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Chest. 2016 Jun;149(6):1473-81. doi: 10.1016/j.chest.2015.12.030. Epub 2016 Jan 18.

Chronic Hypersensitivity Pneumonitis With a Usual Interstitial Pneumonia-Like Pattern: Correlation Between Histopathologic and Clinical Findings.

Author information

1
Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
2
Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: tsuchiya.pulm@tmd.ac.jp.
3
Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan.
4
Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
5
Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.

Abstract

BACKGROUND:

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of environmental antigens. The relationship between clinical, radiologic, and histopathologic findings of chronic HP remains unclear.

METHODS:

Sixteen patients with proven chronic bird-related HP with a usual interstitial pneumonia-like pattern were analyzed retrospectively. Histopathologic findings were semiquantitatively assessed and compared with clinical and radiologic findings. We also evaluated the histopathologic findings affecting prognosis.

RESULTS:

The extent of centrilobular fibrosis was negatively correlated with Pao2 (r = -0.55, P = .03). The extent of bridging fibrosis was positively correlated with the ratio of maximal expiratory flow at 50% of forced vital capacity to that at 25% (r = 0.60, P = .02). Patients with a greater extent of fibroblastic foci (FF) had more radiologic reticulation (P = .01), honeycombing (P = .01), and traction bronchiectasis (P = .02), and had significantly shorter survival time (P = .01) than patients with a lesser extent of FF. Multivariate analysis showed that the extent of FF was a significant prognostic factor (hazard ratio, 2.36; 95% confidence interval, 1.02-5.48; P = .04).

CONCLUSIONS:

Our findings demonstrated that the extent of FF was significantly associated with reticulation, honeycombing, and traction bronchiectasis on high-resolution CT scanning. Moreover, the extent of FF could be a useful predictor of mortality in chronic HP with a usual interstitial pneumonia-like pattern.

KEYWORDS:

fibroblastic foci; hypersensitivity pneumonia; interstitial lung disease; lung biopsy

PMID:
26836921
DOI:
10.1016/j.chest.2015.12.030
[Indexed for MEDLINE]

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