Histologic Changes--Transbronchial Biopsy

One of the transbronchial biopsies shows an intact normal epithelium. In the compressed alveolar tissue are widened alveolar walls with hyperplastic type II cells (if you can see them at all, they're hyperplastic). Centrally are some faintly bluish areas of early granulation tissue.

At higher magnification in another biopsy, the interstitial pneumonia shows characteristic features:

  • widened alveolar walls,
  • type II cell hyperplasia,
  • mild chronic inflammatory cell infiltrate, which is concentrated around small vessels (arrows).

Note again the granulation tissue in air spaces (asterisks).

Here, the bluish granulation tissue that fills an air space has both spindled fibroblasts and some chronic inflammatory cells. The bluish color is characteristic of newly-formed intercellular matrix.

What is the diagnosis? Answer

Clinical summary Image 2

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Diagnosis: Organizing pneumonia, which suggests in this case the entity of bronchiolitis obliterans organizing pneumonia although no bronchioles were present in the biopsies.

Clinical summary Image 2

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