with DIP. The diagnosis was confirmed in all cases by surgical lung biopsy. Bronchoscopy with transbronchial lung biopsy had been performed in 12 patients and was nondiagnostic in all. The most common pulmonary function abnormality was a reduced diffusing capacity of the lung for carbon monoxide. A CT scan of the chest revealed ground-glass opacities bilaterally in most patients who had DIP and RB-ILD. No differences were observed between subjects with DIP and RB-ILD with respect to clinical features, radiologic findings, or pulmonary function test results. The clinical course was characterized by relative stability in the majority of patients in both groups and a partial response to corticosteroid therapy. Five deaths were observed, including three resulting from progressive diffuse lung disease, all in subjects with DIP. Conclusions We concluded that DIP and RB-ILD are chronic disease processes that in most patients are related to smoking. Persistent abnormalities can be seen on pulmonary function testing and radiologic studies despite smoking cessation and corticosteroid therapy. Corticosteroid therapy appeared to be associated with modest clinical benefit but usually not with resolution of disease. Progressive disease with eventual death can occur in subjects with DIP, especially with continued cigarette smoking.
Andrew G. Nicholson - One of the best experts on this subject based on the ideXlab platform.
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Desquamative Interstitial Pneumonia, respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P
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Desquamative Interstitial Pneumonia respiratory bronchiolitis and their relationship to smoking
Histopathology, 2004Co-Authors: P J Craig, Thomas V Colby, Ron M Du Bois, David M Hansell, Au Wells, S Doffman, Doris Rassl, Andrew G. NicholsonAbstract:Aims : Respiratory bronchiolitis (RB) and Desquamative Interstitial Pneumonia (DIP) are closely associated histological patterns of Interstitial Pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-Interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP. The aim of this study was to compare histological parameters in cases of DIP and RB and then to review in detail clinical, imaging and histological data for DIP in relation to a history of smoking. Methods and results : Forty-nine cases were reviewed, 24 with RB and 25 with DIP; five cases of DIP were re-classified as RB on review due to bronchocentricity of the infiltrate. There was a significantly greater extent of Interstitial fibrosis (P = 0.02), lymphoid follicles (P < 0.001) and eosinophilic infiltration (P < 0.0001) in patients with DIP compared with RB. In addition, the extents of these three parameters were significantly interrelated. Patients with DIP had a lower incidence of smoking (60%) when compared with patients with RB-ILD (93%) (P < 0.005). Further analysis of smokers versus never-smokers with DIP showed no difference in histological parameters, extent of haemosiderin deposition or the number of CD1a+ macrophages between the two groups, nor were there any differences in clinical data to suggest other aetiologies. Follow-up high-resolution computed tomography data from patients with DIP suggested that a pattern of fibrotic non-specific Interstitial Pneumonia (NSIP) may develop in the long term in both smokers and never-smokers. Conclusion : There are significant differences in the extent of Interstitial fibrosis, lymphoid follicles and eosinophilic infiltration between DIP and RB, as well as a much lower incidence of smoking in patients with DIP. Whether the lower reported incidence of smoking in DIP reflects referral bias or conservatism in giving a history of smoking remains uncertain, as neither histological parameters nor clinical data indicate a difference between smokers and never-smokers with DIP. Nevertheless, some cases of DIP are likely to remain idiopathic and unrelated to RB, though still have a good prognosis. Furthermore, they may evolve into a pattern resembling fibrotic NSIP. Therefore, whilst SR-ILD is appropriate in the correct clinical setting, the distinction between the histological patterns of RB and DIP remains appropriate.
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Desquamative Interstitial Pneumonia and respiratory bronchiolitis associated Interstitial lung disease
Seminars in Respiratory and Critical Care Medicine, 2001Co-Authors: S L Elkin, Andrew G. Nicholson, Ron M Du BoisAbstract:Our understanding of the various types and patterns of diffuse lung disease that might result in fibrosis has evolved considerably over the last 50 years. Many entities now regarded as distinct had been previously "lumped'' together as a single disease, "lung fibrosis,'' and more recently misdiagnosed as idiopathic pulmonary fibrosis (IPF, synonymous with cryptogenic fibrosing alveolitis). In 1965 Desquamative Interstitial Pneumonia (DIP) was first described, and later it was clearly demonstrated that the clinical and pathological features of DIP and IPF were different, particularly in terms of survival and response to therapy. They are not part of the same disease spectrum nor does DIP evolve into usual Interstitial Pneumonia (UIP). Later, in the mid-1980s, RBILD was described as a distinct clinicopathologic syndrome with features consistent with an Interstitial lung disease among current or former smokers. In the recent histopathological classification of idiopathic Interstitial Pneumonia (IIP), DIP and RBILD have been included as separate entities, although there is some evidence that suggests they may lie at the two ends of a single spectrum. The debate bears similarities with the debate about DIP and UIP and is as yet unresolved. This article will give a broad and current overview of these two rarer forms of IIP, including issues that relate to diagnosis, imaging, histopathology, treatment, and prognosis.