DOI: 10.1097/PCR.0b013e31805d0113

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Issn Print: 1082-9784

Publication Date: 2007/05/01


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Non-Neoplastic Pulmonary Pathology

Arnold M. Schwartz

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Excerpt

Medical lung diseases represent a broad range of pathologies that consist of primary and systemic conditions, involve all components of lung anatomy, and result from many etiologies and pathogenetic mechanisms. The pathologic conditions may include inflammatory and infectious processes, autoimmune or hypersensitivity responses, congenital or acquired malformations, environmental or occupational exposures, secondary effects of chemoradiation therapy, and primary and secondary vascular reactions. The pathologist, as consultant and diagnostician, must be aware of pulmonary medical conditions and collaborate with his/her clinical colleagues to focus on and improve the diagnostic accuracy and relevance of the pathologic consultation. The pathologist should be aware of the clinical presentation in terms of symptoms, the progression and evolution of the process, the presence of underlying systemic diseases, knowledge of environmental exposures, or therapeutic or illicit drug reactions, and pertinent results of the physical examination, including pulmonary function tests and radiographic findings.
The lung has a limited number of specific anatomic structures, including large and small airways, alveolar parenchyma, pleura, and vasculature, and a limited number of host responses to an inordinate number of conditions and injuries. Along with the clinical information, the radiologic features provide the “big picture” and “gross” pathology of the disease process, in an analogous fashion to orthopedic pathology or neuropathology. The pathologist must collaborate with the clinician and radiologist in creating a set of overlapping Venn diagrams containing the differential diagnosis offered by each specialty. Equally important is the role of the pathologist in communicating with the thoracic surgeon so that optimal processing and handling of resected tissue is achieved. Communication is necessary to arrive at an accurate diagnosis and to provide insight into the subsequent management of the patient. It is not only important to be correct, it is necessary to be helpful.
We present in this issue of Pathology Case Reviews a set of 9 reports on non-neoplastic lung diseases. We begin with 2 cases of solitary pulmonary nodules that were initially suspected to be malignant but proved to be benign. The approach to the radiographic findings is discussed and the role of intraoperative consultation provides a diagnosis and prevents unnecessary extensive surgery. Two reports relating to vascular disease of the lung are presented; one considering an unusual vascular anomaly that may present with serious hemoptysis and the other discussing the progression of pulmonary arterial hypertension in an HIV seropositive individual. We then consider a set of 4 reports on parenchymal lung diseases that include acute eosinophilic lung disease, idiopathic interstitial pneumonia in the form of UIP (usual interstitial pneumonitis), autoimmune lung disease in the form of Goodpasture's disease, and drug-induced lung disease. Our 2 final reports focus on infectious diseases that may be confused by underlying lung conditions or appear difficult to diagnose. In this regard the collaboration of both anatomic pathology and clinical microbiology are necessary to achieve a definitive diagnosis.
We hope that you find this issue challenging and informative.
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