Difference between revisions of "Desquamative interstitial pneumonia"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Desquamative interstitial pneumonia -- intermed mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Desquamative interstitial pneumonia. [[H&E stain]]. (WC/Nephron)
| Synonyms  =
| Synonyms  =
| Micro      = abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis")
| Micro      = abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis")
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| Staging    =
| Staging    =
| Site      = [[lung]] - see ''[[diffuse lung diseases]]''
| Site      = [[lung]] - see ''[[diffuse lung diseases]]''
| Assdx      = [[smoking]]
| Assdx      = +/-[[smoking]]
| Syndromes  =
| Syndromes  =
| Clinicalhx =  
| Clinicalhx =  
| Signs      =
| Signs      =
| Symptoms  =
| Symptoms  =
| Prevalence = uncommon
| Prevalence = rare
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      = ground glass airspaces changes - usu. all lobes but peripheral predominant and in lower lobe predominant
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  =
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    =
| Tx        = stop smoking
| Tx        = stop smoking/remove insult
}}
}}
'''Desquamative interstitial pneumonia''', abbreviated '''DIP''', is a [[diffuse lung diseases|diffuse lung disease]] that is strongly associated with [[smoking]].
'''Desquamative interstitial pneumonia''', abbreviated '''DIP''', is a [[diffuse lung diseases|diffuse lung disease]] that is strongly associated with [[smoking]].
The term ''desquamative interstitial pneumonia'' is a [[misnomer]]. The airspace cells that characterize the condition were once thought to represent desquamated epithelial cells, but they are now know to represent macrophages.<ref name=pmid18794314>{{Cite journal  | last1 = Attili | first1 = AK. | last2 = Kazerooni | first2 = EA. | last3 = Gross | first3 = BH. | last4 = Flaherty | first4 = KR. | last5 = Myers | first5 = JL. | last6 = Martinez | first6 = FJ. | title = Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation. | journal = Radiographics | volume = 28 | issue = 5 | pages = 1383-96; discussion 1396-8 | month =  | year =  | doi = 10.1148/rg.285075223 | PMID = 18794314 | url=http://pubs.rsna.org/doi/full/10.1148/rg.285075223}}</ref>


==General==
==General==
*Thought to be advanced ''[[RBILD]]''.
*Rare.<ref name=pmid20854463/>
*Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref>
*Strong association with smoking.<ref name=Ref_WMSP93>{{Ref WMSP|93}}</ref><ref name=pmid26324804>{{Cite journal  | last1 = Margaritopoulos | first1 = GA. | last2 = Vasarmidi | first2 = E. | last3 = Jacob | first3 = J. | last4 = Wells | first4 = AU. | last5 = Antoniou | first5 = KM. | title = Smoking and interstitial lung diseases. | journal = Eur Respir Rev | volume = 24 | issue = 137 | pages = 428-35 | month = Sep | year = 2015 | doi = 10.1183/16000617.0050-2015 | PMID = 26324804 }}</ref>
**Treatment: stop smoking.
**Thought to be advanced ''[[RBILD]]''.
*May be seen in non-smokers (up to ~40% of cases) due to occupational exposures, drugs, viral illnesses and autoimmune diseases.<ref name=pmid23728865>{{Cite journal  | last1 = Godbert | first1 = B. | last2 = Wissler | first2 = MP. | last3 = Vignaud | first3 = JM. | title = Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology. | journal = Eur Respir Rev | volume = 22 | issue = 128 | pages = 117-23 | month = Jun | year = 2013 | doi = 10.1183/09059180.00005812 | PMID = 23728865 }}</ref>
 
Diagnosis:
*Requires - surgical biopsy.<ref name=pmid23728865/>
 
Treatment:
*Stop smoking/remove or manage underlying cause.
 
==Gross/Radiology==
Features:<ref name=pmid8497631>{{Cite journal  | last1 = Hartman | first1 = TE. | last2 = Primack | first2 = SL. | last3 = Swensen | first3 = SJ. | last4 = Hansell | first4 = D. | last5 = McGuinness | first5 = G. | last6 = Müller | first6 = NL. | title = Desquamative interstitial pneumonia: thin-section CT findings in 22 patients. | journal = Radiology | volume = 187 | issue = 3 | pages = 787-90 | month = Jun | year = 1993 | doi = 10.1148/radiology.187.3.8497631 | PMID = 8497631 }}</ref>
*Ground glass (airspace changes).
**Usually peripheral predominant (~60% of cases) and lower lobe predominant (~70-75% of cases).
**Typically all lobes are involved - though upper lobe spared in ~20% of cases.
*Fibrotic (radiologic) changes ~50% of cases.


==Microscopic==
==Microscopic==
Features:
Features:<ref name=pmid20854463>{{Cite journal  | last1 = Tazelaar | first1 = HD. | last2 = Wright | first2 = JL. | last3 = Churg | first3 = A. | title = Desquamative interstitial pneumonia. | journal = Histopathology | volume = 58 | issue = 4 | pages = 509-16 | month = Mar | year = 2011 | doi = 10.1111/j.1365-2559.2010.03649.x | PMID = 20854463 }}</ref>
*Abundant brown pigmented airspace macrophages - ''smoker's macrophages'' - '''key feature'''.
*Abundant airspace macrophages - usually with brown pigment (so called ''smoker's macrophages'') - '''key feature'''.
*Architecture preserved; "linear fibrosis".
*Interstitial inflammation ''or'' interstitial fibrosis with a preserved architecture - so called "linear fibrosis".


Notes:
Notes:
Line 52: Line 68:


===Images===
===Images===
<gallery>
Image: Desquamative interstitial pneumonia -- low mag.jpg | DIP - low mag.
Image: Desquamative interstitial pneumonia -- intermed mag.jpg | DIP - intermed. mag.
Image: Desquamative interstitial pneumonia -- high mag.jpg | DIP - high mag.
Image: Desquamative interstitial pneumonia -- very high mag.jpg | DIP - very high mag.
Image: Desquamative interstitial pneumonia - alt -- low mag.jpg | DIP - low mag.
Image: Desquamative interstitial pneumonia - alt -- intermed mag.jpg | DIP - intermed. mag.
Image: Desquamative interstitial pneumonia - alt -- high mag.jpg | DIP - high mag.
Image: Desquamative interstitial pneumonia - alt 2 -- intermed mag.jpg | DIP - intermed mag.
</gallery>
====www====
*[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)].
*[http://pathhsw5m54.ucsf.edu/case27/dip27.html DIP (ucsf.edu)].


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==See also==
==See also==
*[[Diffuse lung diseases]].
*[[Diffuse lung diseases]].
*[[Smoking]].
*[[Smoking-related interstitial fibrosis]].


==References==
==References==

Latest revision as of 14:57, 8 May 2019

Desquamative interstitial pneumonia
Diagnosis in short

Desquamative interstitial pneumonia. H&E stain. (WC/Nephron)
LM abundant brown pigmented airspace macrophages (smoker's macrophages), architecture preserved ("linear fibrosis")
LM DDx amiodarone toxicity, fibrotic NSIP, RBILD
Site lung - see diffuse lung diseases
Associated Dx +/-smoking
Prevalence rare
Radiology ground glass airspaces changes - usu. all lobes but peripheral predominant and in lower lobe predominant
Treatment stop smoking/remove insult

Desquamative interstitial pneumonia, abbreviated DIP, is a diffuse lung disease that is strongly associated with smoking.

The term desquamative interstitial pneumonia is a misnomer. The airspace cells that characterize the condition were once thought to represent desquamated epithelial cells, but they are now know to represent macrophages.[1]

General

  • Rare.[2]
  • Strong association with smoking.[3][4]
    • Thought to be advanced RBILD.
  • May be seen in non-smokers (up to ~40% of cases) due to occupational exposures, drugs, viral illnesses and autoimmune diseases.[5]

Diagnosis:

  • Requires - surgical biopsy.[5]

Treatment:

  • Stop smoking/remove or manage underlying cause.

Gross/Radiology

Features:[6]

  • Ground glass (airspace changes).
    • Usually peripheral predominant (~60% of cases) and lower lobe predominant (~70-75% of cases).
    • Typically all lobes are involved - though upper lobe spared in ~20% of cases.
  • Fibrotic (radiologic) changes ~50% of cases.

Microscopic

Features:[2]

  • Abundant airspace macrophages - usually with brown pigment (so called smoker's macrophages) - key feature.
  • Interstitial inflammation or interstitial fibrosis with a preserved architecture - so called "linear fibrosis".

Notes:

  • Some fields of view may be indistinguishable from RBILD.

DDx:

Images

  • DIP - low mag.

  • DIP - intermed. mag.

  • DIP - high mag.

  • DIP - very high mag.

  • DIP - low mag.

  • DIP - intermed. mag.

  • DIP - high mag.

  • DIP - intermed mag.

www

Stains

  • Macrophages PAS +ve.

See also

References

  1. ↑ Attili, AK.; Kazerooni, EA.; Gross, BH.; Flaherty, KR.; Myers, JL.; Martinez, FJ.. "Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation.". Radiographics 28 (5): 1383-96; discussion 1396-8. doi:10.1148/rg.285075223. PMID 18794314. http://pubs.rsna.org/doi/full/10.1148/rg.285075223.
  2. ↑ 2.0 2.1 Tazelaar, HD.; Wright, JL.; Churg, A. (Mar 2011). "Desquamative interstitial pneumonia.". Histopathology 58 (4): 509-16. doi:10.1111/j.1365-2559.2010.03649.x. PMID 20854463.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 93. ISBN 978-0781765275.
  4. ↑ Margaritopoulos, GA.; Vasarmidi, E.; Jacob, J.; Wells, AU.; Antoniou, KM. (Sep 2015). "Smoking and interstitial lung diseases.". Eur Respir Rev 24 (137): 428-35. doi:10.1183/16000617.0050-2015. PMID 26324804.
  5. ↑ 5.0 5.1 Godbert, B.; Wissler, MP.; Vignaud, JM. (Jun 2013). "Desquamative interstitial pneumonia: an analytic review with an emphasis on aetiology.". Eur Respir Rev 22 (128): 117-23. doi:10.1183/09059180.00005812. PMID 23728865.
  6. ↑ Hartman, TE.; Primack, SL.; Swensen, SJ.; Hansell, D.; McGuinness, G.; Müller, NL. (Jun 1993). "Desquamative interstitial pneumonia: thin-section CT findings in 22 patients.". Radiology 187 (3): 787-90. doi:10.1148/radiology.187.3.8497631. PMID 8497631.
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