Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, 55904, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55904, USA.
Hum Pathol. 2020 Jul;101:58-63. doi: 10.1016/j.humpath.2020.04.013. Epub 2020 May 14.
Cicatricial organizing pneumonia (CiOP) refers to intraluminal collagen deposition in a background of otherwise classic appearing organizing pneumonia (OP), sometimes with formation of peculiar fibrous nodules or densely fibrotic linear bands. Dendriform ossification has been also described in CiOP cases. This study is to evaluate the clinicopathologic and radiologic characteristics of CiOP identified in a cohort of OP cases diagnosed by surgical lung biopsy at a single institution. Electronic search was performed to find surgical lung biopsy cases with OP as the main histopathologic diagnosis during a 9-year period (2005-2013). The presence of mature collagen deposition in intraluminal plugs of OP (Masson bodies), linear fibrous bands, and ossification in association with OP was evaluated. Pertinent clinical information was obtained from medical records, and available chest computed tomography (CT) scans were reviewed by a chest radiologist. A total of 56 cases met the study criteria. Thirty-two of 56 cases (57.1%) showed at least 10% of cicatricial element within Masson bodies, 9 of which revealed cicatricial elements comprising 50% or higher proportion of OP. All 9 cases with CiOP as the major component (≥50%) revealed some areas of linear fibrous bands. Five of these 9 cases had intraluminal ossification, with features suggestive of dendriform ossification. Twenty of 32 cases with the cicatricial component had postoperative follow-up CT scans ranging from 0.4 to 171 months (median = 44) after the biopsy; 18 of these 20 cases showed stable finding or resolution of radiologic densities. Six of 9 patients with CiOP with major cicatricial change (≥50%) were alive and well at the time of clinical follow-up (median = 47 months; range = 12-125). In summary, minor cicatricial changes involving Masson bodies were seen in more than half of our OP cases, and patients with CiOP seem to follow an indolent and favorable course on radiologic and clinical follow-up, even in those with major cicatricial changes (≥50%) that were often accompanied by linear fibrous bands and/or intraluminal ossification.
瘢痕性机化性肺炎（CiOP）是指在经典表现的机化性肺炎（OP）背景下出现管腔内胶原沉积，有时伴有特殊的纤维性结节或密集的纤维化线性带形成。CiOP 病例中也描述了树突状骨化。本研究旨在评估在单一机构进行的手术肺活检中诊断的 OP 病例队列中发现的 CiOP 的临床病理和影像学特征。电子检索在 9 年期间（2005-2013 年）找到了 OP 作为主要组织病理学诊断的手术肺活检病例。评估 OP 中腔内 plugs 中的成熟胶原沉积（Masson 小体）、线性纤维带和与 OP 相关的骨化的存在。从病历中获得相关临床信息，并由胸部放射科医生审查可用的胸部计算机断层扫描（CT）扫描。共有 56 例符合研究标准。56 例中有 32 例（57.1%）在 Masson 小体中至少有 10%的瘢痕形成，其中 9 例显示瘢痕形成占 OP 的 50%或更高比例。所有 9 例以 CiOP 为主（≥50%）的病例均显示出一些线性纤维带区域。其中 5 例有腔内骨化，具有树突状骨化的特征。32 例瘢痕形成中有 20 例在活检后有术后随访 CT 扫描，范围从 0.4 到 171 个月（中位数=44）；其中 18 例显示影像学密度稳定或消失。9 例以 CiOP 为主（≥50%）的患者中有 6 例在临床随访时仍然存活且情况良好（中位数=47 个月；范围=12-125）。总之，我们的 OP 病例中有一半以上存在涉及 Masson 小体的微小瘢痕改变，CiOP 患者似乎在影像学和临床随访中表现出惰性和良好的病程，即使在那些有主要瘢痕改变（≥50%）的患者中也是如此，这些改变通常伴有线性纤维带和/或腔内骨化。
