OpenLB
Open Library of Bioscience
Advanced Search
Der Pathologe
Feb, 2021;42 (1): 55-63.

[Cryptogenic organizing pneumonia versus secondary organizing pneumonia].

Rosemarie Krupar, Christiane Kümpers, Alexander Haenel, Sven Perner, Florian Stellmacher
Author Information
  1. Rosemarie Krupar: Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland. rkrupar@fz-borstel.de.
  2. Christiane Kümpers: Institut für Pathologie, Universität zu Lübeck und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
  3. Alexander Haenel: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
  4. Sven Perner: Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland.
  5. Florian Stellmacher: Pathologie, Forschungszentrum Borstel, Leibniz Lungenzentrum, Parkallee 3A, 23845, Borstel, Deutschland.
PMID: 33462627 DOI: 10.1007/s00292-020-00903-8

Abstract

Organizing pneumonia (OP) describes a histological pattern of acute or subacute lung damage. Clinically, patients present with cough, fever, and dyspnea. A distinction is made between idiopathic or cryptogenic organizing pneumonia (COP) and secondary organizing pneumonia (OP). In COP, neither clinical/radiological nor histological causes can be determined. It is classified as an interstitial idiopathic pneumonia (IIP) according to the criteria of the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Secondary organizing pneumonia has a known triggering mechanism, such as infectious agents, certain medications, or concomitant symptoms of other primary pulmonary diseases and diseases of other organ systems. Common to both forms is the histological picture of intra-alveolar mesenchymal buds. These are myofibroblast proliferates that branch out along the alveolar spaces. They are usually accompanied by a moderate interstitial and alveolar, chronic, and macrophage-rich inflammatory cell infiltrate. The most important differential diagnosis is common interstitial pneumonia (UIP). It also shows fibroblast proliferates, which are, however, located in the interstitium. The correct classification of an IIP as a COP by means of clinical, radiological, and histological findings is essential, since the COP, in contrast to the UIP, responds very well to corticosteroids and therefore has an excellent prognosis compared to the UIP. The course of secondary organizing pneumonia depends on the respective underlying disease. Here it is important for the pathologist to correctly identify potential accompanying histological characteristics in order to be able to provide clues to a possible cause of OP.

Keywords

Bronchiolitis obliterans organizing pneumonia (BOOP) Fibroblast proliferation Idiopathic interstitial pneumonia Idiopathic organizing pneumonia Masson bodies

References

  1. American Thoracic Society, European Respiratory Society (2002) American thoracic society/European respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. This joint statement of the American thoracic society (ATS), and the European respiratory society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS executive committee, June 2001. Am J Respir Crit Care Med 165:277–304. https://doi.org/10.1164/ajrccm.165.2.ats01 doi:10.1164/ajrccm.165.2.ats01
  2. Baha A, Yıldırım F, Köktürk N et al (2018) Cryptogenic and secondary organizing pneumonia: clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 cases. Turk Thorac J 19:201–208. https://doi.org/10.5152/TurkThoracJ.2018.18008 doi:10.5152/TurkThoracJ.2018.18008; pubmed:30322441; pmcid:6196895
  3. Chandra D, Maini R, Hershberger DM (2020) Cryptogenic organizing pneumonia. StatPearls Publishing, Treasure Island (FL)
  4. Cordier JF, Loire R, Brune J (1989) Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients. Chest 96:999–1004. https://doi.org/10.1378/chest.96.5.999 doi:10.1378/chest.96.5.999; pubmed:2805873
  5. Costabel U, Guzman J (1991) BOOP: what is old, what is new? Eur Respir J 4:771–773 pubmed:1954995
  6. Cottin V, Cordier J‑F (2012) Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 33:462–475. https://doi.org/10.1055/s-0032-1325157 doi:10.1055/s-0032-1325157; pubmed:23001801
  7. Daniels CE, Myers JL, Utz JP et al (2007) Organizing pneumonia in patients with hematologic malignancies: a steroid-responsive lesion. Respir Med 101:162–168. https://doi.org/10.1016/j.rmed.2006.03.035 doi:10.1016/j.rmed.2006.03.035; pubmed:16704928
  8. Davison AG, Heard BE, McAllister WA, Turner-Warwick ME (1983) Cryptogenic organizing pneumonitis. Q J Med 52:382–394 pubmed:6647749
  9. Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M et al (2011) Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 139:893–900. https://doi.org/10.1378/chest.10-0883 doi:10.1378/chest.10-0883; pubmed:20724743
  10. Elicker BM, Webb WR (2013) Fundamentals of high-resolution lung CT: common findings, common patterns, common diseases, and differential diagnosis, 1. Aufl. Lippincott Williams & Wilkins, Philadelphia, PA
  11. Enomoto N, Sumikawa H, Sugiura H et al (2020) Clinical, radiological, and pathological evaluation of “NSIP with OP overlap” pattern compared with NSIP in patients with idiopathic interstitial pneumonias. Respir Med 174:106201. https://doi.org/10.1016/j.rmed.2020.106201 doi:10.1016/j.rmed.2020.106201; pubmed:33120192
  12. Fischer A, Antoniou KM, Brown KK et al (2015) An official European respiratory society/American thoracic society research statement: interstitial pneumonia with autoimmune features. Eur Respir J 46:976–987. https://doi.org/10.1183/13993003.00150-2015 doi:10.1183/13993003.00150-2015; pubmed:26160873
  13. Gudmundsson G, Sveinsson O, Isaksson HJ et al (2006) Epidemiology of organising pneumonia in Iceland. Thorax 61:805–808. https://doi.org/10.1136/thx.2006.059469 doi:10.1136/thx.2006.059469; pubmed:16809413; pmcid:2117106
  14. Izumi T, Kitaichi M, Nishimura K, Nagai S (1992) Bronchiolitis obliterans organizing pneumonia. Clinical features and differential diagnosis. Chest 102:715–719. https://doi.org/10.1378/chest.102.3.715 doi:10.1378/chest.102.3.715; pubmed:1516392
  15. Katzenstein A‑LA (2016) Diagnostic atlas of non-neoplastic lung disease: a practical guide for surgical pathologists, 1. Aufl. DEMOS HEALTH, New York, NY
  16. Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 180:1251–1254. https://doi.org/10.2214/ajr.180.5.1801251 doi:10.2214/ajr.180.5.1801251; pubmed:12704033
  17. King TE, Mortenson RL (1992) Cryptogenic organizing pneumonitis. The North American experience. Chest 102:8S–13S doi:10.1378/chest.102.1.8S
  18. Kligerman SJ, Franks TJ, Galvin JR (2013) From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics 33:1951–1975. https://doi.org/10.1148/rg.337130057 doi:10.1148/rg.337130057; pubmed:24224590
  19. Lange W (1901) Ueber eine eigenthumliche Erkrankung der kleinen Bronchien und Bronchiolen (Bronchitis et Bronchiolits Obliterans). Dtsch Arch Klin Med 70:342–364
  20. Leslie KO, Wick MR (2011) Practical pulmonary pathology: a diagnostic approach, 2. Aufl. Elsevier, Saunders
  21. Lohr RH, Boland BJ, Douglas WW et al (1997) Organizing pneumonia. Features and prognosis of cryptogenic, secondary, and focal variants. Arch Intern Med 157:1323–1329. https://doi.org/10.1001/archinte.157.12.1323 doi:10.1001/archinte.157.12.1323; pubmed:9201006
  22. Mukhopadhyay S (2016) Non-neoplastic pulmonary pathology with online resource, 1. Aufl. Cambridge University Press,
  23. Perner S, Stellmacher F, Jongik D, Rabe K‑F (2018) Nicht-neoplastische/interstitielle Lungenerkrankungen. Internationale Akademie für Pathologie Deutsche Abteilung e .V., Herbsttutorial 2018:516
  24. Poletti V, Cazzato S, Minicuci N et al (1996) The diagnostic value of bronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia. Eur Respir J 9:2513–2516. https://doi.org/10.1183/09031936.96.09122513 doi:10.1183/09031936.96.09122513; pubmed:8980962
  25. Todd NW, Marciniak ET, Sachdeva A et al (2015) Organizing pneumonia/non-specific interstitial pneumonia overlap is associated with unfavorable lung disease progression. Respir Med 109:1460–1468. https://doi.org/10.1016/j.rmed.2015.09.015 doi:10.1016/j.rmed.2015.09.015; pubmed:26482523
  26. Travis WD, Costabel U, Hansell DM et al (2013) An official American thoracic society/European respiratory society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188:733–748. https://doi.org/10.1164/rccm.201308-1483ST doi:10.1164/rccm.201308-1483ST; pubmed:24032382; pmcid:24032382

MeSH Term

Cryptogenic Organizing Pneumonia
Humans
Lung
Lung Diseases, Interstitial
Pneumonia
Prognosis
Journal Article Review

Word Cloud