Biopsy transbronchial

A 49-year-old man had a progressive unproductive cough and right hemithoracic pain after 3 months of interferon beta-la 30 micrograms/week for multiple sclerosis. A CT scan showed a right basal pulmonary infiltrate and transbronchial biopsies showed features consistent with bronchiolitis obliterans with organizing pneumonia. The lesions resolved fully on interferon beta-la withdrawal and prednisone treatment. 

A 62-year-old woman with severe asthma took oral pranlukast 450 mg/day and oral prednisolone 80 mg/day for a severe asthmatic attack. After oral prednisolone was tapered and subsequently withdrawn by day 35, she was maintained on pranlukast only and 5 days later had fever, deteriorating pulmonary symptoms, hypoxemia, and bibasal reticulonodular pulmonary infiltrates on chest CT. A transbronchial biopsy was consistent with drug-related interstitial pneumonitis. A lymphocyte stimulation test was positive for pranlukast. Her fever abated and her pulmonary symptoms markedly improved 3 days after withdrawal of pranlukast, and 5 months later the pulmonary infiltrates had completely resolved. 

B. anthracis are usually used to diagnose anthrax however, previous antibiotic treatment will affect culture yield and Gram stain identification of the bacteria. Immunohistochemistry has demonstrated high sensitivity and specihcity for the detection of B. anthracis in skin biopsies, pleural biopsies, transbronchial biopsies, and pleural fluids (see Fig. 

FIGURE 12.38 This transbronchial biopsy was initially diagnosed as a small cell lung cancer. X 400. 

The second patient was a 71-year-old woman whose transbronchial biopsy showed focal areas of crushed cells (Fig. 12.38) and was initially diagnosed as small cell lung cancer. On review, the neoplastic cells were round to slightly spindle shaped, had a uniform chromatin pattern, and showed no mitotic activity. The cytoplasm of the neoplastic cells showed intense immunostaining for chromogranin A and synaptophysin (Fig. 12.39) and no... 

The third patient was a 70-year-old man whose transbronchial biopsy showed a uniform population of cells with focal crush artifact but no necrosis or mitotic activity. The neoplastic cells showed no immunostaining for TTF-1 but showed intense immunostaining for chromogranin A and synaptophysin. The Ki-67 labeling index was less than 20%. 

Yousem SA, Martin T, Paradis IL, Keenan R, Griffith BP. Can immunohistological analysis of transbronchial biopsy specimens predict responder status in early acute rejection of lung allografts Hum Pathol 1994 25 525-529. 

Milne DS, Gascoigne AD, Wilkes J, et al. MHC class II and ICAM-1 expression and lymphocyte subsets in transbronchial biopsies from lung transplant recipients. Transplantation 1994 57 1762—1766. 

Both the clinician and pathologist should be aware of the limitations of the lung biopsy. Transbronchial biopsy has quite a Umited role in evaluation of ILD with the most notable exceptions being for the diagnosis of sarcoidosis and infections and to exclude other disorders. In most other settings, the biopsy material is too small and nonspecific for a reUable interpretation (2). 

Berbescu EA, Katzenstein AL, Snow JL, et al. Transbronchial biopsy in usual interstitial pneumonia. Chest 2006 129 1126-1131. 

Usually it requires a wedge biopsy of the lung to identify the histologic features and perform the necessary special studies for diagnosis. Occasionally, a transbronchial biopsy is sufficient to confirm recurrent disease, particularly when supported by immunohistochemistry or flow cytometry on cells studied from the bronchoalveolar lavage. In these cases, small specimens (transbronchial biopsy. 

The prevalence of ILD in SjS depends on the methods used for detection. In historical series primary and secondary SjS were pooled (193-199). Lung involvement is usually subclinical. In the largest prospective study, containing 100 patients with primary SjS, about 5% had abnormal radiography, and a reduction in FVC and DLco was found at presentation in 12% and 10%, respectively (197). BAL yields an alveolitis in about half of cases without clinical manifestations (147,200). HRCT reveals abnormalities in a third of unselected patients with primary SjS (201) and in up to 89% of patients with respiratory symptoms (202), but significant pulmonary fibrosis in only approximately 20% (201,202). Over two-thirds of dyspneic patients with primary SjS have interstitial abnormalities on transbronchial biopsy (203). 

Housini I, Tomashefski JF, Jr., Cohen A, et al. Transbronchial biopsy in patients with pulmonary eosinophilic granuloma. Comparison with findings on open lung biopsy. Arch Pathol Lab Med 1994 118(5) 523-530. 

Guinee DG Jr., Feuerstein I, Koss MN, et al. Pulmonary l3fmphangioleiomyoma-tosis. Diagnosis based on results of transbronchial biopsy and immunohistochemical studies and correlation with high-resolution computed tomography Endings. Arch Pathol Lab Med 1994 118(8) 846-849. 

Leslie KO, Gruden JF, Parish JM, et al. Transbronchial biopsy interpretation in the patient with diffuse parenchymal lung disease. Arch Pathol Lab Med 2007 131(3) 407 23. 

Fig. 2.1.4. Berylliosis. This image is from a transbronchial biopsy and shows several noncaseating granulomas. Histologically this appearance is identical to sarcoidosis...

As is true of most forms of diffuse interstitial fibrosis (ATS/ERS 2002), transbronchial biopsies are totally unsuitable for diagnosing asbestosis. At a minimum, a large open or thoracoscopic biopsy is required. 

A radiographic response to treatment may confirm the suspicion of rejection. In most cases rejection is confirmed by transbronchial biopsy. 

Radiographic findings are often nonspecific and usually do not distinguish pneumonia from rejection, unless findings are present in the native lung. CT is useful for early detection of pneumonia and is helpful in directing bronchoscopy or transbronchial biopsy, and is very useful in following response to therapy. 

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