Organizing Alveolar Pneumonia

Figure 1. Organizing Pneumonia

This subpleural focus of inflammation from a patient with LWS has filled alveolar spaces and obliterated alveolar walls. It consists of lymphoid cells and histiocytes with increased cytoplasm (epithelioid cells). A multinucleated giant cell can be seen in the center of the image. Granulomas and necrosis are absent.

giant

 

This nodule represents active disease.

Find a multinucleated giant cell with peripheral nuclei (Langhans' giant cell).

macs

Figure 2. Fibrosing Parenchymal Pneumonia

In another patient, collagenous scar is infiltrated by large numbers of lymphoid cells. Some residual air spaces contain macrophages. Granulomas are absent in this region.

Find a cluster of macrophages in an air space.

granulomagranuloma1

Figure 3. Granulomas in Areas of Organizing Pneumonia

Here, two non-necrotizing granulomas are present in another area of the biopsy shown above. One is a very ill-defined collection of epithelioid cells and lymphoid cells and the other is a circumscribed collection of epithelioid cells with a Langhans' giant cell.

Find the ill-defined granuloma.

Find the granuloma with the giant cell.

Radiographic irregular opacities representing organizing pneumonia are potentially reversible in the absence of scarring.

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Multinucleated giant cell

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Collection of alveolar macrophages

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Ill-defined granuloma

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Well-defined granuloma with giant cell

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