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Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation.
Ann Diagn Pathol. 2008 Jun; 12(3):171-80.AD

Abstract

Bronchiolitis combined with interstitial pneumonitis generally has been equated with bronchiolitis obliterans organizing pneumonia (BOOP). We describe our experience with lung biopsies that had both bronchiolar and interstitial diseases. We studied 31 patients who had respiratory difficulty leading to open lung biopsy, which showed a combination of both prominent bronchiolitis and prominent interstitial pneumonitis. We compared these cases clinically and pathologically with 6 other pulmonary diseases, namely, bronchiolitis obliterans, BOOP, nonspecific interstitial pneumonitis, usual interstitial pneumonitis, airway-centered interstitial fibrosis, and idiopathic bronchiolocentric interstitial pneumonia, and with 10 cases of cystic fibrosis, an unrelated disease with both bronchiolar and interstitial pathology. The commonality of our cases was a combination of bronchiolitis and interstitial inflammation and fibrosis but little or no intra-alveolar organizing pneumonia. Bronchiolitis obliterans with organizing pneumonia involved less area than the interstitial pneumonitis in each case. All 19 patients for whom we had follow-up received corticosteroids for their pulmonary diseases. Seven patients had improvement in symptoms and pulmonary function test results and radiographic findings, 5 patients experienced subjective improvement with unchanged results of pulmonary function tests or chest x-ray, 1 patient's condition was unchanged, 6 patients' disease worsened, and 4 of these 6 died. The natural history of these cases, which we have designated bronchiolitis interstitial pneumonitis, seems more sanguine than usual interstitial pneumonitis and worse than BOOP at least in the short term. On the one hand, response to corticosteroids was not as frequent as generally accepted for BOOP. On the other hand, disease did not progress in most patients on corticosteroids.

Authors+Show Affiliations

Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02214, USA. emark@partners.orgNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18486892

Citation

Mark, Eugene J., and Ruchira Ruangchira-urai. "Bronchiolitis Interstitial Pneumonitis: a Pathologic Study of 31 Lung Biopsies With Features Intermediate Between Bronchiolitis Obliterans Organizing Pneumonia and Usual Interstitial Pneumonitis, With Clinical Correlation." Annals of Diagnostic Pathology, vol. 12, no. 3, 2008, pp. 171-80.
Mark EJ, Ruangchira-urai R. Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation. Ann Diagn Pathol. 2008;12(3):171-80.
Mark, E. J., & Ruangchira-urai, R. (2008). Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation. Annals of Diagnostic Pathology, 12(3), 171-80. https://doi.org/10.1016/j.anndiagpath.2007.07.002
Mark EJ, Ruangchira-urai R. Bronchiolitis Interstitial Pneumonitis: a Pathologic Study of 31 Lung Biopsies With Features Intermediate Between Bronchiolitis Obliterans Organizing Pneumonia and Usual Interstitial Pneumonitis, With Clinical Correlation. Ann Diagn Pathol. 2008;12(3):171-80. PubMed PMID: 18486892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bronchiolitis interstitial pneumonitis: a pathologic study of 31 lung biopsies with features intermediate between bronchiolitis obliterans organizing pneumonia and usual interstitial pneumonitis, with clinical correlation. AU - Mark,Eugene J, AU - Ruangchira-urai,Ruchira, Y1 - 2007/10/24/ PY - 2008/5/20/pubmed PY - 2008/6/25/medline PY - 2008/5/20/entrez SP - 171 EP - 80 JF - Annals of diagnostic pathology JO - Ann Diagn Pathol VL - 12 IS - 3 N2 - Bronchiolitis combined with interstitial pneumonitis generally has been equated with bronchiolitis obliterans organizing pneumonia (BOOP). We describe our experience with lung biopsies that had both bronchiolar and interstitial diseases. We studied 31 patients who had respiratory difficulty leading to open lung biopsy, which showed a combination of both prominent bronchiolitis and prominent interstitial pneumonitis. We compared these cases clinically and pathologically with 6 other pulmonary diseases, namely, bronchiolitis obliterans, BOOP, nonspecific interstitial pneumonitis, usual interstitial pneumonitis, airway-centered interstitial fibrosis, and idiopathic bronchiolocentric interstitial pneumonia, and with 10 cases of cystic fibrosis, an unrelated disease with both bronchiolar and interstitial pathology. The commonality of our cases was a combination of bronchiolitis and interstitial inflammation and fibrosis but little or no intra-alveolar organizing pneumonia. Bronchiolitis obliterans with organizing pneumonia involved less area than the interstitial pneumonitis in each case. All 19 patients for whom we had follow-up received corticosteroids for their pulmonary diseases. Seven patients had improvement in symptoms and pulmonary function test results and radiographic findings, 5 patients experienced subjective improvement with unchanged results of pulmonary function tests or chest x-ray, 1 patient's condition was unchanged, 6 patients' disease worsened, and 4 of these 6 died. The natural history of these cases, which we have designated bronchiolitis interstitial pneumonitis, seems more sanguine than usual interstitial pneumonitis and worse than BOOP at least in the short term. On the one hand, response to corticosteroids was not as frequent as generally accepted for BOOP. On the other hand, disease did not progress in most patients on corticosteroids. SN - 1532-8198 UR - https://www.unboundmedicine.com/medline/citation/18486892/Bronchiolitis_interstitial_pneumonitis:_a_pathologic_study_of_31_lung_biopsies_with_features_intermediate_between_bronchiolitis_obliterans_organizing_pneumonia_and_usual_interstitial_pneumonitis_with_clinical_correlation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1092-9134(07)00119-0 DB - PRIME DP - Unbound Medicine ER -