Practical Lung Pathology: Frequently Asked Questions PDF
Preview Practical Lung Pathology: Frequently Asked Questions
Practical Anatomic Pathology Series Editors: Fan Lin · Ximing J. Yang Haodong Xu Robert W. Ricciotti Jose G. Mantilla Editors Practical Lung Pathology Frequently Asked Questions Practical Anatomic Pathology Series Editors Fan Lin, Geisinger Health System Danville, PA, USA Ximing J. Yang, Feinberg School of Medicine Northwestern University Chicago, IL, USA This Book Series is designed to provide a comprehensive, practical and state-of-the-art review and update of the major issues and challenges specific to each subspecialty field of surgical pathology in a question and answer (Q&A) format. Making an accurate diagnosis especially from a limited sample can be quite challenging, yet crucial to patient care. This Book Series, using the most current and evidence-based resources 1) focuses on frequently asked questions in surgical pathology in day-to-day practice; 2) provides quick, accurate, terse, and useful answers to many practical questions encountered in daily practice; 3) emphasizes the importance of a triple test (clinical, radiologic, and histologic correlation); 4) delineates how to appropriately utilize immunohistochemistry, in situ hybridization and molecular tests; and 5) minimizes any potential diagnostic pitfalls in surgical pathology. These books also include highly practical presentations of typical case scenarios seen in an anatomic pathology laboratory. These are in the form of case presentations with step-by-step expert analysis. Sample cases include common but challenging situations, such as evaluation of well-differentiated malignant tumors vs. benign/reactive lesions; distinction of two benign entities; sub-classification of a malignant tumor; identification of newly described tumor and non-tumor entities; workup of a tumor of unknown origin; and implementation of best practice in immunohistochemistry and molecular testing in a difficult case. The Q&A format is well accepted, especially by junior pathologists, for several reasons: 1) this is the most practical and effective way to deliver information to a new generation of pathologists accustomed to using the Internet as a resource and, therefore, comfortable and familiar with a Q&A learning environment; 2) it’s impossible to memorialize and digest massive amounts of new information about new entities, new and revised classifications, molecular pathology, diagnostic IHC, and the therapeutic implications of each entity by reading large textbooks; 3) sub-specialization is a very popular practice model highly demanded by many clinicians; and 4) time is very precious for a practicing pathologist because of increasing workloads in recent years following U.S. health care reforms. This Book Series meets all of the above expectations. These books are written by established and recognized experts in their specialty fields and provide a unique and valuable resource in the field of surgical pathology, both for those currently in training and for those already in clinical practice at various skill levels. It does not seek to duplicate or completely replace other large standard textbooks; rather, it is a new, comprehensive yet concise and practical resource on these timely and critical topics. Haodong Xu • Robert W. Ricciotti Jose G. Mantilla Editors Practical Lung Pathology Frequently Asked Questions Editors Haodong Xu Robert W. Ricciotti Department of Laboratory Medicine and Department of Laboratory Medicine Pathology and Pathology University of Washington Medical Center University of Washington Medical Center Seattle, WA, USA Seattle, WA, USA Jose G. Mantilla Department of Laboratory Medicine and Pathology University of Washington Medical Center Seattle, WA, USA ISSN 2629-3692 ISSN 2629-3706 (electronic) Practical Anatomic Pathology ISBN 978-3-031-14401-1 ISBN 978-3-031-14402-8 (eBook) https://doi.org/10.1007/978-3-031-14402-8 © Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Aim and Scope This text consists of neoplastic and nonneoplastic lung pathology. The aim is to discuss fre- quently encountered issues and diagnostic problems using a Q&A format and case presenta- tions. Emphasis is placed on differentiating one from another based on histopathological features, ancillary tests including immunohistochemical and molecular analyses, and clinical and radiologic correlation. In particular, clinical-radiologic-pathologic correlation is empha- sized in the diagnosis of interstitial lung disease (ILD). This text addresses the issues and diagnostic criteria in segregating a reactive process from adenocarcinoma, poorly differentiated adenocarcinoma from poorly differentiated squamous cell carcinoma, small cell carcinoma from other types of neuroendocrine tumors, large cell carcinoma from large cell neuroendocrine carcinoma, spindle cell/sarcomatoid carcinoma from sarcomatoid mesothelioma, and carcinoma from epithelioid mesothelioma in small biopsy specimens. It also discusses key features useful for differentiating usual interstitial pneumonia (UIP) pattern from non-UIP patterns of ILD such as hypersensitivity pneumonitis, nonspecific interstitial pneumonia, and organizing pneumonia patterns in wedge biopsy speci- mens as well as highlights the differential diagnosis in granulomatous inflammation. As a whole, this text answers many of the difficult questions relevant to daily practice of lung pathology. Each chapter is well written and addresses a specific diagnostic question sig- nificantly related to patients’ treatment options. Audience: Practicing pathologists and pathology trainees including residents, fellows, and medical students, as well as trainees in other medical specialties. v Preface The practice of pulmonary pathology usually encompasses a wide variety of findings beyond the histologic features. Behind every case there is a milieu of clinical signs and symptoms, radiographic characteristics, and measurable functional alterations, which lend accuracy to our diagnostic interpretation. In addition, the continuous expansion of our understanding of human genetics has offered us a variety of novel tools to aid in the diagnosis and treatment of both neoplastic and nonneoplastic diseases. In this textbook we discuss common and rare diagnostic dilemmas that we experience in the practice of neoplastic and nonneoplastic lung pathology. We use a Q&A format with a compre- hensive focus that includes clinical, radiologic, and histopathologic findings, as well as ancil- lary studies such as immunohistochemistry and molecular analysis, aiming to bring answers relevant to each patient’s treatment. The topics we cover are varied and include neoplasms, interstitial lung disease, infection and vascular processes, among others. As a whole, the objective of this text is to answer many of the difficult questions relevant to the daily practice of lung pathology. We hope that it will be useful for practicing pathologists and trainees, as well as physicians practicing in other specialties that diagnose and treat pul- monary diseases. Seattle, WA Haodong Xu Seattle, WA Robert W. Ricciotti Seattle, WA Jose G. Mantilla vii Contents Part I Neoplastic Lung Pathology 1 Bronchial Squamous Cell Papilloma Versus Squamous Cell Carcinoma . . . . . . . 3 Ari Kassardjian and Gregory A. Fishbein 2 Pulmonary Hamartoma Versus Chondroid Neoplasms . . . . . . . . . . . . . . . . . . . . . 7 Sofia Liou and Gregory A. Fishbein 3 Reactive Type II Pneumocyte Hyperplasia Versus Adenocarcinoma . . . . . . . . . . . 13 Jiqing Ye 4 Atypical Adenomatous Hyperplasia Versus Peribronchiolar Metaplasia . . . . . . . 21 Christopher M. Chandler and Haodong Xu 5 Adenocarcinoma In Situ Versus Atypical Adenomatous Hyperplasia . . . . . . . . . . 27 Marie Perrone and Robert W. Ricciotti 6 Invasive Adenocarcinoma Versus Adenocarcinoma In Situ . . . . . . . . . . . . . . . . . . 31 Sofia Liou and Gregory A. Fishbein 7 Solid Pulmonary Adenocarcinoma Versus Large-Cell Undifferentiated Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Jared Cobb and Chen Zhang 8 Large-Cell Neuroendocrine Carcinoma Versus Solid-Predominant Lung Adenocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Sophia Shaddy and Eric C. Huang 9 Poorly Differentiated Squamous Cell Carcinoma Versus Solid Pattern Adenocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Anshu Bandhlish and Haodong Xu 10 Invasive Mucinous Adenocarcinoma Versus Ciliated Muconodular Papillary Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Yu Yang and Chen Zhang 11 Mucoepidermoid Carcinoma Versus Adenosquamous Carcinoma . . . . . . . . . . . . 61 Jennifer J. Chia and Gregory A. Fishbein 12 Large-Cell (Undifferentiated) Carcinoma (LCC) Versus Large-Cell Neuroendocrine Carcinoma (LCNEC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Aimi T. Rothrock, Mufaddal Najmuddin, and Faqian Li 13 Large-Cell Neuroendocrine Carcinoma Versus Small-Cell Carcinoma of the Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Rebecca Baldassarri, Stephen Baldassarri, and Guoping Cai ix x Contents 14 Atypical Carcinoid Tumor Versus Large- Cell Neuroendocrine Carcinoma . . . . . 75 Esther C. Yoon and Guoping Cai 15 Small-Cell Carcinoma Versus Atypical Carcinoid Tumor. . . . . . . . . . . . . . . . . . . . 83 Esther C. Yoon, Xuchen Zhang, and Guoping Cai 16 Typical Versus Atypical Carcinoid and Diffuse Idiopathic Neuroendocrine Cell Hyperplasia Versus Carcinoid Tumorlets . . . . . . . . . . . . . . . 89 Ryan J. Morse and Haodong Xu 17 Minute Meningothelial-Like Nodules Versus Tumorlet. . . . . . . . . . . . . . . . . . . . . . 97 Sophia Shaddy and Eric C. Huang 18 Primary Lung Versus Metastatic Adenocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . .101 Rouba Hadi and Haodong Xu 19 Metastatic Urothelial Carcinoma Versus Squamous Cell Carcinoma . . . . . . . . . .107 L. Angelica Lerma, Christopher M. Chandler, and Haodong Xu 20 Thymic Carcinoma Versus Lung Squamous Cell Carcinoma . . . . . . . . . . . . . . . .113 Jennifer J. Chia and Gregory A. Fishbein 21 Pulmonary Epithelioid Hemangioendothelioma Versus Carcinoma and Other Epithelioid Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 John M. Gross and Robert W. Ricciotti 22 Epithelioid Malignant Mesothelioma Versus Adenocarcinoma . . . . . . . . . . . . . . .129 Anshu Bandhlish and Haodong Xu 23 Pleomorphic Carcinoma Versus Sarcomatoid Malignant Mesothelioma . . . . . . .137 Marina K Baine, Guoping Cai, and Xuchen Zhang 24 Primary Sarcoma (Unclassified) Versus Sarcomatoid Mesothelioma/Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147 Amir Qorbani, Gregory A. Fishbein, and Scott D. Nelson 25 Synovial Sarcoma Versus Solitary Fibrous Tumor . . . . . . . . . . . . . . . . . . . . . . . . .157 Hui Zhu 26 Inflammatory Myofibroblastic Tumor Versus Organizing Pneumonia . . . . . . . . .163 Omer Abdelaziz Mohammed Saeed and Chen Zhang 27 Metastatic Malignant Epithelioid Melanoma Versus Poorly Differentiated Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Hui Zhu 28 Pulmonary Epithelioid Angiosarcoma Versus Carcinoma . . . . . . . . . . . . . . . . . . .173 John M. Gross and Robert W. Ricciotti 29 Epithelioid Sarcoma Versus Large-Cell (Undifferentiated) Carcinoma . . . . . . . .179 Amir Qorbani, Gregory A. Fishbein, and Scott D. Nelson 30 Intimal Sarcoma Versus Other Spindle Cell Neoplasms . . . . . . . . . . . . . . . . . . . . .185 John M. Gross and Robert W. Ricciotti 31 Sclerosing Pneumocytoma Versus Lung Adenocarcinoma . . . . . . . . . . . . . . . . . . .193 Cherise Meyerson and Gregory A. Fishbein 32 Erdheim-Chester Disease Versus Reactive Inflammatory Infiltrates . . . . . . . . . .199 Rouba Hadi and Haodong Xu Contents xi 33 Mucosal Marginal Zone Lymphoma Versus Follicular Bronchiolitis . . . . . . . . . .203 Craig Dunseth and Chen Zhao 34 Primary Pulmonary Diffuse Large B-Cell Lymphoma Versus Poorly Differentiated Carcinomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .207 Zhao Ming (David) Dong and Paul D. Simonson 35 Lymphomatoid Granulomatosis Versus Granulomatosis with Polyangiitis . . . . .213 Marina K Baine and Xuchen Zhang 36 Primary Pulmonary Classic Hodgkin Lymphoma Versus Other Non-Hodgkin Lymphomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 Zhao Ming (David) Dong and Paul D. Simonson 37 Posttransplant Lymphoproliferative Disorders in Lung After Lung Transplantation Versus Infection and Inflammation . . . . . . . . . . . . .225 Paul D. Simonson and Zhao Ming (David) Dong Part II Non-neoplastic Lung Pathology 38 Usual Interstitial Pneumonia Versus Nonspecific Interstitial Pneumonia . . . . . . .233 L. Angelica Lerma, Christopher M. Chandler, and Haodong Xu 39 Hypersensitivity Pneumonitis Versus Usual Interstitial Pneumonia . . . . . . . . . . .239 Nicholas Stanzione and Gregory A. Fishbein 40 Organizing Pneumonia Versus Usual Interstitial Pneumonia . . . . . . . . . . . . . . . .247 Brian Mau, Lisa Noel Johnson, and Haodong Xu 41 Diffuse Alveolar Damage (Organizing Phase) Versus Nonspecific Interstitial Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253 Nicholas Stanzione and Gregory A. Fishbein 42 Chronic Eosinophilic Pneumonia Versus Organizing Pneumonia . . . . . . . . . . . . .259 Lisa Han and Haodong Xu 43 Pulmonary Langerhans Cell Histiocytosis with Fibrosis Versus Organizing Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263 Thomas H. Long and Haodong Xu 44 IgG4-Related Lung Disease Versus Other Fibroinflammatory Processes . . . . . . .267 Jennifer J. Chia and Gregory A. Fishbein 45 Pulmonary Alveolar Proteinosis Versus Pulmonary Edema . . . . . . . . . . . . . . . . . .275 Karen E. Trevino and Chen Zhang 46 Nonspecific Interstitial Pneumonia Versus Lymphoid Interstitial Pneumonia Versus Follicular Bronchiolitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281 Brian D. Cone and Gregory A. Fishbein 47 Respiratory Bronchiolitis Versus Desquamative Interstitial Pneumonia . . . . . . .287 Brian D. Cone and Gregory A. Fishbein 48 Constrictive Bronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293 Chen Zhang 49 Granulomatosis with Polyangiitis Versus Mycobacterial/Fungal Infection . . . . .299 Jason V. Scapa and Gregory A. Fishbein
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