Kevin O. Leslie, MD Mark R. Wick, MD
A fundamental truth about medical textbooks is that they are often not read from beginning to end once a student of medicine has progressed beyond the basic medical school curriculum. In the practice of medicine, textbooks are more commonly used as references for learning about a disease or entity that a clinician suspects a patient may have based on history, physical findings, and imaging/lab oratory data gleaned from an initial screening evaluation. The disease-based textbook is analogous to a dictionary or encyclopedia, both of which are much easier to use if a person already has a good idea of what he or she is investigating.
Today, the vast majority of diagnosis-oriented medical textbooks continue to exist as compendia of individual diseases, more or less grouped by the anatomic compartment or structure affected (e.g., brainstem diseases, bile duct diseases, glomerular diseases) or a common mechanism if one is discernible (e.g., inflammatory diseases, neoplastic diseases). Typically, the discussion of each disease begins with a historical introduction, continues with the characteristics of the disease, and ends with the treatment and prognosis. This book is no different, but the authors have added this introductory material as a tool to help navigate the contents. The approach is based on the premise that six primary histopathologic patterns exist for all lung diseases. Identifiable using the low-magnification microscope objective lens, these patterns serve as the introductory image of the disease process. (In truth, chest imaging with high-resolution computed tomography is an even better place to begin—see Chapter 4). Once the primary pattern is recognized, the histopathologist must collect additional findings from the biopsy specimen. With the primary pattern and secondary attributes in hand, a cogent differential diagnosis can be proffered. This process is significantly enhanced by knowledge of the clinical presentation and imaging characteristics, but if these are not available when the slides are being examined, they can still be useful for narrowing the differential diagnosis after the histopathology has been evaluated. A detailed analysis of the use of clinical, radiologic, and histopathologic data in the evaluation of the diffuse medical lung diseases (often referred to as interstitial lung diseases, or ILDs) is available for the interested reader (open access file for download).*
A basic knowledge of the two-dimensional structure of the lung is essential for accurately assessing patterns of disease. We assume that the reader is familiar with basic lung anatomy by the time a diagnostic problem is being evaluated in the patient care setting, but a brief review is always helpful (see Chapter 1). An overview of the six major patterns is provided (see Table 1), followed by illustrations of each pattern. The pattern-based approach presented here was devised mainly to assist in the interpretation of the diffuse lung diseases, commonly referred to as ILDs. Given the tumefactive nature of neoplasms, these are heavily represented in Pattern 5 (Nodules), but some nonneoplastic diseases, such as sarcoidosis, nodular infections, granulomatosis with polyangiitis, and certain pneumoconioses, may also manifest a nodular pattern. Rarely, neoplasms can present as diffuse ILD clinically and radiologically (e.g., lymphangitic carcinoma, intravascular lymphoma). Within each of the major patterns, the authors have provided the reader with the appropriate chapters and relevant pages in the book for further study, reasonably confident that the answer (or approach) to a particular diagnostic problem will be present. There are diagnostic considerations for which no specific chapter or page number is provided. Some of these may require reference to another source. For the distinctive or unusual finding not identified in the list for a given major pattern, the reader is directed to the Appendix, where the authors have assembled a “visual encyclopedia” of distinctive findings and artifacts encountered in the course of microscopic evaluation.
As every diagnostic pathologist knows, overlap occurs between diseases, and sometimes this overlap can be useful in establishing the correct diagnosis. For example, some infections both are nodular (Pattern 5) and have airspace filling (e.g., botryomycosis, aspiration pneumonia), whereas others are characterized by acute lung injury and diffuse airspace filling (e.g., pneumococcal pneumonia, pneumocystis pneumonia). In fact, some diffuse inflammatory conditions of the lung may manifest all of the six patterns in different areas of the same biopsy (e.g., rheumatoid lung). In some cases, it may be necessary to include several possibilities in the final diagnosis, especially for the nonneoplastic diseases, where the effect of ancillary data not available at the time of diagnosis may be very large. The exposition begins with Pattern 1 (Acute Lung Injury) because this is the pattern that dominates all others and is most often the reason a biopsy was performed at all.
*See Leslie KO: My approach to interstitial lung disease using clinical, radiological and histopathologic patterns. J Clin Pathol. 2009;62(5):387-401. The Worksheet for the Pattern-Based Approach to Lung Disease, located on page xvi, is a printable form for organizing these data.
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Worksheet for the Pattern-Based Approach to Lung Disease |
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Patient Information |
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Age: Gender: Male |
Female |
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Disease Onset |
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Acute (hours to days) Subacute (weeks to a few months) |
Chronic (months to years) |
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Character of Infiltrate(s) on CT Scan Nodular Ground glass Consolidation Reticular |
Honeycombing |
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Biopsy Information |
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Transbronchial biopsy Cytology specimen Surgical wedge biopsy |
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Lung Pathology Pattern |
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Pattern 1 (Acute Lung Injury) With hyaline membranes (DAD) With necrosis (infection) With fibrin and organization only (infection, CVD, drug, EP) With siderophages (infection, CVD, drug, EP) With background fibrosis (acute on chr disease ddx) With vasculitis (infection, DAH, CVD, drug, EP) With eosinophils (infection, drug, EP) |
Pattern 2 (Fibrosis) With temporal heterogeneity (UIP) With diffuse septal fibrosis (NSIP ddx) With granulomas (sarcoid, chr HP) With acute lung injury (acute on chr disease ddx) With honeycombing only (many causes) With pleuritis (CVD) |
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Pattern 3 (Cellular Infiltrates) With lymphocytes and plasma cells (NSIP ddx) With neutrophils (infection, DAH, drug) With fibrin and organization (infection, CVD, drug) With granulomas (infection, HP, hot tub, drug, LIP ddx) With background fibrosis (NSIP ddx, chr drug) With vasculitis (infection, CVD, DAH) With pleuritis (CVD) |
Pattern 4 (Alveolar Filling) With macrophages (EP, SRILD, aspir) With granulomas (infection, hot tub, aspir) With giant cells only (aspir, EP, hard metal) With neutrophils (infection, aspir, DAH capil) With eosinophilic material (PAP, PAM, edema) With blood only (artifact) With blood + siderophages (DAH, IPH, smoker) With OP (infection, drug, CVD, COP) |
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Pattern 5 (Nodules) With granulomas (infection, sarcoid, aspir) With lymphoid cells (lymphoma, PLCH, GPA) With necrosis (infection, tumor, infarction) With atypical cells (virus, tumor, EP) With OP (infection, aspir, idiop nod OP) With vasculitis (infection, GPA) With stellate scars (PLCH) |
Pattern 6 (Minimal Changes) With small airways disease (OB) With vascular disease (PHT, VOD) With cysts (PLCH, LAM) With no specific findings (sampling) |
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aspir, Aspiration; chr, chronic; COP, cryptogenic organizing pneumonia; CVD, collagen vascular disease; DAD, diffuse alveolar damage; DAH, diffuse alveolar hemorrhage; DAH capill, diffuse alveolar hemorrhage with capillaritis; ddx, differential diagnosis; drug, drug toxicity; EP, eosinophilic pneumonia; GPA, granulomatosis with polyangiitis; hard metal, cobalt-associated hard metal disease; hot tub, “hot tub” lung; HP, hypersensitivity pneumonitis; idiop, idiopathic; IPH, idiopathic pulmonary hemosiderosis; LAM, lymphangioleiomyomatosis; LIP, lymphoid interstitial pneumonia; nod, nodular; NSIP, nonspecific interstitial pneumonia; OB, obliterative bronchiolitis (constrictive bronchiolitis); OP, organizing pneumonia; PAM, pulmonary alveolar microlithiasis; PAP, pulmonary alveolar proteinosis; PHT, pulmonary hypertension; PLCH, pulmonary Langerhans cell histiocytosis; smoker, changes related to cigare The smoking; SRILD, smoking-related interstitial lung disease; UIP, usual interstitial pneumonia; virus, viral infection; VOD, venoocclusive disease. |
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Pattern |
Diseases to Be Considered |
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Acute lung injury |
Diffuse alveolar damage (DAD) Infection Eosinophilic pneumonia Drug toxicity Certain systemic connective tissue diseases Diffuse alveolar hemorrhage Irradiation injury Idiopathic (acute interstitial pneumonia) Acute hypersensitivity pneumonitis Acute pneumoconiosis Acute aspiration pneumonia Idiopathic acute fibrinous and organizing pneumonitis |
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Fibrosis |
Usual interstitial pneumonia (UIP) Collagen vascular diseases Chronic eosinophilic pneumonia Chronic drug toxicity Chronic hypersensitivity pneumonitis Nonspecific interstitial pneumonia (NSIP) Smoking-related interstitial lung disease (ILD)/advanced Langerhans cell histiocytosis Sarcoidosis (advanced) Pneumoconioses Erdheim-Chester disease Hermansky-Pudlak syndrome Idiopathic pleuroparenchymal fibroelastosis Idiopathic airway-centered fibrosis |
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Chronic cellular infiltrates |
Hypersensitivity pneumonitis Nonspecific interstitial pneumonia (NSIP) Systemic connective tissue diseases Certain chronic infections Certain drug toxicities Lymphocytic and lymphoid interstitial pneumonia Lymphomas and leukemias Lymphangitic carcinomatosis |
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Alveolar filling |
Infections Airspace organization (organizing pneumonia) Diffuse alveolar hemorrhage Desquamative interstitial pneumonia (DIP) Respiratory bronchiolitis-associated ILD Alveolar proteinosis Dendriform (racemose) calcification Alveolar microlithiasis Mucostasis and mucinous tumors |
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Nodules |
Infections (mycobacterial and fungal, primarily) Primary and metastatic neoplasms Granulomatosis with polyangiitis Sarcoidosis/berylliosis Aspiration pneumonia Pulmonary Langerhans cell histiocytosis |
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Nearly normal biopsy |
Chronic small airways disease (as constrictive bronchiolitis) Vasculopathic diseases Lymphangioleiomyomatosis (LAM) Other rare cystic diseases |
Elements of the pattern: the lung biopsy shows patchy or diffuse edema, fibrin, and reactive type 2 cell hyperplasia. The dominance of noncellular, protein-rich material imparts an overall red or pink appearance to the biopsy at scanning magnification (in routine hematoxylin-eosin stained sections).
Special stains for organisms are required for all lung specimens that show acute injury.
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Additional Findings |
Diagnostic Consideration |
Chapter:Page |
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Hyaline membranes |
Diffuse alveolar damage |
Ch. 5:110; Ch. 6:125 |
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Necrosis in parenchyma |
Infection |
Ch. 6:130 |
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Some tumors |
Ch. 17:586 |
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Infarct |
Ch. 11:390 |
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Necrosis in bronchioles |
Infections |
Ch. 6:133; Ch. 9:312 |
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Acute aspiration |
Ch. 9:306 |
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Fibrin in alveoli |
Diffuse alveolar damage |
Ch. 6:128 |
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Drug toxicity |
Ch. 6:136 |
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Connective tissue disease |
Ch. 6:134 |
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Infection |
Ch. 6:133; Ch. 7:203 |
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Eosinophils in alveoli |
Eosinophilic lung diseases |
Ch. 6:139; Ch. 8:255 |
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Siderophages in alveoli |
Diffuse alveolar hemorrhage |
Ch. 6:140; Ch. 11:393 |
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Drug toxicity |
Ch. 11:394 |
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Infarct |
Ch. 7:152; Ch. 11:390 |
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Fibrinous pleuritis |
Connective tissue diseases |
Ch. 6:134 |
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Eosinophilic pneumonia |
Ch. 6:139 |
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Pneumothorax |
Ch. 8:276 |
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Neutrophils |
Infections |
Ch. 6:143 |
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Capillaritis in diffuse alveolar hemorrhage |
Ch. 11:395 |
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Atypical cells |
Acute lung injury |
Ch. 6:142 |
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Viral infections |
Ch. 6:143 |
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Leukemias |
Ch. 16:528 |
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Intravascular lymphoma |
Ch. 16:548 |
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Fibrin + vacuolated macrophages |
Infection |
Ch. 7:174 |
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Drug toxicity |
Ch. 6:136 |
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Connective tissue diseases |
Ch. 6:136 |
Elements of the pattern: the lung biopsy is involved by variable amounts of fibrosis. As in Pattern 1, the biopsy tends to be more pink than blue at scanning magnification, as a result of collagen deposition (in routine hematoxylin-eosin stained sections). Some fibrosis patterns are accompanied by chronic inflammation that may impart a blue tinge to the process, or even dark blue lymphoid aggregates.
Significant lung fibrosis is always associated with some degree of structural remodeling. Avoid diagnosing "fibrosis" on transbronchial biopsies.
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Additional Findings |
Diagnostic Consideration |
Chapter:Page |
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Hyaline membranes |
“Acute on chronic” disease |
Ch. 5:110 |
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Infection on fibrosis |
Ch. 6:128 |
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Drug toxicity on fibrosis |
Ch. 6:136 |
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Connective tissue disease in “exacerbation” |
Ch. 6:140 |
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Acute exacerbation of idiopathic pulmonary fibrosis (IPF) |
Ch. 8:234 |
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Microscopic honeycombing |
Usual interstitial pneumonia (UIP) |
Ch. 8:229 |
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Hypersensitivity pneumonitis |
Ch. 8:269 |
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Connective tissue disease |
Ch. 8:247 |
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Prominent bronchiolization |
Pulmonary Langerhans cell histiocytosis |
Ch. 8:272 |
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Respiratory bronchiolitis ILD |
Ch. 8:240 |
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Connective tissue diseases |
Ch. 8:247 |
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Chronic hypersensitivity pneumonitis |
Ch. 8:269 |
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Small airways disease |
Ch. 9:317 |
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Chronic aspiration |
Ch. 8:267; Ch. 9:312 |
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Uniform alveolar septal fibrosis |
Connective tissue diseases |
Ch. 8:247 |
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Postirradiation |
Not specifically addressed |
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Peripheral lobular fibrosis |
UIP/IPF |
Ch. 8:229 |
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Erdheim Chester disease |
Ch. 8:276 |
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Rosai-Dorfman disease |
Ch. 19:650 |
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Chronic eosinophilic pneumonia |
Ch. 8:255 |
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Siderophages in alveoli |
Chronic cardiac congestion |
Ch. 5:114 |
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Chronic venous outflow obstruction |
Not specifically addressed |
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Chronic hemorrhage in connective tissue disease |
Ch. 8:250 |
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Chronic hemorrhage in bronchiectasis |
Ch. 11:390 |
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Pneumoconiosis |
Ch. 10:339 |
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Pulmonary Langerhans cell histiocytosis |
Ch. 8:272 |
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Smoking-related interstitial lung disease |
Ch. 8:243 |
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Chronic renal dialysis |
Not specifically addressed |
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Idiopathic pulmonary hemosiderosis |
Ch. 11:395 |
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Fibrinous pleuritis |
Connective tissue disease |
Ch. 8:247 |
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Eosinophilic pleuritis in pneumothorax |
Ch. 8:276; Appendix:770 |
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Prominent nonnecrotizing granulomas |
Sarcoidosis |
Ch. 8:266 |
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Many vacuolated cells |
Chronic airway obstruction |
Ch. 8:272 |
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Drug toxicity |
Ch. 8:289 |
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Hermansky-Pudlak syndrome |
Ch. 8:279 |
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Genetic storage diseases |
Ch. 5:120 |
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Prominent chronic inflammation |
Nonspecific interstitial pneumonia (NSIP) |
Ch. 8:235 |
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Rheumatoid arthritis and other connective tissue diseases |
Ch. 8:247 |
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Airway-centered scarring |
Pulmonary Langerhans cell histiocytosis |
Ch. 8:272 |
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Pneumoconiosis |
Ch. 9:320 |
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Chronic hypersensitivity pneumonitis |
Ch. 8:269 |
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Connective tissue diseases |
Ch. 8:247 |
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Idiopathic airway-centered fibrosis |
Ch. 8:288 |
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Idiopathic pleuroparenchymal fibroelastosis |
Ch. 8:246 |
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Chronic aspiration |
Ch. 8:267; Ch. 9:312 |
Elements of the pattern: the lung biopsy is dominated by interstitial chronic inflammation and variable reactive type 2 cell hyperplasia. The dominance of mononuclear infiltrates may impart an overall blue appearance to the biopsy at scanning magnification (in routine hematoxylin-eosin stained sections).
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Additional Findings |
Diagnostic Consideration |
Chapter:Page |
|
Hyaline membranes |
“Acute on chronic” connective tissue disease Drug toxicity Diffuse alveolar hemorrhage |
Ch. 6:134 Ch. 6:136 Ch. 11:393 |
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Necrosis in parenchyma |
Viral and fungal infections |
Ch. 7:178, 199 |
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Aspiration |
Ch. 7:161; Ch. 9:306 |
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Infarction in antiphospholipid syndrome |
Ch. 8:251 |
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Necrosis in bronchioles |
Viral infections |
Ch. 7:199 |
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Aspiration |
Ch. 7:161; Ch. 9:306 |
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Poorly formed granulomas (small and nonnecrotizing) |
Hypersensitivity pneumonitis (subacute) |
Ch. 8:269 |
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Atypical mycobacterial infection |
Ch. 8:270 |
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“Hot tub” lung |
Ch. 7:175 |
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Lymphoid interstitial pneumonia |
Ch. 8:244 |
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Drug toxicity |
Ch. 8:259 |
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Well-formed necrotizing granulomas |
Infections |
Ch. 7:177 |
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Rare drug reactions |
Not specifically addressed |
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Necrotizing sarcoidosis |
Ch. 11:383 |
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Middle lobe syndrome |
Ch. 9:303 |
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Eosinophils in alveoli |
Eosinophilic lung diseases |
Ch. 6:139; Ch. 8:255 |
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Smoking-related lung diseases |
Ch. 8:243 |
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Siderophages in alveoli |
Diffuse alveolar hemorrhage |
Ch. 11:393 |
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Chronic cardiac congestion |
Ch. 5:114 |
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Drug toxicity |
Ch. 8:259 |
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Fibrinous/chronic pleuritis |
Connective tissue diseases |
Ch. 8:247 |
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Thoracic trauma/infection |
Ch. 8:248 |
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Pancreatitis-associated pleuritis |
Not specifically addressed |
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Patchy organizing pneumonia |
Drug toxicity |
Ch. 8:259 |
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Connective tissue diseases |
Ch. 8:247 |
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Infections |
Ch. 8:239 |
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Cryptogenic organizing pneumonia |
Ch. 8:237 |
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Diffuse alveolar hemorrhage |
Ch. 11:393 |
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Aspiration |
Ch. 7:161; Ch. 9:306 |
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Atypical cells |
Viral infections |
Ch. 7:199 |
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Lymphangitic carcinoma |
Ch. 8:246 |
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Multinucleated giant cells |
Hard metal disease |
Ch. 10:354 |
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Mica pneumoconiosis |
Ch. 10:347 |
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Hypersensitivity pneumonitis |
Ch. 8:269 |
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Intravenous drug abuse |
Ch. 8:263 |
|
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Drug toxicity |
Ch. 8:259 |
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Aspiration pneumonia |
Ch. 7:161; Ch. 9:306 |
|
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Eosinophilic pneumonia |
Ch. 6:139; Ch. 8:255 |
|
|
Dense mononuclear infiltration |
Lymphomas |
Ch. 16:542 |
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Lymphoid interstitial pneumonia |
Ch. 8:244 |
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Connective tissue diseases |
Ch. 8:247 |
|
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Hypersensitivity pneumonitis |
Ch. 8:269 |
|
|
Certain infections ( The atypical pneumonias) |
Ch. 7:162 |
|
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Lymphoid aggregates/germinal centers |
Connective tissue diseases |
Ch. 8:247 |
|
Diffuse lymphoid hyperplasia |
Ch. 8:245; Ch. 16:537 |
|
|
Lymphoid interstitial pneumonia |
Ch. 8:244 |
|
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Follicular bronchiolitis |
Ch. 9:308 |
Elements of the pattern: the dominant finding is alveolar spaces filled with cells or noncellular elements.
|
Additional Findings |
Diagnostic Consideration |
Chapter:Page |
|
Hyaline membranes and fibrin |
Organizing diffuse alveolar damage |
Ch. 6:125; Ch. 7:162 |
|
Necrosis and neutrophils |
Bacterial infection |
Ch. 7:159 |
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Viral and fungal infection |
Ch. 7:178, 199 |
|
|
Organizing pneumonia |
Organizing infection |
Ch. 7:159 |
|
Drug toxicity |
Ch. 8:259 |
|
|
Cryptogenic organizing pneumonia |
Ch. 8:237 |
|
|
Fibrin and macrophages |
Eosinophilic pneumonia, poststeroid |
Ch. 6:139; Ch. 8:255 |
|
Drug toxicity |
Ch. 8:259 |
|
|
Connective tissue diseases |
Ch. 8:247 |
|
|
Malakoplakia-like reaction |
Ch. 7:160 |
|
|
Eosinophils and macrophages |
Eosinophilic lung diseases |
Ch. 6:139; Ch. 8:255 |
|
Siderophages and fibrin |
Diffuse alveolar hemorrhage |
Ch. 11:393 |
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Mucin |
Mucostasis in small airways disease |
Ch. 9:317 |
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Bronchioloalveolar carcinoma |
Ch. 17:576 |
|
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Cryptococcus infection |
Ch. 7:184 |
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Bone/calcification |
Dendriform calcification |
Ch. 8:240; Appendix:774 |
|
Metastatic calcification |
Appendix:774 |
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Pulmonary alveolar microlithiasis |
Ch. 8:280 |
|
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Atypical cells |
Bronchioloalveolar carcinoma |
Ch. 17:576 |
|
Herpesvirus infections |
Ch. 7:203 |
|
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Acute eosinophilic pneumonia |
Ch. 6:139; Ch. 8:255 |
|
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Carcinomas and sarcomas |
Not specifically addressed |
|
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Proteinaceous exudates |
Edema |
Ch. 6:126 |
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Pulmonary alveolar proteinosis (PAP) |
Ch. 8:283 |
|
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PAP reactions |
Ch. 8:283 |
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Pneumocystis pneumonia |
Ch. 7:191 |
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Multinucleated giant cells |
Hard metal disease |
Ch. 10:354 |
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Eosinophilic pneumonia |
Ch. 6:139; Ch. 8:255 |
|
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Granulomatosis with polyangiitis |
Ch. 11:367 |
|
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Aspiration pneumonia |
Ch. 7:161; Ch. 9:306 |
|
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Polypoid mesenchymal bodies resembling chorionic villi |
Bullous placental transmogrification |
Appendix:779 |
Elements of the pattern: One, or many, nodules of variable size and shape. An interface between the nodular lesion and more normal lung should be discernible. In the case of very large nodules encompassing the entire specimen, radiologic imaging can be used as part of the definition.
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Additional Findings |
Diagnostic Consideration |
Chapter:Page |
|
Large neoplastic lymphoid cells |
Malignant lymphoma |
Ch. 16:542 |
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Small lymphoid cells without germ |
Mucosa-associated lymphoid tissue (MALT) |
Ch. 16:542 |
|
centers |
lymphoma, low grade |
|
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Small lymphoid cells with germ centers |
Follicular bronchiolitis |
Ch. 16:534 |
|
Diffuse lymphoid hyperplasia |
Ch. 16:534 |
|
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Intraparenchymal lymph node |
Not specifically addressed |
|
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Giant multinucleated neoplastic cells |
Sarcomatoid carcinoma |
Ch. 15:467 |
|
Large cell undifferentiated carcinoma |
Ch. 17:583 |
|
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Primary and metastatic sarcomas |
Ch. 15:476 |
|
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Primary or metastatic pleomorphic carcinomas |
Ch. 15:467 |
|
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Primary or metastatic melanoma |
Ch. 15:500 |
|
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Giant cell tumor (primary or metastatic) |
Ch. 15:467 |
|
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Primitive small round neoplastic cells |
Small cell carcinoma |
Ch. 14:453 |
|
Malignant lymphoma |
Ch. 16:542 |
|
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Small cell squamous carcinoma |
Ch. 17:581 |
|
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Metastatic tumors |
Ch. 18:597 |
|
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Ewing sarcoma |
Ch. 18:625 |
|
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Primitive neuroectodermal tumor |
Ch. 14:459 |
|
|
Small cell osteosarcoma |
Ch. 18:621 |
|
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Neuroblastoma |
Ch. 14:460 |
|
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Pleuropulmonary blastoma (with cysts) |
Ch. 15:513 |
|
|
Spindled or fusiform neoplastic cells |
Primary sarcomatoid carcinoma |
Ch. 15:467 |
|
Primary and metastatic sarcomas |
Ch. 15:476 |
|
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Lymphangioleiomyomatosis (with cysts) |
Ch. 8:276 |
|
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Inflammatory myofibroblastic tumor |
Ch. 19:646; Ch. 20:692 |
|
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Benign metastasizing leiomyoma |
Ch. 15:482; Ch. 20:681 |
|
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Localized fibrous tumor |
Ch. 15:485 |
|
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Extraabdominal desmoid tumor |
Ch. 20:703 |
|
|
Large pink epithelioid neoplastic cells |
Poorly differentiated primary carcinomas |
Ch. 17:583 |
|
Large cell undifferentiated carcinoma |
Ch. 17:583 |
|
|
Metastatic carcinomas |
Ch. 18:606 |
|
|
Metastatic sarcomas |
Ch. 18:617 |
|
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Epithelioid hemangioendothelioma |
Ch. 15:482 |
|
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Melanoma (primary or metastatic) |
Ch. 15:497 |
|
|
Large clear epithelioid neoplastic cells |
Primary clear cell adenocarcinoma |
Ch. 17:581 |
|
Primary squamous carcinoma |
Ch. 17:581 |
|
|
Large cell carcinoma (primary) |
Ch. 17:583 |
|
|
Sugar tumor |
Ch. 20:705 |
|
|
Perivascular epithelioid cell tumor (PEComa) |
Ch. 20:689 |
|
|
Metastatic clear cell carcinoma |
Ch. 18:609 |
|
|
Metastatic clear cell sarcoma |
Ch. 18:632 |
|
|
Large basophilic epithelial cells with peripheral palisade |
Large cell undifferentiated carcinoma |
Ch. 17:583 |
|
Large cell neuroendocrine carcinoma |
Ch. 14:450 |
|
|
Basaloid large cell lung carcinoma |
Ch. 17:583 |
|
|
Basaloid squamous carcinoma |
Ch. 17:583 |
|
|
Certain metastatic tumors |
Ch. 17:584 |
Table continues on following page.
|
Additional Findings |
Diagnostic Consideration |
Chapter:Page |
|
Glands or tubules, malignant |
Primary adenocarcinoma |
Ch. 17:576 |
|
Metastatic adenocarcinoma |
Ch. 18:606 |
|
|
Carcinoid tumor (primary or metastatic) |
Ch. 14:443 |
|
|
Synovial sarcoma (primary or metastatic) |
Ch. 15:491 |
|
|
Fetal-type primary adenocarcinoma |
Ch. 15:472 |
|
|
Carcinosarcoma (primary or metastatic) |
Ch. 15:467 |
|
|
Glands or tubules, benign or mild atypia |
Alveolar adenoma |
Ch. 20:679 |
|
Adenoma of type II cells |
Ch. 20:684 |
|
|
Pulmonary sclerosing hemangioma |
Ch. 20:695 |
|
|
Hamartoma |
Ch. 19:643 |
|
|
Micronodular pneumocyte hyperplasia |
Ch. 8:282 |
|
|
Adenomatoid tumor |
Ch. 20:689 |
|
|
Malignant heterologous elements (cartilage, bone, skeletal muscle) |
Carcinosarcoma |
Ch. 15:467 |
|
Metastatic teratocarcinoma |
Ch. 15:516 |
|
|
Metastatic sarcoma |
Ch. 15:467 |
|
|
Distinct keratinization |
Primary squamous cell carcinoma |
Ch. 17:581 |
|
Squamous metaplasia of terminal airways |
Ch. 6:126, 130 |
|
|
Basaloid squamous cell carcinoma |
Ch. 17:583 |
|
|
Adenosquamous carcinoma |
Ch. 17:583 |
|
|
Metastatic squamous cell carcinoma |
Ch. 17:581 |
|
|
Pigmented cells |
Cellular phase of Langerhans cell histiocytosis |
Ch. 8:273 |
|
Primary or metastatic melanoma |
Ch. 15:497 |
|
|
Melanotic carcinoid tumor |
Ch. 15:499 |
|
|
Metastatic angiosarcoma (hemosiderin) |
Ch. 15:498 |
|
|
Malignant with dominant necrosis |
Small cell carcinoma |
Ch. 14:453 |
|
Sarcomatoid carcinoma (primary or metastatic) |
Ch. 15:467 |
|
|
High-grade malignant lymphoma |
Ch. 16:542 |
|
|
Benign with necrosis |
Necrotizing infections Bacterial Fungal Mycobacterial Viral |
Ch. 6:128, 133; Ch. 9:312 |
|
Granulomatosis with polyangiitis |
Ch. 11:367 |
|
|
Churg-Strauss syndrome |
Ch. 11:367 |
|
|
Lung infarct |
Ch. 11:385 |
|
|
Benign with dominant organizing pneumonia |
Nodular organizing pneumonia |
Not specifically addressed |
|
Aspiration pneumonia |
Ch. 7:161; Ch. 9:306 |
|
|
Benign with well-formed granulomas |
Granulomatous infection Fungal Mycobacterial Bacterial (botryomycosis) |
Ch. 7:178 |
|
Sarcoidosis/berylliosis |
Ch. 7:177 |
|
|
Certain pneumoconioses |
Ch. 10:335 |
|
|
Aspiration pneumonia |
Ch. 7:161; Ch. 9:306 |
|
|
Necrotizing sarcoidosis |
Ch. 11:383 |
|
|
Benign with stellate airways centered lesions and variable fibrosis |
Pulmonary Langerhans cell histiocytosis |
Ch. 8:272 |
|
Certain inhalational injuries |
Ch. 8:263 |
|
|
Pneumoconioses |
Ch. 10:335 |
Elements of the pattern: the lung biopsy has little or no disease evident at scanning magnification.
|
Additional Findings |
Diagnostic Consideration |
Chapter:Page |
|
Thick pulmonary arteries |
Pulmonary hypertension Chronic obstructive pulmonary disease |
Ch. 12:403 Ch. 9:326 |
|
Cysts |
Lymphangioleiomyomatosis Pulmonary Langerhans cell histiocytosis Bullous emphysema |
Ch. 8:276 Ch. 8:272 Appendix:779 |
|
Patchy hyaline membranes |
Acute lung injury, early (may be subtle) |
Ch. 6:126; Ch. 7:205 |
|
Airway scarring |
Constrictive bronchiolitis (CB) |
Ch. 9:319 |
|
Bronchiolization (bronchiolar metaplasia) |
Small airways disease with or without CB |
Ch. 9:319 |
|
Dilated bronchioles |
Small airways disease with or without CB |
Ch. 9:319 |
|
Bronchioles absent, markedly decreased, or dilated |
Constrictive bronchiolitis |
Ch. 9:319 |
|
Prominent emphysema |
Small airways disease with or without CB |
Ch. 9:319 |
|
Atypical cells |
Lymphangitic and intravascular carcinoma |
Ch. 8:246 |