Welcome to another edition of Pulmonary Pathology Reviews, an international, multi-institutional journal club in which members meet monthly via teleconference to discuss the latest publications relevant to pulmonary pathology drawing on print peer-reviewed literature from the preceding month. This month's edition comes from sunny Scottsdale, Arizona through the hard work of Tom Colby. What follows is his OVERVIEW of what's hot and what's not in the fast-paced world of academic pulmonary pathology. Click here to see a PDF version of his summary for the three articles selected for discussion. Click here for his summary of articles on neoplastic diseases that were chosen for notation, and click here for a summary of notation articles focusing on non-neoplastic diseases. And if you want to hear how it all went down at 06:15 MST on Monday, March 30, 2015 click here to download an MP3 audiofile (be patient - depending on your bandwidth it may take awhile).
The number of articles from February was considerably fewer than those from January reviewed in the February Journal Club Meeting.
Probably the most significant article from the point of view of morphologic diagnosis is the study on lymphomatoid granulomatosis (LYG) that represents NIH/Elaine Jaffe’s experience over 15 years. This article provides guidelines for the diagnosis of LYG and addresses several issues. Importantly, the authors acknowledge that there are some cases of grade 1 LYG that do not show all the criteria; large B cells and EBV positivity may be lacking in cases that otherwise fit the clinical-pathologic spectrum of LYG.
There were two studies on neuroendocrine cell proliferations in the lung, one from National Jewish Hospital in Colorado representing a clinical series primarily of patients with obstructive lung disease referred to that institution. The patients selected for this study represent a small portion of those with neuroendocrine cell proliferations as evidenced by the fact that the second study, a pathology study from Dr. Marchevsky at Cedars-Sinai, had essentially no cases that fit the criteria of those for the Denver group. Dr. Marchevsky’s group looked at a consecutive series of cases with neuroendocrine cell proliferation in order to define criteria for that entity represents a pure pathologic approach to this condition (representing all comers found histologically in consecutive cases) whereas the National Jewish group represents a clinical series that is a small subset of all patients that show some evidence of neuroendocrine cell proliferation. An interesting finding from the Denver study was that two of their cases were diagnosed clinically without histologic support and another portion were diagnosed on the basis of findings in transbronchial biopsy; they propose diagnostic criteria for cases in which surgical lung biopsy (or larger specimen) is lacking. Dr. Marchevsky’s group provides a (somewhat arbitrary) definition for neuroendocrine cell hyperplasia: “the presence of five or more NE cells, singly or in clusters, within the membrane of the bronchial or epithelium of at least three bronchioles”.
Among the articles for notation I will highlight a couple. Of the neoplastic articles that by Remark, et al. is a review of the immune microenvironment of lung cancer and could be of interest to those looking for putative sites to target new therapies. Frank Schneider showed in the study from Pittsburgh that an appreciable percentage of either core needle biopsies or fine needle aspirations are inadequate for molecular study, something known to all of us, but something which we continually have to remind our clinical colleagues about. Among the non-neoplastic articles for notation there is an interesting radiologic study from Chung suggesting that the “possible UIP” radiologic group from the IPF guidelines be divided into two subsets: probable UIP and indeterminant UIP; the former showing a higher association with histologic UIP. Finally, there is a very nice review article by Guignabert on new molecular targets in pulmonary hypertension. There are some very nice pictures and it provides a nice review of the newer therapies for pulmonary hypertension.