Giorgia Dalpiaz Alessandra Cancellieri Bologna Malattie granulomatose interstiziali [email protected] [email protected] Granuloma: an immunologic, nodular aggregate of macrophages +/- giant cells Histopathology 2007;50:289 DEFINING HISTOLOGY One Hundred Consecutive Granulomas in a Pulmonary Pathology Consultation Practice Julianne Roberta Hutton Klein, MD, Henry Dale Tazelaar, MD, Kevin Orr Leslie, MD, and Thomas Vail Colby, MD A confident diagnosis was rendered in 27 cases, a specific diagnosis was strongly favored in 34, and in 39 a differential diagnosis was provided. The most common unrecognized diagnosis was aspiration pneumonia and the most common diagnosis omitted from the differential diagnosis by the primary pathologist was hypersensitivity pneumonia Am J Surg Pathol 2010;34:1456-1464 Approccio anatomico Colby TV and Swensen SJ J Thor Imaging 1996 Noduli avidi di pleura Perilinfatici Sarcoidosi Noduli perilinfatici Pseudoplacche & Remy-Jardin M., Radiology 1990 Noduli perilinfatici Linfonodi mediastinici ed ilari simmetrici Ma JL, Gal A, Koss MN. The pathology of sarcoidosis: update. Semin Diagn Pathol 2007;24:150 Non-necrotizing granulomas Fibrinoid, granular necrosis not unusual TBB TBNA (WANG NEEDLE) OF MEDIASTINAL LYMPH NODES Apply strict criteria (>50% lymphocytes) Well-formed aggregates No necrosis Beware of “normal” findings Sarcoidosi: Malattia a molte facce & Criado. Pulmonary sarcoidosis: typical and atypical manifestations at HRCT with pathologic correlation. Radiographics. 2010 Pattern alveolare Addensamenti bilaterali e simmetrici Pattern alveolare Vetro smerigliato (Ground-glass) • In HRCT nel 20-60% dei pazienti • Raramente è il segno prevalente & Leung A. Radiology, 1993 Sarcoidosi o Linfangite carcinomatosa ? Sarcoidosi o Linfangite carcinomatosa ? La chiave per la diagnosi è … … calcificazioni a spruzzo Noduli pavidi di pleura Centrolobulari AAE subacuta AAE subacuta HP (subacute) Coleman & Colby Am J Surg Pathol 1988;12(7):514-518 13 cases of chronic HP 3 patterns: UIP-like, NSIP-like, peribronchiolar fibrosis Am J Surg Pathol 2006;30:201-208 Am J Surg Pathol 2009;33:1765 11.3 yrs 2.1 yrs 2.8 yrs Noduli indifferenti alla pleura Random TB miliare TB miliare TB bronchiolare Cortesia di K.O.Leslie, USA Am J Surg Pathol 2012;1497 HOT TUB LUNG Khoor et al. Am J Clin Pathol 2001;115:755-762 Chest, 2007; 131:1414-1423 Am J Pathol 1981;102:447 Am J Surg Pathol 2007;31:752 Reperto occasionale in TC eseguite per altri motivi Sindrome da aspirazione: condizioni favorenti • Riduzione stato di coscienza • Malattie gastrointestinali: • Malattie neurologiche/neuromuscolari Frequente sede basale Am J Surg Pathol 2003;27:213 Respiration 2007;74:698 Am J Surg Pathol 2014;38:354 TAKE HOME MESSAGE Granulomas are a common diagnostic problem for pathologists Keys: morphology & topography Pathological key features: necrosis (infection), inflammation (infection, HP), fibrosis (sarcoid), illdefined / well-defined (HP vs sarcoid) CT key features: nodules, but also tree-in-bud and consolidation Topographic key features: perilymphatic (sarcoid), random (infection), centrilobular (HP, aspiration)
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