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Pathology of hypersensitivity pneumonitis.
Curr Opin Pulm Med. 2008 Sep; 14(5):440-54.CO

Abstract

PURPOSE OF REVIEW

Hypersensitity pneumonitis, caused by inhalation of various antigens, is characterized by interstitial mononuclear cell infiltration, nonnecrotizing granulomas, cellular bronchiolitis, and fibrosis. The pathological picture of chronic hypersensitivity pneumonitis is, however, complicated; it is sometimes difficult to differentiate chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia, nonspecific interstitial pneumonia, and connective-tissue-related lung disease. The clinical, radiological, and pathological features of chronic hypersensitivity pneumonitis have recently been described. This study reviews the previously reported information and provides new insights into the pathological features of chronic hypersensitivity pneumonitis.

RECENT FINDINGS

The pathological features of chronic hypersensitivity pneumonitis comprise overlapping usual interstitial pneumonia-like pattern with subpleural patchy fibrosis, alternating normal alveoli and fibroblastic foci, a nonspecific interstitial pneumonia-like pattern, and centrilobular fibrosis. In contrast to pathological features of acute and subacute hypersensitivity pneumonitis, epithelioid cell granulomas are sparse or absent, but giant cells are seen in the interstitium. Bridging fibrosis between peribronchiolar area and perilobular areas is an outstanding feature of chronic hypersensitivity pneumonitis. Autopsy cases of chronic hypersensitivity pneumonitis have demonstrated not only upper lobe contraction but also lower lobe contraction, mimicking usual interstitial pneumonia pattern and diffuse alveolar damage.

SUMMARY

The present review focuses on the pathological features of chronic hypersensitivity pneumonitis and presents that centrilobular fibrosis and bridging fibrosis are the important hallmarks of chronic hypersensitivity pneumonitis, even with a usual interstitial pneumonia-like pattern.

Authors+Show Affiliations

Department of Pathology, Japanese Red Cross Medical Center, Japan. byori@med.jrc.or.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18664975

Citation

Takemura, Tamiko, et al. "Pathology of Hypersensitivity Pneumonitis." Current Opinion in Pulmonary Medicine, vol. 14, no. 5, 2008, pp. 440-54.
Takemura T, Akashi T, Ohtani Y, et al. Pathology of hypersensitivity pneumonitis. Curr Opin Pulm Med. 2008;14(5):440-54.
Takemura, T., Akashi, T., Ohtani, Y., Inase, N., & Yoshizawa, Y. (2008). Pathology of hypersensitivity pneumonitis. Current Opinion in Pulmonary Medicine, 14(5), 440-54. https://doi.org/10.1097/MCP.0b013e3283043dfa
Takemura T, et al. Pathology of Hypersensitivity Pneumonitis. Curr Opin Pulm Med. 2008;14(5):440-54. PubMed PMID: 18664975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathology of hypersensitivity pneumonitis. AU - Takemura,Tamiko, AU - Akashi,Takumi, AU - Ohtani,Yoshio, AU - Inase,Naohiko, AU - Yoshizawa,Yasuyuki, PY - 2008/7/31/pubmed PY - 2008/10/7/medline PY - 2008/7/31/entrez SP - 440 EP - 54 JF - Current opinion in pulmonary medicine JO - Curr Opin Pulm Med VL - 14 IS - 5 N2 - PURPOSE OF REVIEW: Hypersensitity pneumonitis, caused by inhalation of various antigens, is characterized by interstitial mononuclear cell infiltration, nonnecrotizing granulomas, cellular bronchiolitis, and fibrosis. The pathological picture of chronic hypersensitivity pneumonitis is, however, complicated; it is sometimes difficult to differentiate chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia, nonspecific interstitial pneumonia, and connective-tissue-related lung disease. The clinical, radiological, and pathological features of chronic hypersensitivity pneumonitis have recently been described. This study reviews the previously reported information and provides new insights into the pathological features of chronic hypersensitivity pneumonitis. RECENT FINDINGS: The pathological features of chronic hypersensitivity pneumonitis comprise overlapping usual interstitial pneumonia-like pattern with subpleural patchy fibrosis, alternating normal alveoli and fibroblastic foci, a nonspecific interstitial pneumonia-like pattern, and centrilobular fibrosis. In contrast to pathological features of acute and subacute hypersensitivity pneumonitis, epithelioid cell granulomas are sparse or absent, but giant cells are seen in the interstitium. Bridging fibrosis between peribronchiolar area and perilobular areas is an outstanding feature of chronic hypersensitivity pneumonitis. Autopsy cases of chronic hypersensitivity pneumonitis have demonstrated not only upper lobe contraction but also lower lobe contraction, mimicking usual interstitial pneumonia pattern and diffuse alveolar damage. SUMMARY: The present review focuses on the pathological features of chronic hypersensitivity pneumonitis and presents that centrilobular fibrosis and bridging fibrosis are the important hallmarks of chronic hypersensitivity pneumonitis, even with a usual interstitial pneumonia-like pattern. SN - 1531-6971 UR - https://www.unboundmedicine.com/medline/citation/18664975/Pathology_of_hypersensitivity_pneumonitis_ L2 - http://dx.doi.org/10.1097/MCP.0b013e3283043dfa DB - PRIME DP - Unbound Medicine ER -