Leslie Kevin O, Gruden James F, Parish James M, Scholand Mary Beth
Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
Arch Pathol Lab Med. 2007 Mar;131(3):407-23. doi: 10.5858/2007-131-407-TBIITP.
The most common lung tissue samples seen by pathologists worldwide are obtained with the flexible bronchoscope. Specimens taken for examination of diffuse or multifocal parenchymal lung abnormalities pose special challenges for the general surgical pathologist, and these challenges are often compounded by high clinical expectations for accurate and specific diagnosis.
To present and discuss the most common histopathologic patterns and diagnostic entities seen in transbronchial biopsy specimens in the setting of diffuse or multifocal lung disease. Specifically, acute lung injury, eosinophilic pneumonia, diffuse alveolar hemorrhage, chronic cellular infiltrates, organizing pneumonia, alveolar proteinosis, sarcoidosis, Wegener granulomatosis, intravenous drug abuse-related microangiopathy, Langerhans cell histiocytosis, and lymphangioleiomyomatosis are presented. Clinical and radiologic context is provided for the more specific diagnostic entities.
The published literature and experience from a consultation practice.
The transbronchial biopsy specimen can provide valuable information for clinical management in the setting of diffuse or multifocal lung disease. Computed tomographic scans are useful for selecting appropriate patients to undergo biopsy and in limiting the differential diagnosis. Knowledge of the clinical context, radiologic distribution of abnormalities, and histopathologic patterns is essential. With this information, the surgical pathologist can substantially influence the diagnostic workup and help guide the clinician to an accurate clinical/radiologic/pathologic diagnosis.
全球病理学家最常看到的肺组织样本是通过可弯曲支气管镜获取的。用于检查弥漫性或多灶性肺实质异常的标本给普通外科病理学家带来了特殊挑战，而准确和特异性诊断的高临床期望往往使这些挑战更加复杂。
介绍并讨论在弥漫性或多灶性肺部疾病背景下经支气管活检标本中最常见的组织病理学模式和诊断实体。具体包括急性肺损伤、嗜酸性肺炎、弥漫性肺泡出血、慢性细胞浸润、机化性肺炎、肺泡蛋白沉积症、结节病、韦格纳肉芽肿、静脉药物滥用相关微血管病、朗格汉斯细胞组织细胞增多症和淋巴管平滑肌瘤病。为更具体的诊断实体提供临床和放射学背景。
已发表的文献和会诊实践经验。
经支气管活检标本可为弥漫性或多灶性肺部疾病的临床管理提供有价值的信息。计算机断层扫描有助于选择合适的患者进行活检并限制鉴别诊断。了解临床背景、异常的放射学分布和组织病理学模式至关重要。有了这些信息，外科病理学家可以极大地影响诊断检查，并帮助指导临床医生做出准确的临床/放射学/病理学诊断。
