2 October 2013 - Case #287
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Mattia Barbareschi, Trentino Biobank (Italy), for contributing this case.
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Case #287
Clinical history:
A 71 year old man with recent history of meningitis presented with recurrent episodes of pneumonia. High resolution CT scans showed crazy paving and tree in bud images. The patient underwent a transbronchial biopsy.
Micro images:
What is your diagnosis?
Diagnosis: Aspiration with granulomatous bronchiolitis and lipoid pneumonia
Discussion:
Aspiration of particulate matter, traditionally observed at autopsy, has also been described in debilitated patients, who often have a history of recurrent pneumonia, which is often unrecognized (Am J Surg Pathol 2007;31:752, Am J Surg Pathol 2010;34:1456). It usually (88%) shows bronchiolitis obliterans organizing pneumonia, often with multinucleated giant cells, acute bronchopneumonia / bronchiolitis or suppurative granulomas. Foreign material is usually but not always present (Am J Surg Pathol 2011;35:426).
The differential diagnosis of pulmonary granulomatous inflammation is broad and requires special stains, culture and clinical correlation (Ann Diagn Pathol 2003;7:127, Histopathology 2007;50:289).
Lipoid pneumonia is often an incidental postmortem finding associated with debilitating disease. The lipid may be exogenous (from nasal sprays or inhalation of other lipid containing substances) or endogenous (bronchial obstruction).
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Mattia Barbareschi, Trentino Biobank (Italy), for contributing this case.
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(1) Do you want to look up an old Job, Conference or Fellowship ad? We post the existing version of each of these files as of the first of the month in this format: jobsYYYYMM.html, jobsrelatedYYYYMM.html, fellowshipsYYYYMM.html and conferencesYYYYMM.html, where YYYY is the year (i.e. 2013) and MM is the month with two digits (i.e. 09). These files started in 201108 (August 2011). So, to look up jobs posted on February 1, 2013, visit www.pathologyoutlines.com/jobs201302.html.
(2) In September 2013, we again had record traffic of 446,886 visits (over 10 million "hits"), averaging 14,896 visits per day, a 45% increase from September 2012. On October 1, 2013, we had a new single day record of 19,165 visits. We continue to convert all topics to our new format, to add more images, to add new Stains and CD Markers, and to update stains, CD markers and the 20 "oldest" chapters.
(3) Don't forget about the Google search bar located at the top of our Home page, which can be used to search our entire site . We are planning a new version of our website with better formatting for SmartPhones, and a "topic" search bar - more to follow.
Visit and follow our Blog to see recent updates to the website.
Case #287
Clinical history:
A 71 year old man with recent history of meningitis presented with recurrent episodes of pneumonia. High resolution CT scans showed crazy paving and tree in bud images. The patient underwent a transbronchial biopsy.
Micro images:
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Aspiration with granulomatous bronchiolitis and lipoid pneumonia
Discussion:
Aspiration of particulate matter, traditionally observed at autopsy, has also been described in debilitated patients, who often have a history of recurrent pneumonia, which is often unrecognized (Am J Surg Pathol 2007;31:752, Am J Surg Pathol 2010;34:1456). It usually (88%) shows bronchiolitis obliterans organizing pneumonia, often with multinucleated giant cells, acute bronchopneumonia / bronchiolitis or suppurative granulomas. Foreign material is usually but not always present (Am J Surg Pathol 2011;35:426).
The differential diagnosis of pulmonary granulomatous inflammation is broad and requires special stains, culture and clinical correlation (Ann Diagn Pathol 2003;7:127, Histopathology 2007;50:289).
Lipoid pneumonia is often an incidental postmortem finding associated with debilitating disease. The lipid may be exogenous (from nasal sprays or inhalation of other lipid containing substances) or endogenous (bronchial obstruction).
