Focal organizing pneumonia on surgical lung biopsy

Causes, clinicoradiologic features, and outcomes

Fabien Maldonado, Craig E. Daniels, Elizabeth A. Hoffman, Eunhee S. Yi, Jay H Ryu

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background: Organizing pneumonia (OP) is a histologic pattern that is morphologically distinctive but nonspecific and can be seen in diverse clinical settings. Focal OP has been described as a discrete form of OP, but relatively little is known regarding this clinicopathologic entity. Methods: We sought to clarify the clinicoradiologic presentation, underlying causes, and outcomes associated with focal OP by retrospectively reviewing 26 consecutive cases diagnosed by surgical lung biopsy over an 8-year period from January 1, 1997, to December 31, 2004. Results: All patients presented with an unifocal opacity detected on chest radiography (20 patients) or CT scans (6 patients). At the time of presentation, 10 patients (38%) had symptoms, including cough, shortness of breath, or chest pain; 16 patients were asymptomatic. Contrast-enhancement CT scanning or positron emission tomography (PET) scan was performed in 11 patients, and the results were positive in all. Surgical procedures included wedge resection in 21 patients (81%), segmentectomy in 3 patients (11%), and lobectomy in 2 patients (8%). Three case of focal OP (12%) were related to infections, but the remaining cases were cryptogenic. Follow-up over a median interval of 11 months (range, 1 to 71 months) yielded no recurrence of OP. Conclusions: The radiologic features of focal OP are often indistinguishable from those of lung cancer, and include positivity on contrast-enhancement CT scan and PET scan. Most cases of focal OP are cryptogenic, and infection is identified in a minority of cases. Surgical resection alone appears to suffice in the management of cryptogenic focal OP.

Original languageEnglish (US)
Pages (from-to)1579-1583
Number of pages5
JournalChest
Volume132
Issue number5
DOIs
StatePublished - Nov 2007

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Pneumonia
Biopsy
Lung
Cryptogenic Organizing Pneumonia
Positron-Emission Tomography
Segmental Mastectomy
Infection
Chest Pain
Cough
Radiography
Dyspnea
Lung Neoplasms
Thorax
Recurrence

Keywords

  • Cryptogenic organizing pneumonia
  • Interstitial lung disease
  • Organizing pneumonia
  • Pulmonary nodule

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Focal organizing pneumonia on surgical lung biopsy : Causes, clinicoradiologic features, and outcomes. / Maldonado, Fabien; Daniels, Craig E.; Hoffman, Elizabeth A.; Yi, Eunhee S.; Ryu, Jay H.

In: Chest, Vol. 132, No. 5, 11.2007, p. 1579-1583.

Research output: Contribution to journalArticle

Maldonado, Fabien ; Daniels, Craig E. ; Hoffman, Elizabeth A. ; Yi, Eunhee S. ; Ryu, Jay H. / Focal organizing pneumonia on surgical lung biopsy : Causes, clinicoradiologic features, and outcomes. In: Chest. 2007 ; Vol. 132, No. 5. pp. 1579-1583.
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abstract = "Background: Organizing pneumonia (OP) is a histologic pattern that is morphologically distinctive but nonspecific and can be seen in diverse clinical settings. Focal OP has been described as a discrete form of OP, but relatively little is known regarding this clinicopathologic entity. Methods: We sought to clarify the clinicoradiologic presentation, underlying causes, and outcomes associated with focal OP by retrospectively reviewing 26 consecutive cases diagnosed by surgical lung biopsy over an 8-year period from January 1, 1997, to December 31, 2004. Results: All patients presented with an unifocal opacity detected on chest radiography (20 patients) or CT scans (6 patients). At the time of presentation, 10 patients (38{\%}) had symptoms, including cough, shortness of breath, or chest pain; 16 patients were asymptomatic. Contrast-enhancement CT scanning or positron emission tomography (PET) scan was performed in 11 patients, and the results were positive in all. Surgical procedures included wedge resection in 21 patients (81{\%}), segmentectomy in 3 patients (11{\%}), and lobectomy in 2 patients (8{\%}). Three case of focal OP (12{\%}) were related to infections, but the remaining cases were cryptogenic. Follow-up over a median interval of 11 months (range, 1 to 71 months) yielded no recurrence of OP. Conclusions: The radiologic features of focal OP are often indistinguishable from those of lung cancer, and include positivity on contrast-enhancement CT scan and PET scan. Most cases of focal OP are cryptogenic, and infection is identified in a minority of cases. Surgical resection alone appears to suffice in the management of cryptogenic focal OP.",
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