Pleuroparenchymal Fibroelastosis: A Review of Histopathologic Features and the Relationship Between Histologic Parameters and Survival.

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Title: Pleuroparenchymal Fibroelastosis: A Review of Histopathologic Features and the Relationship Between Histologic Parameters and Survival.
Authors: Khiroya, R
Macaluso, C
Montero, MA
Wells, AU
Chua, F
Kokosi, M
Maher, TM
Devaraj, A
Rice, A
Renzoni, EA
Nicholson, AG
Item Type: Journal Article
Abstract: Pleuroparenchymal fibroelastosis (PPFE) is now a defined clinicopathologic entity in the updated 2013 ATS/ERS classification of idiopathic interstitial pneumonias (IIPs), which has led to a significant increase in cases being diagnosed at our institution. We have therefore reviewed 43 PPFE cases (58 biopsies in total) to assess whether any clinical or histopathologic features provide prognostic information. A semiquantatitive grading system was used to assess extent of fibroblastic foci, intra-alveolar fibroelastosis, visceral pleural fibrosis, chronic inflammation in areas of fibrosis, vascular fibrointimal thickening, and presence of granulomas. Other patterns of interstitial lung disease were also noted, if present. All biopsies showed intra-alveolar fibroelastosis, fibroblastic foci at the leading edge of fibrosis and chronic inflammation within areas of fibrosis, 91% showed vascular fibrointimal thickening of vessels, 73% showed pleural fibrosis, and 35% showed granulomas. Ten cases showed a coexistent IIP (5 usual IIP, 5 showed features of hypersensitivity pneumonitis). There was no significant correlation with mortality and severity of histologic parameters, other than a significant decrease in mortality in PPFE with coexistent granulomas, after adjusting for age and gender (hazard ratio, 0.27; P=0.049). Male gender was also associated with an increased risk of mortality, after adjusting for age (hazard ratio, 4.8; P=0.045). PPFE is more common than previously thought, not infrequently showing coexistent pathology, specifically usual interstitial pneumonia and granulomatous lung disease, our data suggesting the latter may have prognostic significance.
Issue Date: 4-Sep-2017
Date of Acceptance: 1-Sep-2017
ISSN: 0147-5185
Publisher: Wolters Kluwer Health, Inc.
Start Page: 1683
End Page: 1689
Journal / Book Title: American Journal of Surgical Pathology
Volume: 41
Issue: 12
Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in The American Journal of Surgical Pathology
Sponsor/Funder: NIHR Research for Patient Benefit Programme
Funder's Grant Number: PB-PG-0712-28073
Keywords: 1103 Clinical Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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