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Query: UMLS:C0206061 (interstitial pneumonia)
 6,105 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many pathologists and pulmonologists have trained and practiced in an era during which therapeutic options for patients have increased manyfold with regard to pharmacologic agents. Toxicity to the lung may be recognized as data accumulate in the form of case reports and clinical reviews to document the clinical and pathologic manifestations. For the histopathologist, paradoxically the more we learn the more difficult problems of interpretation become. Drug reactions previously described extensively at the autopsy now can be relatively easily interpreted in living patients with tissue obtained by open lung biopsy. This latter procedure is becoming less common with diffuse infiltrative lung disease in favor of the transbronchial biopsy in which sampling error abounds. There may be no disease or minimal change. The pathologic lesions may be duly noted and described, but then defy interpretation. An accurate differential diagnosis following biopsy may not solve the clinical problems for which a tissue diagnosis was sought. A specific diagnosis may be made that does not fit the clinical picture, or the real "answer" may be revealed distressingly later in the clinical-course or, more distressingly, at autopsy. The prudent histopathologist deals with such limitation by objectively stating the observable facets of tissue injury and synthesizing an interpretation. Notwithstanding the burgeoning literature on mechanisms of injury of toxic substances, the "state of the art" in 1990 for interpretation of pulmonary drug reactions still lies with the exacting judgment of experienced clinical physicians. Proper evaluation can result in exclusion of important mimickers of interstitial lung disease, usually infection and neoplasia; accurate categorization of tissue injury and comparison with known injurious responses to the drug in question may lead to a relatively specific diagnosis of drug-induced injury. Most drug reactions in the lung are classified as an interstitial pneumonia. This article illustrates and describes several interstitial reactions to injury that have few histologic features in common. However, because the lung can only react to injury in a limited number of ways, lesions that were thought at one time to be a specific clinicopathologic entity, for example, DIP, now evoke an ever-expanding differential diagnosis. In applying diagnostic criteria emphasis must be placed on the areas of overlap among tissue reactions as well. Specific agents may cause changes that are described as common for that agent, but a given patient may react with a variation or in a distinctly uncommon manner. There is enormous potential in this field for the laboratory investigation of drug injury.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The histopathology of pulmonary reactions to drugs. 169 Oct 70

Currently, five types of interstitial pneumonia of unknown etiology or IIP have been described; DAD, UIP, BOOP, DIP and LIP. A summary of the features of clinical course, prognosis and therapeutic effects to steroid hormone treatment of the five types of interstitial pneumonia of unknown etiology or IIP is given in Table 15). Among the previous mentioned 52 open lung biopsy cases of interstitial pneumonia of unknown etiology or IIP, for which an open lung biopsy was necessary for diagnosis, the majority of those cases (81%) was IPF (UIP) while idiopathic BOOP occurred as the second in frequency (13%). These data will help in understanding the clinical outcome and the therapeutic response to steroid hormone treatment in cases of interstitial pneumonia of unknown etiology or IIP, because idopathic UIP is slowly progressive and usually not responsive to steroid while idiopathic BOOP is usually responsive to steroid hormone treatment and may regress even spontaneously. Cases of IPF (UIP) should have revolutional modalities for therapy.
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PMID:Pathologic features and the classification of interstitial pneumonia of unknown etiology. 213 41

A 61-year-old man was admitted to our hospital with fever, cough and dyspnea on exertion. The chest X-ray showed diffuse reticulo-granular infiltrates. Deterioration of clinical features and remarkable elevation of BALF lymphocytes (64.3%) suggested active interstitial pneumonia. The open lung biopsy specimen showed chronic interstitial pneumonia with DIP-like pathologic change. There was a remarkable clinical, physiological and roentgenographic improvement associated with decrease of BALF lymphocytes in response to steroid therapy. BAL is useful for monitoring disease activity and tapering steroids in patients with interstitial pneumonia who respond to steroid therapy.
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PMID:[Desquamative interstitial pneumonia-like changes in idiopathic pulmonary fibrosis]. 226 32

We obtained results of lung immune complexes (LIC), circulating immune complexes (CIC), 48-hour gallium lung scans (scans), bronchoalveolar lavage (BAL), and pulmonary function tests in 20 patients with idiopathic interstitial pneumonitis-fibrosis. Sixteen patients had predominantly interstitial (13 cases UIP) and/or intraalveolar (3 cases DIP) cellular disease (group 1). Prior to corticosteroid therapy in group 1, scans were positive in 75 percent, CIC were elevated in 86 percent, LIC were present in 64 percent, and BAL was abnormal in 90 percent. Duration of follow-up after treatment was 3.5 +/- 1.0 year. In group 1 after treatment with corticosteroids in 13 patients and corticosteroids and penicillamine (three patients) and plasmapheresis (one patient), only four patients remain stable or improved. After corticosteroid therapy, elevated CIC returned to normal values despite progressive patient deterioration. In three patients, lung immune complexes were still detected after circulating immune complexes had returned to normal after corticosteroid therapy. In group 2 were four patients with fibrotic disease; scans and CIC were uniformly negative, LIC were weakly present in only one patient, and BAL was abnormal in all. Despite corticosteroid therapy, all have died or deteriorated. These results suggest that positive gallium lung scans, BAL, circulating immune complexes, and to a lesser extent, lung immune complexes are associated with the cellular phase of interstitial pneumonia, but do not reliably identify a corticosteroid-responsive group.
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PMID:Immune complexes, gallium lung scans, and bronchoalveolar lavage in idiopathic interstitial pneumonitis-fibrosis. 687 93

We report the experience with and evaluation of treatment strategies in fibrosing alveolitis and desquamative interstitial pneumonitis (FA/DIP) over the last 16 years by a review of all cases referred to a tertiary referral center. There were 25 cases, 16 boys and 9 girls (mean age at onset, 2.3 years; range, 7 days to 11.6 years). In each case the diagnosis was confirmed by open lung biopsy at a mean age of 3.3 years (range, 7 weeks to 15.1 years). Presently features were tachypnea (19), cyanosis (15), cough (12), exertional dyspnea (7), recurrent chest infections +/- wheezing (9), and clubbing (8). Four patients recovered without antiinflammatory medication. The others received specific treatment. Of 11 patients given only prednisolone, six improved, two did not, and three died despite treatment. Of five patients receiving only chloroquine, four responded. Five patients received both prednisolone and chloroquine; one died, two responded well. There was poor progress in the remaining two. Of the 10 patients receiving chloroquine six (60%) showed a good response. A younger presentation carried a worse prognosis, but chest radiology at presentation and outcome were not interrelated. Those with mild histological changes all survived, but severe desquamation or fibrosis at biopsy was not related to outcome. In four cases there was a family history (16%). Patients with FA/DIP probably represent a disease spectrum of multiple etiology with a variable prognosis and response to treatment.
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PMID:Fibrosing alveolitis and desquamative interstitial pneumonitis. 809 Jun 6

Idiopathic interstitial pneumonias are defined from the pathological point of view as non granulomatous intralobular inflammatory and fibrotic processes involving the alveolar walls. More than thirty years ago Liebow and Carrington pioneered the notion that morphological characteristics could be used with benefit in separating the different entities found in this group, which present with typical, but not pathognomonic clinical features. In the mid-1980s some entities, including giant cell interstitial pneumonia (GIP) and lymphocytic interstitial pneumonia (LIP), were removed from this group and considered as peculiar forms. In the early 90s the concept of cellular or nonspecific interstitial pneumonia was reconsidered, leading to an in depth revision of various types of interstitial pneumonia of unknown etiology. The histological pattern observed in patients with idiopathic pulmonary fibrosis is now referred to as usual interstitial pneumonia (UIP). Other entities that have been revised during the last ten years are desquamative interstitial pneumonia/alveolar macrophage pneumonia (DIP/AMP), respiratory bronchiolitis-interstitial lung disease (RB-ILD), acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP) and nonspecific interstitial pneumonia (NSIP). This paper provides a detailed description of pulmonary disorders which have been included in the new classification systems of idiopathic interstitial pneumonias. In the second part of the paper we will discuss several doubts and controversies that this new classification schemes leave unresolved.
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PMID:Facts and controversies in the classification of idiopathic interstitial pneumonias. 1103 38

A 70-year-old man in whom nodular and reticular shadows had been noted on chest radiography since 1992 was admitted to our hospital with complaints of persistent cough and dyspnea on exertion in August, 2000. The definitive diagnosis of lung abnormalities was not confirmed by TBLB. He was re-admitted to our hospital to undergo a lung biopsy by video-assisted thoracoscopic surgery. Although desquamative interstitial pneumonia was diagnosed, respiratory failure developed rapidly after surgery. He responded well to high-dose steroid administration followed by maintenance therapy with a moderate dose of steroid, resulting in a considerable importance of the clinical condition associated with a significant decrease in the ground-glass opacities and infiltrative shadows. Although we could find no literature reporting acute exacerbation of DIP, our case demonstrates that DIP may also be acutely exacerbated when a severe insult is superimposed.
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PMID:[A case of acute exacerbation of desquamative interstitial pneumonia after video-assisted thoracoscopic surgery (VATS)]. 1283 43

DIP (desquamative interstitial pneumonia) is an interstitial lung disease with diffuse and uniform accumulation of alveolar macrophages. There is a strong association with tobacco since 90% of the patients are smokers. The interstitial lung diseases related to tobacco are diverse and include tumours, emphysema, chronic bronchitis, RBILD (Respiratory Bronchilites associated Interstitial Lung Disease), DIP and Langerhans Cell Histiocitosis. The authors present a case of DIP. A brief theorycal revision and discussion of a case is made facing the association with tobacco.
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PMID:[DIP (desquamative interstitial pneumonia): as a tobacco-associated disease -- case report]. 1562 38

Respiratory bronchiolitis associated with interstitial lung disease (RB-ILD), first described by Niewoehner et al in an autopsy study of cigarette smokers who died from non pulmonary causes in 1974, is a rare entity that should be distinguished from the other interstitial lung diseases and in particular from desquamative interstitial pneumonia, although the two conditions share a similar histopathological pattern. RB-ILD is clearly connected with tobacco smoking and has been inserted in the "smoking related interstitial lung diseases" together with DIP and Cell histiocytosis of Langerhans; it may also be associated with occupational exposure to machine fumes. The following is a case report of a patient with both smoking and occupational exposure.
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PMID:Respiratory bronchiolitis associated with interstitial lung disease. 1567 12

Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease), RB-ILD (respiratory bronchiolitis and interstitial lung disease), DIP (desquamative interstitial pneumonia), bronchiolitis and bronchiolocentric interstitial fibrosis, Langerhans cells histiocytosis, eosinophilic pneumonia, sarcoidosis, epidermoid metaplasia in respiratory epithelium and lung cancer. The chronic tobacco induced inflammatory state is the basis for the acquisition of genetic alterations dependent on the tobacco contaminants.
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PMID:[Tobacco and morphology: pulmonary diseases]. 1763 77


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