How do clinicians recognize and deal with organizing pneumonia in pathology / 中国综合临床

ABSTRACT

Objective:Organizing pneumonia (OP) is a clinical syndrome manifested by granulation tissue plug in respiratory bronchioles, alveolar ducts and alveolar spaces pathologically.With advent of lung biopsy techniques, increasing pathological diagnosis of organizing pneumonia was made, most of which were confirmed secondary organizing pneumonia (SOP) either at time of diagnosis or on follow-up.The secondary etiology is related to the choice of treatment and prognosis.First of all, we need to rule out infection, find evidence of connective tissue disease, or previous medication, radiotherapy and even transplantation.The coexistence of multiple pathological features and simultaneous involvement of pulmonary vessels and pleura suggest possible secondary causes.The pathological diagnosis of organic pneumonia by empty core needle puncture or transbronchial lung biopsy needs to be combined with imaging to avoid omitting the tumor, granuloma and necrosis around organic pneumonia.In general, organizing pneumonia, no matter cryptogenic or secondary, is mostly responsive to corticosteroids compared with other interstitial lung diseases, although relapses are frequent.In summary, real cryptogenic organized pneumonia is actually relatively uncommon and should be diagnosed with caution.Long term follow up is not only crucial to assess the evolution of lung disease but also for looking into the underlying etiologies behind an organizing pneumonia.