Gross Appearance of Some Features of Lung Disease in Rheumatoid Arthritis

Postmortem specimen from another patient shows three features (A, B, & C) of lung disease associated with rheumatoid arthritis. What are these features? Answer

Histologic Features of Our Patient's Biopsy

The specimen of RLL showed two pleural based, poorly circumscribed, soft, white lesions, 1.4 and 1 cm in diameter. The RML sample had two pleural based, well-circumscribed, soft, white lesions, 0.6 and 0.5 cm in diameter. At low power (A) a cavitary, parenchymal nodule shows pleural invasion. Erosion of the pleura by the inflammation sometimes produces a bronchopleural fistula. The surrounding lung tissue is mostly normal.

A

B

 

Higher magnification of another subpleural nodule (B) shows central necrosis, which is surrounded by a chronic inflammatory infiltrate.

At the edge of the necrosis is a zone of palisaded histiocytes, some of which are multinucleated. The central necrotic zone has both pink and bluish areas indicating, respectively, more or less digestion of a preceding cellular infiltrate. A chronic inflammatory infiltrate lies outside the necrotic and palisaded zones.

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Postmortem specimen from another patient shows three features (A, B, & C) of lung disease associated with rheumatoid arthritis. What are these features?

Answers:

A: Pleural fibrosis

B. Laminated, cavitating rheumatoid nodules above and below the fissure

C. Purulent, necrotizing pneumonia with yellowish exudate--an opportunistic infection in this immunocompromised patient

The subpleural bulla also had pus related to the pneumonia. Patients with rheumatoid arthritis often die of pneumonia related to immunosuppression.

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