Eosinophilic Pneumonia-like Areas in Idiopathic Usual Interstitial Pneumonia

Yousem, Samuel A.

doi:10.1038/modpathol.3880234

Cited by 19 publications

(10 citation statements)

References 40 publications

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“…Against a backdrop of otherwise typical UIP, "eosinophilic pneumonia-like" changes have no etiologic or clinical significance (7). Peribronchiolar lymphoid aggregates occur in some patients but are rarely a dominant feature.…”

Section: Pathologic Features Of Uip/ipfmentioning

confidence: 99%

Histologic Spectrum of Idiopathic Interstitial Pneumonias

Visscher

Myers²

2006

Proceedings of the American Thoracic Society

121

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Histopathologic classification plays a key role in separating multiple forms of idiopathic interstitial pneumonia into clinically meaningful categories with important differences in natural history, prognosis, and treatment. Microscopic criteria in diagnosis of these entities include the pattern and microanatomic distribution of inflammation, fibroblast proliferation, collagen deposition, and architectural remodeling. Usual interstitial pneumonia (UIP) defines idiopathic pulmonary fibrosis and is the most common of the idiopathic interstitial pneumonias. UIP has distinctive morphologic features that allow precise diagnosis in classical cases. Other forms of idiopathic interstitial pneumonia include desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, acute interstitial pneumonia, and nonspecific interstitial pneumonia. These latter categories differ from UIP in that the histopathologic findings do not, by themselves, allow specific diagnosis in most cases and require careful correlation with clinical and radiologic findings.

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Section: Pathologic Features Of Uip/ipfmentioning

confidence: 99%

Histologic Spectrum of Idiopathic Interstitial Pneumonias

Visscher

Myers²

2006

Proceedings of the American Thoracic Society

121

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“…Histological aspects close to those described in adult idiopathic ILDs, such as usual interstitial pneumonia (UIP), desquamative interstitial pneumonia (DIP), and lymphoid interstitial pneumonia (LIP), were observed in 21/185 pediatric patients in the European task Force . Mild BAL eosinophilia has been described in adult interstitial pulmonary fibrosis (IPF), in up to 50% of patients with DIP, in nonspecific interstitial pneumonia (NSIP), and in cryptogenic organizing pneumonia . In a study gathering 1,059 BAL, interstitial lung disease was the most common cause of mild (5% or more) increase in BAL eosinophils .…”

Section: Idiopathic Interstitial Pneumoniasmentioning

confidence: 88%

“…57 Mild BAL eosinophilia has been described in adult interstitial pulmonary fibrosis (IPF), in up to 50% of patients with DIP, in nonspecific interstitial pneumonia (NSIP), and in cryptogenic organizing pneumonia. [58][59][60][61][62][63] In a study gathering 1,059 BAL, interstitial lung disease was the most common cause of mild (5% or more) increase in BAL eosinophils. 64 Ten percent (19/183) of ILD had increased BAL eosinophils, IPF being the more frequent etiology in this series (14/19) with a mean of 13% BAL eosinophils, but with a range going up to 51%.…”

Section: Idiopathic Interstitial Pneumoniasmentioning

confidence: 99%

Eosinophilic pneumonias in children: A review of the epidemiology, diagnosis, and treatment

Giovannini‐Chami

Blanc

Hadchouel

et al. 2015

Pediatric Pulmonology

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Pediatric eosinophilic pneumonias (EPs) are characterized by a significant infiltration of the alveolar spaces and lung interstitium by eosinophils, with conservation of the lung structure. In developed countries, EPs constitute exceptional entities in pediatric care. Clinical symptoms may be transient (Löffler syndrome), acute (<1 month and mostly <7 days), or chronic (>1 month). Diagnosis relies on demonstration of alveolar eosinophilia on bronchoalveolar lavage, whether or not associated with blood eosinophilia. EPs are a heterogeneous group of disorders divided into: (i) secondary forms (seen mainly in parasitic infections, allergic bronchopulmonary aspergillosis, and drug reactions); and (ii) primary forms (eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome, idiopathic chronic eosinophilic pneumonia, and idiopathic acute eosinophilic pneumonia). Despite their rarity, the etiological approach to EP must be well-defined as some causes can be rapidly life-threatening without initiation of the proper treatment. This approach (i) eliminates secondary forms, with comprehensive history taking and minimal biological assessment, (ii) is oriented in primary forms by the acute or chronic setting, and the existence of extrapulmonary symptoms. Treatment of primary forms has traditionally relied on corticosteroids, usually with a dramatic response. Specific treatments or the adjunction of corticosteroid-sparing treatment or immunosuppressors are currently being evaluated in order to improve the prognosis and the side effects associated with corticosteroid treatment in a pediatric setting.

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“…Features such as smooth muscle hypertrophy, endarteritis obliterans and type 2 cell hyperplasia are also found in UIP, but these are likely to be secondary phenomena and are not specific to this pattern. Occasionally, eosinophilic pneumonia‐like areas may be seen in UIP 36 …”

Section: Usual Interstitial Pneumoniamentioning

confidence: 99%

“…Occasionally, eosinophilic pneumonia-like areas may be seen in UIP. 36 Prognosis is significantly worse for UIP when compared with the other subsets, [10][11][12][13][14][15] and its distinction from the histological patterns is also valuable in terms of planning treatment. As the pattern is quite distinctive, most cases are correctly diagnosed, but occasionally alveolar macrophages may be numerous, mimicking the pattern of DIP.…”

Section: Histological Patternsmentioning

confidence: 99%

Classification of idiopathic interstitial pneumonias: making sense of the alphabet soup

Nicholson

2002

Histopathology

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Since Liebow and Carrington's original classification of idiopathic interstitial pneumonias, there have been controversies over which histological patterns should be included and how they relate to clinicopathological diseases such as cryptogenic fibrosing alveolitis/idiopathic pulmonary fibrosis (CFA/IPF). Because of these differences and the wealth of overlapping terminology, a consensus classification system has been proposed, devised by a group of clinicians, radiologists and pathologists. Seven histological patterns are recognized: usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), diffuse alveolar damage (DAD), organizing pneumonia (OP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis (RB) and lymphocytic interstitial pneumonia (LIP), each with a clinicopathological counterpart, the most well defined being UIP and CFA/IPF. The system is applicable both in terms of the pathologist identifying histological patterns in isolation and in terms of the pathologist's role in contributing to the final clinicopathological diagnosis. It will probably provide greater consistency in diagnosis, early studies suggesting that the system is reproducible, and also identify purer cohorts for studies investigating causation. It also highlights the fact that the 'gold standard for diagnosis' is no longer a surgical lung biopsy in isolation but more the clinicopathological conference, when clinical, imaging and histological data are jointly discussed to produce the final clinicopathological diagnosis.

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Eosinophilic Pneumonia-like Areas in Idiopathic Usual Interstitial Pneumonia

Cited by 19 publications

References 40 publications

Histologic Spectrum of Idiopathic Interstitial Pneumonias

Histologic Spectrum of Idiopathic Interstitial Pneumonias

Eosinophilic pneumonias in children: A review of the epidemiology, diagnosis, and treatment

Classification of idiopathic interstitial pneumonias: making sense of the alphabet soup

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