In 50 of 94 patients with bronchiolitis obliterans we found no apparent cause or associated disease, and the bronchiolitis obliterans occurred with patchy organizing pneumonia. Histologic characteristics included polypoid masses of granulation tissue in lumens of small airways, alveolar ducts, and some alveoli. The fibrosis was uniform in age, suggesting that all repair had begun at the same time. The distribution was patchy, with preservation of background architecture. Clinically, there was cough or flu-like illness for 4 to 10 weeks, and crackles were heard in the lungs of 68 per cent of the patients. Radiographs showed an unusual pattern of patchy densities with a "ground glass" appearance in 81 per cent. Physiologically, there was restriction in 72 per cent of the patients, and 86 per cent had impaired diffusing capacity. Obstruction was limited to smokers. The mean follow-up period was four years. With corticosteroids, there was complete clinical and physiologic recovery in 65 per cent of the subjects; two died from progressive disease. This disorder differs from bronchiolitis obliterans with irreversible obstruction. It was confused most often with idiopathic pulmonary fibrosis. In view of the benign course and therapeutic response, a histologic distinction is important.

Bronchiolitis obliterans organizing pneumonia.

Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures.

The Senile Lung: Comparison with Normal and Emphysematous Lungs 1. Structural Aspects

Introduction
Inflammatory myofibroblastic tumors (IMT) while uncommon may arise within numerous organs. Historically, the literature regarding IMT has been confined to small one organ case series, with few reviews encompassing multiple anatomic sites, and little data regarding adjuvant treatment.

Methods
A review of patients with IMT treated at two large academic medical centers over a 15-year period was undertaken. Patient demographics, pathologic diagnoses, and pertinent clinical data were obtained.

Results
Forty-four cases of pathologically confirmed IMT were identified. Tumor locations included multiple anatomic sites. Therapies included complete resection, incomplete resection, observation, or chemotherapy, and/or radiation. Five patients underwent adjuvant chemotherapy and/or radiation therapy following surgery (14%) for local aggressiveness of the tumor, invasion, positive margins, or location of tumor that was not amenable to surgical resection. A second, concomitant, histologically distinct, neoplasm was identified in five cases. Of the patients who underwent treatment three local recurrences were noted (8%) and occurred in patients with partial resection without adjuvant chemo- or radiotherapy.

Conclusions
Inflammatory myofibroblastic tumors may be a locally aggressive and destructive neoplasm. Tumor recurrence is unusual following complete surgical resection or organ-preserving combined modality therapy. J. Surg. Oncol. 2006;94:385–391. © 2006 Wiley-Liss, Inc.

Inflammatory myofibroblastic tumors

The histopathologic and ultrastructural features of intraluminal organizing and fibrotic changes were studied in open lung biopsies and autopsy specimens from 373 patients with interstitial lung disorders, including hypersensitivity pneumonitis (n = 44), idiopathic pulmonary fibrosis (n = 92), collagen-vascular diseases (n = 20), chronic eosinophilic pneumonia (n = 10), pulmonary histiocytosis X (n-90), pulmonary sarcoidosis (n = 62), pneumoconioses (n = 25), Legionnaire's disease (n = 5), drug- and toxin-induced pneumonitis (n = 4), radiation-induced pneumonitis (n = 2), lymphangioleiomyomatosis (n = 11), and chronic organizing pneumonia of unknown cause (n = 8) Three patterns of intraluminal organization and fibrosis were recognized: 1) intraluminal buds, which partially filled the alveoli, alveolar ducts and/or distal bronchioles; 2) obliterative changes, in which loose connective tissue masses obliterated the lumens of alveoli, alveolar ducts or distal bronchioles, and 3) mural incorporation of previously intraluminal connective tissue masses, which fused with alveolar, alveolar ductal, or bronchiolar structures and frequently became reepithelialized All three patterns had common morphologic features, suggesting that, regardless of their severity, they resulted from a common pathogenetic mechanism, ie, the migration of activated connective tissue cells, through defects in the epithelial lining and its basement membrane, from the interstitial into the intraluminal compartment Intraluminal buds were observed most frequently in hypersensitivity pneumonitis, chronic eosinophilic pneumonia, and organizing pneumonia of unknown cause Mural incorporation and, to a lesser extent, obliterative changes were observed in most interstitial disorders and were very prominent in idiopathic pulmonary fibrosis Mural incorporation and obliterative changes play an important role in pulmonary remodeling, especially when several adjacent alveoli and/or other air spaces are involved Under these circumstances, intraluminal organization can mediate the fusion of adjacent alveolar structures by intraluminal connective tissue

Intraluminal fibrosis in interstitial lung disorders.

Bronchiolitis Obliterans: Report of Three Cases with Detailed Physiologic Studies

Report of Three Cases with Detailed Physiologic Studies

An attempt was made to determine if emphysema and static lung recoil were related in a group of 65 excised human lungs. We studied 23 normal lungs, 24 lungs with an emphysema score of 5 or less, and 18 lungs with an emphysema score greater than 5. A comparison of the percentage of predicted elastic recoil revealed that both emphysema groups were significantly different from normal lungs. In addition, the total lung capacities were significantly different between the three groups. In the group with an emphysema score greater than 5 we found a linear negative correlation between the extent of emphysema and percent of predicted elastic recoil at 90% total lung capacity (r = -0.696, p < 0.01). We found a negative correlation between the percentage of predicted elastic recoil and the lung volume (r = -0.612, p < 0.01). We conclude that a significant loss of elastic recoil and a significant increase in total lung capacity occurs in the early stages of emphysema.

https://thorax.bmj.com/content/thoraxjnl/35/7/490.full.pdf

Elastic recoil changes in early emphysema.

Plasma cell granuloma of the lung is an uncommon, slow-growing, benign “pseudotumor” morphologically and clinically distinct from malignant plasma cell tumor (plasmacytoma). Its histopathology is distinct from sclerosing hemangioma and pseudolymphoma. Most are located in lung parenchyma, but a few p

Plasma Cell Granuloma of the Lung: Endobronchial Presentation and Absence of Response to Radiation Therapy

The morphologic and morphometric characteristics of the small airways of the lung and their relationship to airflow as measured by forced expiratory volume in one second (FEV1) were determined in 37 excised human lungs. After fixation the lungs were graded as to the degree of emphysema and the degree of small airway pathology. The internal diameters of the small airways were measured and corrected for shrinkage during processing. The mean bronchiolar diameter was positively correlated with the % predicted FEV1 (p less than 0.001) and negatively correlated with the small airway fibrosis (p less than 0.01). We conclude that fibrosis of the small airways of the lung is associated with a decrease in airway dimension which is in turn correlated with decreased FEV1 in excised human lungs.

R. E. Stanford

Papers

Bronchiolitis Obliterans: Report of Three Cases with Detailed Physiologic Studies

Report of Three Cases with Detailed Physiologic Studies

Elastic recoil changes in early emphysema.

Plasma Cell Granuloma of the Lung: Endobronchial Presentation and Absence of Response to Radiation Therapy

The morphology and morphometry of small airways disease (relevance to chronic obstructive pulmonary disease).