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Presented by Peter Illei, M.D. and prepared by ChanJuan Shi, M.D., Ph.D.
Case 6: 59 y.o. female with history significant for esophageal hernia.
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1. Question
Week 359: Case 6
59 y.o. female with history significant for esophageal hernia, status post multiple repair 01/01, diverticulosis, status post appendectomy, abdominal hernia CT and mild obstructive sleep apnea who presents for evaluation for abnormal on chest CT and setting of recurrent pneumonia and
persistent dyspnea.images/7-28-2008-6a.jpg
images/7-28-2008-6b.jpg
images/7-28-2008-6c.jpgCorrect
Answer: Extensive bronchial metaplasia in background of emphysema
Histology: The sections show lung with emphysematous changes with interstitial scarring and several foci of extensive bronchial metaplasia. The affected areas show colonization by uniform ciliated columnar cells that lack cytologic atypia and any tissue response.
Discussion: In contrast, in cases with atypical adenomatous hyperplasia (AAH) there is mild to moderate cytologic atypia and the cells are not ciliated. In bronchioloalveolar carcinoma (BAC) of the non-mucinous type the cells are similar to those seen in AAH and may show variable degree of dense interstitial fibrosis (sclerosing variant). In the current WHO classification, the distinction between AAH and BAC is based on size criteria rather than morphologic features (> 5 mm is considered AAH).
Incorrect
Answer: Extensive bronchial metaplasia in background of emphysema
Histology: The sections show lung with emphysematous changes with interstitial scarring and several foci of extensive bronchial metaplasia. The affected areas show colonization by uniform ciliated columnar cells that lack cytologic atypia and any tissue response.
Discussion: In contrast, in cases with atypical adenomatous hyperplasia (AAH) there is mild to moderate cytologic atypia and the cells are not ciliated. In bronchioloalveolar carcinoma (BAC) of the non-mucinous type the cells are similar to those seen in AAH and may show variable degree of dense interstitial fibrosis (sclerosing variant). In the current WHO classification, the distinction between AAH and BAC is based on size criteria rather than morphologic features (> 5 mm is considered AAH).
