Surgical Pathology Criteria–

Desquamative Interstitial Pneumonia

Differential Diagnosis

Respiratory Bronchiolitis Associated Interstitial Lung Disease Desquamative Interstitial Pneumonia
Patchy Diffuse pulmonary involvement
Intra-alveolar macrophages only focally present Diffuse intra-alveolar macrophages
Mild pneumocyte hyperplasia Prominent pneumocyte hyperplasia
Peribronchiolar thickening Interstitial thickening

 

Langerhans Cell Histiocytosis Desquamative Interstitial Pneumonia
Intra-alveolar macrophages only focally present Diffuse intra-alveolar macrophages
Temporal heterogeneity Temporally uniform
Focal or multifocal disease Diffuse disease
Numerous eosinophils Occasional eosinophils
Cystic change frequent No cystic change
Produces stellate scars Lacks scarring
Histiocytes with folded nuclei Histiocytes with round nuclei
Langerhans cells positive for CD1a and langerin Macrophages CD1a and langerin negative

 

Giant Cell Interstitial Pneumonia Desquamative Interstitial Pneumonia
Centrilobular distribution Diffuse intra-alveolar macrophages
Numerous multinodular giant cells Giant cells not present
Heavy metal may be identified No heavy metals

 

Usual Interstitial Pneumonia Desquamative Interstitial Pneumonia
Intra-alveolar macrophages only focally present Diffuse intra-alveolar macrophages
Temporal heterogeneity Temporally uniform
Architecture destroyed, honeycomb change prominent Architecture preserved, honeycomb change uncommon
Fibroblastic foci common Fibroblastic foci absent
Interstitial fibrosis marked Interstitial fibrosis mild to moderate
Interstitial fibrosis variably distributed Interstitial fibrosis tends to be more uniform

 

Desquamative Interstitial Pneumonia Acute Eosinophilic Pneumonia
Subacute onset Acute, fulminant onset
Eosinophils infrequent Prominent eosinophils in lavage and biopsy specimens
Following steroid treatment, eosinophils may be harder to identify

 

Post-obstructive Pneumonia Desquamative Interstitial Pneumonia
Foamy macrophages Finely granular macrophages
No pigment in macrophages (unless a smoker) Pigment in macrophages
No interstitial pneumonitis Interstitial pneumonitis present (but mild)
Localized Generalized

 

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