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Usual interstitial pneumonia end-stage features from explants with radiologic and pathological correlations

Abstract : Idiopathic pulmonary fibrosis (IPF) is the most frequent and severe idiopathic interstitial pneumonia, with typical high-resolution computed tomography (HRCT) features and histologic pattern of usual interstitial pneumonia (UIP); its main differential diagnosis is fibrotic nonspecific interstitial pneumonia (F-NSIP). Usual interstitial pneumonia was mainly described from lung biopsies, and little is known on explants. Twenty-two UIP/IPF explants were analyzed histologically and compared with previous open lung biopsies (OLBs; n = 11) and HRCT (n = 19), when available. Temporospatial heterogeneity and subpleural and paraseptal fibrosis were similarly found in UIP/IPF explants and OLB (91%-95%). Fibroblastic foci were found in 82% of OLBs and 100% of explants, with a higher mean score in explants (P = .023). Honeycombing was present in 64% of OLBs and 95% of explants, with a higher mean score in explants (P = .005). Almost 60% of UIP/IPF explants showed NSIP areas and 41% peribronchiolar fibrosis; inflammation, bronchiolar metaplasia, and vascular changes were more frequent in UIP/IPF explants; and Desquamative Interstitial Pneumonia (DIP)-like areas were not common (18%-27%). Numerous large airspace enlargements with fibrosis were frequent in UIP/IPF explants (59%). On HRCT, honeycombing was observed in 95% of the cases and ground-glass opacities in 53%, correlating with NSIP areas or acute exacerbation at histology. Six patients had combined IPF and emphysema. Lesions were more severe in UIP/IPF explants, reflecting the worsening of the disease. Usual interstitial pneumonia/IPF explants more frequently presented with confounding lesions such as NSIP areas, peribronchiolar fibrosis, and airspace enlargements with fibrosis sometimes associated with emphysema.
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https://hal.univ-grenoble-alpes.fr/hal-01969358
Contributeur : Sarah Hamant <>
Soumis le : vendredi 4 janvier 2019 - 09:09:06
Dernière modification le : jeudi 27 août 2020 - 11:36:04

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HCL | LBFA | UGA

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Maud Rabeyrin, Françoise Thivolet, Gilbert Ferretti, Lara Chalabreysse, Adrien Jankowski, et al.. Usual interstitial pneumonia end-stage features from explants with radiologic and pathological correlations. Annals of Diagnostic Pathology, WB Saunders, 2015, 19 (4), pp.269-276. ⟨10.1016/j.anndiagpath.2015.05.003⟩. ⟨hal-01969358⟩

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