Carcinoma, Large Cell
Carcinoma, Small Cell
Interstitial lung disease (ILD) is a term that can be applied to many different pathological entities, both idiopathic or of a known cause. In a simplistic way, the term represents diffuse parenchymal lung disease in which there is expansion of the pulmonary interstitium by inflammation with or without fibrosis. The role of the pathologist in the workup of interstitial lung disease is to try to categorize the histopathological changes present in the biopsy specimen into groups of entities that have implications for the clinical management of the patient, prognosis, and response to therapy. The histologic patterns found in interstitial pneumonias are distinctive but, unfortunately, they are not specific and can be observed in a variety of other conditions. For example, the histologic pattern noted in usual interstitial pneumonia (UIP) can be detected in collagen vascular diseases as well as in asbestosis or drug reactions. Therefore, the recognition of UIP-like histologic pattern on a lung biopsy raises a differential diagnosis that includes idiopathic UIP, respectively, as well as several other conditions. Surgical biopsies for the diagnosis and classification of ILD are uncommon, which prevents most general pathologists from developing critical knowledge of the histopathological criteria to be able to discriminate the subtle changes among the considerable overlap of histological appearance in ILD. To achieve an accurate pathological diagnosis, it is essential to correlate the findings in the lung biopsy specimen with clinical, high-resolution computed tomography scans, laboratory, and pulmonary function abnormalities. This correlation requires communication between the pathologist and clinical and radiologist colleagues. In this chapter, we discuss the histopathological findings of the most common interstitial pneumonias and the evolving concepts leading to their histopathological classification. © Humana Press, a part of Springer Science+Business Media, LLC 2009.
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