Nonspecific interstitial pneumonia

Interstitial Lung Diseases That Have No Known Cause 338 Idiopathic Interstitial Pneumonias 33S Idiopathic Pulmonary Fibrosis 339 Nonspecific Interstitial Pneumonia 339 Cryptogenic Organizing Pneumonia 339... 

The term idiopathic interstitial pneumonias refers to a group of seven entities with distinct histologic patterns idiopathic pulmonary fibrosis (IFF), characterized by the pattern of usual interstitial pneumonia (UIP) nonspecific interstitial pneumonia (NSIP) cryptogenic organizing pneumonia (COP) respiratory bron-chiohtis-associated interstitial lung disease (RB-ILD) desquamative interstitial pneumonia (DIP) lymphoid interstitial pneumonia (LIP) and acute interstitial pneumonia (AIP). 

Fig. 26.24. A 50-year-old woman with interstitial pneumonia (lP)/nonspecific interstitial pneumonia (NSIP) after bleomycin chemotherapy for Hodgkin s lymphoma. Axial CT image shows irregular linear and reticular opacities (arrowheads) with subtle ground-glass opacities (arrow) in subpleural distribution...

Fig. 26.27. Axial CT image in a patient with progressive systemic sclerosis shows a mixture of fine reticular and ground-glass opacities (black arrows), associated with mild traction bronchiectasis (white arrow), consistent with a nonspecific interstitial pneumonia pattern. Note esophageal dilatation (arrowheads)...

Travis WD, Matsui K et al. (2000) Idiopathic nonspecific interstitial pneumonia prognostic significance of cellular and fibrosing patterns survival comparison with usual interstitial pneumonia and desquamative interstitial pneiuno-nia. Am J Surg Pathol 24 19 33... 

Protopapadakis C, Antoniou KM, Voloudaki A, Samara K, Proklou A, Margaritopoulos G, Siafakas NM. Rituximab-induced nonspecific interstitial pneumonia like reaction in a patient with idiopathic thrombocytopenic purpura. Respir Med CME 2009 2(4) 176-8. 

Idiopathic pulmonary fibrosis Nonspecific interstitial pneumonia Cryptogenic organizing pneumonia Desquamative interstitial pneumonia Respiratory bronchioUtis-associated interstitial lung disease Lymphocytic interstitial pneumonia Acnte interstitial pnemnonia... 

Kinder BW, Collard HR, Koth L, et al. Idiopathic nonspecific interstitial pneumonia lung manifestation of undifferentiated connective tissue disease Am J Respir Crit Care Med 2007 176 691-697. 

Usual interstitial pneumonia Nonspecific interstitial pneumonia Organizing pneumonia Diffuse alveolar damage Respiratory bronchiolitis Desquamative interstitial pneumonia Lymphocytic interstitial pneumonia Idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis Nonspecific interstitial pneumonia (provisional) Cryptogenic organizing pneumonia Acute interstitial pneumonia Respiratory bronchiolitis-associated interstitial lung disease Desquamative interstitial pneumonia Lymphocytic interstitial pneumonia... 

Abbreviations HRCT, high-resolution computed tomography NSIP, nonspecific interstitial pneumonia. 

Elhot TL, Lynch DA, Newell JD Jr., et al. High-resolution computed tomography features of nonspecific interstitial pneumonia and usual interstitial pneumonia. J Comput Assist Tomogr 2005 29(3) 339-345. 

Daniil ZD, Gilchrist FC, Nicholson AG, et al. A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med 1999 160(3) 899-905. 

Katzenstein AL, Fiotelh RF. Nonspecific interstitial pneumonia/fihrosis. Histologic features and clinical significance. Am J Surg Pathol 1994 18(2) 136-147. 

Flaherty KR, Martinez FJ. Nonspecific interstitial pneumonia. Semin Respir Crit Care Med 2006 27(6) 652-658. 

Park JS, Lee KS, Kim JS, et al. Nonspecific interstitial pneumonia with fibrosis radiographic and CT findings in seven patients. Radiology 1995 195(3) 645-648. 

Kim T, Lee K, Chung M, et al. Nonspecific interstitial pneumonia with fibrosis high resolution CT and pathologic findings. AJR Am J Roentgenol 1998 171 1645-1650. 

MacDonald SL, Rubens MB, Hansell DM, et al. Nonspecific interstitial pneumonia and usual interstitial pneumonia comparative appearances at and diagnostic accuracy of thin-section CT. Radiology 2001 221(3) 600-605. 

Kim DS, Yoo B, Lee JS, et al. The major histopathologic pattern of pulmonary fihrosis in scleroderma is nonspecific interstitial pneumonia. Sarcoidosis Vase Diffuse Lung Dis 2002 19(2) 12H27. 

The lymphoplasmacytic interstitial infiltrates seen in UIP are generally sparse in comparison to other entities such as nonspecific interstitial pneumonia (NSIP) or hypersensitivity pneumonitis (HP). Extensive cellular infiltrates or follicular lymphoid hyperplasia should lead to consideration of other entities that may cause a UIP pattern of fibrosis such as CVD or HP. Pleural inflammation is not a feature of idiopathic UIP, and its presence indicates a second process or secondary form of UIP with pleuritis, most likely a CVD such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SUE) (14). 

The term nonspecific interstitial pneumonia (NSIP) was coined by Katzenstein and Fiorelli in 1994 to account for a pattern of interstitial fibrosis that appeared to have distinct features from UIP. Notably, it was observed that in some patients the interstitial process was more cellular than was typical for UIP and the characteristic features of spatial and temporal heterogeneity were not seen. Therefore, a new term, NSIP, was introduced (19). 

Figure 2 (See color insert.) Nonspecific interstitial pneumonia. (A) NSIP fibrotic pattern interstitial fibrosis in a temporally and spatially homogeneous pattern (original magnification, 20x Masson s trichrome stain). (B) NSIP cellular pattern interstitial lymphocytic infiltrates in a temporally and spatially homogeneous pattern (original magnification, 40 x H E stain). (C) NSIP fibrotic pattern interstitial fibrosis in a temporally and spatially homogeneous pattern (original magnification, 200x H E stain). Abbreviation-. NSIP, nonspecific interstitial pneumonia.

Martinez FJ. Idiopathic interstitial pneumonias usual interstitial pneumonia versus nonspecific interstitial pneumonia. Proc Am Thorac Soc 2006 3 81-95. 

FUeder DB, Koss MN. Nonspecific interstitial pneumonia a provisional category of idiopathic interstitial pneumonia. Curr Opin Pulm Med 2004 10 441-446. 

For pulmonary fibrosis, the role of CS is unclear (23,24). Early studies suggested a steroid-responsive group (25-27). However, with the new classification system that separates IFF from nonspecific interstitial pneumonia (NSIF), it is reasonable to assume that most steroid responsive cases of IFF were in fact cellular NSIF and that CSs have no impact on the chronic phase of IFF (14,23,28). However, CSs may have a role in treating acute exacerbations of IFF (29). 

Kondoh Y, Taniguchi H, Yokoi T, et al. Cyclophosphamide and low-dose prednisolone in idiopathic pulmonary fibrosis and fibrosing nonspecific interstitial pneumonia. Eur Respir J 2005 25 528-533. 

Nanki N, Fujita J, Yamaji Y, et al. Nonspecific interstitial pneumonia/fibrosis completely recovered by adding cyclophosphamide to corticosteroids. Intern Med 2002 41 867-870. 

Flaherty KR, Travis WD, Colby TV, et al. Histopathologic variabiUty in usual and nonspecific interstitial pneumonias. Am J Respir Crit Care Med 2001 164(9) ... 

Nishiyama O, Kondoh Y, Taniguchi H, et al. Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis. J Comput Assist Tomogr 2000 24(1) 41 6. 

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