Clinical and Histopathologic Features of Immune Checkpoint Inhibitor-related Pneumonitis

Brandon Larsen, June M. Chae, Anuj S. Dixit, Thomas E Hartman, Tobias D Peikert, Anja Roden

Research output: Contribution to journalArticle

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized oncology, but are associated with immune-related adverse events. Clinically, pneumonitis is a well-recognized complication, but its histopathologic features are poorly understood. Institutional archives were searched for patients having ICI therapy and subsequent lung tissue sampling. After excluding infectious cases, 9 patients (5 women, median: 59 y) were identified with clinically suspected ICI-related pneumonitis. Clinical history, imaging, and pathology slides were reviewed. Patients received pembrolizumab (6 cases), nivolumab (1), ipilimumab followed by pembrolizumab (1), or pembrolizumab followed by nivolumab (1); the latter experienced pneumonitis with both agents. Treatment duration ranged from 1 to 33 cycles (median: 8). Three patients received concurrent chemotherapy and 1 received radiation; the remainder received ICI monotherapy. Symptoms were nonspecific; 2 patients were asymptomatic. Thoracic imaging showed bilateral ground glass or nodular opacities in all cases, often with pleural effusion. Histologically, organizing pneumonia was seen in 7 patients, all with subclinical or mild disease, admixed with vague non-necrotizing airspace granulomas in 3 cases; all 6 patients with follow-up did well. One patient had acute fibrinous pneumonitis and 1 had diffuse alveolar damage; both died. All 9 cases showed foamy macrophages and pneumocyte vacuolization; 6 had rare eosinophils. ICI-related pneumonitis presents as bilateral ground-glass opacities or nodules, and usually manifests as organizing pneumonia histopathologically, often with vague non-necrotizing airspace granulomas. Foamy macrophages and pneumocyte vacuolization are characteristic and rare eosinophils are often seen. Less commonly, acute fibrinous pneumonitis or diffuse alveolar damage can occur, which may be fatal.

Original languageEnglish (US)
JournalAmerican Journal of Surgical Pathology
DOIs
StatePublished - Jan 1 2019

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Pneumonia
Alveolar Epithelial Cells
Granuloma
Eosinophils
Glass
Macrophages
Pleural Effusion
Thorax
Radiation
Pathology
Drug Therapy
Lung
Therapeutics
pembrolizumab

Keywords

  • drug reaction
  • immunotherapy
  • nivolumab
  • pembrolizumab

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Clinical and Histopathologic Features of Immune Checkpoint Inhibitor-related Pneumonitis. / Larsen, Brandon; Chae, June M.; Dixit, Anuj S.; Hartman, Thomas E; Peikert, Tobias D; Roden, Anja.

In: American Journal of Surgical Pathology, 01.01.2019.

Research output: Contribution to journalArticle

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