Akyıl Fatma Tokgöz, Ağca Meltem, Mısırlıoğlu Aysun, Arsev Ayşe Alp, Akyıl Mustafa, Sevim Tülin
Clinif of Chest Diseases, Süreyyapaşa Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey.
Clinif of Chest Surgery, Süreyyapaşa Chest Diseases and Chest Surgery Training and Research Hospital, İstanbul, Turkey.
Turk Thorac J. 2017 Jul;18(3):82-87. doi: 10.5152/TurkThoracJ.2017.16047. Epub 2017 Jul 1.
Organizing pneumonia (OP) is an interstitial lung disease characterized by granulation tissue buds in alveoli and alveolar ductus, possibly accompanied by bronchiolar involvement. Histopathologically, OP may signify a primary disease and be observed as a contiguous disease or as a minor component of other diseases. In this study, the clinical significance of histopathological OP lesions and clinical and radiological features of patients with primary OP were examined.
Between January 2011 and January 2015, of 6,346 lung pathology reports, 138 patients with OP lesions were retrospectively evaluated. According to the final diagnoses, patients were grouped as reactive OP (those with final diagnosis other than OP) and primary OP (those with OP). Patients with primary OP were classified according to etiology as cryptogenic and secondary OP. Radiological evaluation was conducted within a categorization of "typical," "focal," and "infiltrative."
Of 138 patients, 25% were males and the mean age was 54±14 years. Pathologically, 61% of patients had reactive OP and 39% had primary OP. All reactive OP lesions were reported using surgical specimens, and the most frequent primary diagnoses were malignancy (65%), infection (15%), interstitial lung diseases other than OP (7%), and bronchiectasis (5%). Other diagnoses included bullae, foreign body, hamartoma, bronchogenic cyst, and bronchopleural fistula. Of all the primary OP patients, 48 had cryptogenic OP and six had secondary OP. Radiological involvement was consistent with typical OP in 30%, focal OP in 63%, and infiltrative OP in 7% of the patients. All focal OP lesions were defined using surgical resections. Positron emission computed tomography (PET-CT) was recorded in 28 patients. In 11 patients, lymphadenomegaly was comorbid. The mean widest diameter of focal opacity was 2.7±1.2 (1.2-4.9) cm, and the mean the maximum standardized uptake value (SUVmax was 6.1±3.9 (1.7-16.7).
OP lesions generally present as a minor component of other diseases. In patients with OP, cryptogenic OP and radiological focal OP is more frequently observed. Most focal OP lesions are detected using surgical resections because of malignant prediagnosis owing to elevated SUVmax.
机化性肺炎（OP）是一种间质性肺疾病，其特征为肺泡和肺泡管内出现肉芽组织芽，可能伴有细支气管受累。在组织病理学上，OP可能代表一种原发性疾病，也可表现为连续性疾病或其他疾病的次要组成部分。在本研究中，我们对组织病理学OP病变的临床意义以及原发性OP患者的临床和放射学特征进行了研究。
在2011年1月至2015年1月期间，对6346份肺病理报告中的138例有OP病变的患者进行了回顾性评估。根据最终诊断，将患者分为反应性OP（最终诊断不是OP的患者）和原发性OP（诊断为OP的患者）。原发性OP患者根据病因分为隐源性OP和继发性OP。放射学评估按照“典型”“局灶性”和“浸润性”进行分类。
138例患者中，男性占25%，平均年龄为54±14岁。病理检查发现，61%的患者为反应性OP，39%为原发性OP。所有反应性OP病变均通过手术标本报告，最常见的原发性诊断为恶性肿瘤（65%）、感染（15%）、除OP外的间质性肺疾病（7%）和支气管扩张（5%）。其他诊断包括肺大疱、异物、错构瘤、支气管源性囊肿和支气管胸膜瘘。在所有原发性OP患者中，48例为隐源性OP，6例为继发性OP。30%的患者放射学表现符合典型OP，63%为局灶性OP，7%为浸润性OP。所有局灶性OP病变均通过手术切除确定。28例患者进行了正电子发射计算机断层扫描（PET-CT）检查。11例患者合并有淋巴结肿大。局灶性实变影的平均最大直径为2.7±1.2（1.2 - 4.9）cm，平均最大标准化摄取值（SUVmax）为6.1±3.9（1.7 - 16.7）。
OP病变通常表现为其他疾病的次要组成部分。在OP患者中，隐源性OP和放射学局灶性OP更为常见。由于SUVmax升高导致恶性预诊断，大多数局灶性OP病变通过手术切除发现。
