Practical Lung Pathology: Frequently Asked Questions

354 Pages·2022·54.496 MB·English

by  Haodong Xu, Robert W. Ricciotti, Jose G. Mantilla

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,
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made.
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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