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Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad
This case talks about a 50-year-old woman who has undergone lung transplantation.
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1. Question
This is a 50 year old female who has undergone lung transplantation. This is the native explant.
Diagnoses:
Correct
Answer: B
Histologic Description: This clearly is a process that is centered on the airways, which should be paired with small arterioles in the lung. What is striking about the specimen is that the many of the small airways have been completely obliterated, such they appear as small fibrous nodules adjacent to medium sized arterioles. This is best demonstrated using the Movat stain, which demonstrates either obliteration or concentric narrowing of the airways by new fibrous tissue. These are the typical findings of constrictive bronchiolitis.
Differential Diagnosis: Respiratory bronchiolitis is typically associated with smoking, and would feature pigmented macrophages centered upon airways with extension into the adjacent alveolar spaces, frequently associated with interstitial fibrosis. Follicular bronchiolitis would demonstrate more prominent lymphoid follicles centered on the airways, without the narrowing seen in this case. Bronchiolitis obliterans organizing pneumonia would feature fibrous plugs which extend out of the bronchioles into the adjacent alveolar spaces. The concentric narrowing seen in constrictive bronchiolitis differs from the polypoid fibrosis seen in bronchiolitis obliterans organizing pneumonia.
Constrictive bronchiolitis is frequently idiopathic, but may be secondary to viral infections or other etiologies. In a lung transplant, constrictive bronchiolitis usually represents chronic rejection.Incorrect
Answer: B
Histologic Description: This clearly is a process that is centered on the airways, which should be paired with small arterioles in the lung. What is striking about the specimen is that the many of the small airways have been completely obliterated, such they appear as small fibrous nodules adjacent to medium sized arterioles. This is best demonstrated using the Movat stain, which demonstrates either obliteration or concentric narrowing of the airways by new fibrous tissue. These are the typical findings of constrictive bronchiolitis.
Differential Diagnosis: Respiratory bronchiolitis is typically associated with smoking, and would feature pigmented macrophages centered upon airways with extension into the adjacent alveolar spaces, frequently associated with interstitial fibrosis. Follicular bronchiolitis would demonstrate more prominent lymphoid follicles centered on the airways, without the narrowing seen in this case. Bronchiolitis obliterans organizing pneumonia would feature fibrous plugs which extend out of the bronchioles into the adjacent alveolar spaces. The concentric narrowing seen in constrictive bronchiolitis differs from the polypoid fibrosis seen in bronchiolitis obliterans organizing pneumonia.
Constrictive bronchiolitis is frequently idiopathic, but may be secondary to viral infections or other etiologies. In a lung transplant, constrictive bronchiolitis usually represents chronic rejection.
