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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 6: Forty-six-year-old female with constipation and pneumonia.
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Week 201: Case 6
Forty-six-year-old female with constipation and pneumonia.images/PA 9 27 04 case 6 1.jpg
images/PA 9 27 04 case 6 2.jpg
images/PA 9 27 04 case 6 3.jpg
images/PA 9 27 04 case 6 4.jpgCorrect
Answer: Exogenous lipid pneumonia
Histology: The architecture of the lung is markedly distorted by fibrosis and multinucleated giant cells which appear to surround clear spaces. These spaces represent lipid droplets that have dissolved out of these sections upon processing. This patient was taking mineral oil chronically for constipation, and it is known that patients who take mineral oil often silently aspirate it, leading to lipid pneumonia.
Discussion: Endogenous lipid pneumonia is caused by obstruction of airways leading to accumulation of macrophages behind the obstruction. Obstruction may commonly be due to an endobronchial lesion such as squamous cell carcinoma. In endogenous lipid pneumonia, the macrophages have small fine vacuoles and fibrosis is not present. Whipple’s disease would contain prominent PAS-positive macrophages surrounding dilated lymphatic spaces. Pulmonary Interstitial Emphysema typically occurs in patients on high-pressure ventilators; in this setting, air penetrates a small break in the pulmonary epithelial lining and dissects into the interstitium of the lung, inciting a multinucleated giant cell reaction.
Incorrect
Answer: Exogenous lipid pneumonia
Histology: The architecture of the lung is markedly distorted by fibrosis and multinucleated giant cells which appear to surround clear spaces. These spaces represent lipid droplets that have dissolved out of these sections upon processing. This patient was taking mineral oil chronically for constipation, and it is known that patients who take mineral oil often silently aspirate it, leading to lipid pneumonia.
Discussion: Endogenous lipid pneumonia is caused by obstruction of airways leading to accumulation of macrophages behind the obstruction. Obstruction may commonly be due to an endobronchial lesion such as squamous cell carcinoma. In endogenous lipid pneumonia, the macrophages have small fine vacuoles and fibrosis is not present. Whipple’s disease would contain prominent PAS-positive macrophages surrounding dilated lymphatic spaces. Pulmonary Interstitial Emphysema typically occurs in patients on high-pressure ventilators; in this setting, air penetrates a small break in the pulmonary epithelial lining and dissects into the interstitium of the lung, inciting a multinucleated giant cell reaction.
