The Overlap between Respiratory Bronchiolitis and Desquamative Interstitial Pneumonia in Pulmonary Langerhans Cell Histiocytosis: High-Resolution CT, Histologic, and Functional Correlations

Robert Vassallo, Eric A. Jensen, Thomas V. Colby, Jay H. Ryu, William W. Douglas, Thomas E. Hartman, Andrew H. Limper

Research output: Contribution to journalArticle

132 Scopus citations

Abstract

Objectives: To characterize the histologic, high-resolution CT (HRCT), and functional correlates of respiratory bronchiolitis (RB)/desquamative interstitial pneumonia (DIP)-like changes in biopsy specimens of adults with pulmonary Langerhans cell histiocytosis (PLCH). Methods: We retrospectively identified 14 adult patients with histologically proven PLCH (all smokers) in whom both biopsy specimens and HRCT were available for review. The presence and extent of RB/DIP-like changes on lung biopsy specimens of patients with PLCH were correlated with total pack-years of smoking, lung function variables, and the presence of ground-glass attenuation on HRCT. Results: Varying degrees of RB/DIP-like changes were identified in all biopsy specimens. The extent of involvement with RB/DIP-like changes correlated with the cumulative exposure to cigarettes smoked at the time of biopsy (r = 0.61, p = 0.03). Ground-glass attenuation was detected in three HRCTs, two of which had extensive RB/DIP-like changes (≥ 70% involvement) on histology, suggesting that substantial smoking-induced RB/DIP-like changes may be the cause of ground-glass attenuation on the HRCT of patients with PLCH. No correlation was found between the extent of RB/DIP-like changes and total lung capacity, FEV1, or diffusion capacity of the lung for carbon monoxide. Conclusions: RB/DIP-like changes are exceedingly common in PLCH, may be sufficiently severe to cause the appearance of ground-glass attenuation on HRCT, and correlate with the cumulative exposure to cigarettes smoked. This study provides additional evidence that PLCH, RB, and DIP form a spectrum of interstitial patterns of lung injury to cigarette smoke.

Original languageEnglish (US)
Pages (from-to)1199-1205
Number of pages7
JournalChest
Volume124
Issue number4
DOIs
StatePublished - Oct 2003

Keywords

  • Cigarette smoking
  • Desquamative interstitial pneumonia
  • Interstitial lung disease
  • Pulmonary Langerhans cell histiocytosis
  • Respiratory bronchiolitis- associated interstitial lung disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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