组织学对于慢性过敏性肺炎的诊断至关重要，但并非总是如此。
Histology is critical but not always for the diagnosis of chronic hypersensitivity pneumonitis.
作者信息
Zaizen Yoshiaki, Tabata Kazuhiro, Yamano Yasuhiko, Hebisawa Akira, Kataoka Kensuke, Bychkov Andrey, Johkoh Takeshi, Kondoh Yasuhiro, Fukuoka Junya
机构信息
Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
出版信息
Respir Investig. 2020 Jul;58(4):285-290. doi: 10.1016/j.resinv.2020.02.006. Epub 2020 Apr 4.
BACKGROUND
The diagnosis of chronic hypersensitivity pneumonitis (CHP) is often based on the pathology, but evidence is scarce that a pathological diagnosis of CHP may mislead the multidisciplinary diagnosis.
METHOD
We enrolled patients from the consultation case archive whose pathological findings were suggestive of CHP but had a multidisciplinary diagnosis of non-CHP. The histopathological slides were sent to another pathologist, and the ones confirmed with CHP were sent for an additional multidisciplinary discussion (MDD). We examined clinicopathological features of the cases confirmed to be non-CHP through MDD.
RESULTS
Among the 243 cases, five were diagnosed as non-CHP through an additional MDD. The most common causes of discrepancy were the presence of strong autoimmune features, a low lymphocyte level in the bronchoalveolar lavage fluid, and a lack of nodular shadow or mosaic attenuation on computed tomography.
CONCLUSIONS
Cases of suspected CHP on pathology may be determined to be non-CHP through MDD.
背景
慢性过敏性肺炎（CHP）的诊断通常基于病理学，但关于CHP的病理诊断可能会误导多学科诊断的证据很少。
方法
我们从会诊病例档案中纳入了病理结果提示为CHP但多学科诊断为非CHP的患者。将组织病理学切片送交另一位病理学家，确诊为CHP的切片送去进行额外的多学科讨论（MDD）。我们检查了经MDD确认为非CHP的病例的临床病理特征。
结果
在243例病例中，有5例通过额外的MDD被诊断为非CHP。差异最常见的原因是存在强烈的自身免疫特征、支气管肺泡灌洗液中淋巴细胞水平低以及计算机断层扫描上缺乏结节状阴影或马赛克样衰减。
结论
病理上疑似CHP的病例可能通过MDD被确定为非CHP。
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