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The Overlap Between Respiratory Bronchiolitis and Desquamative Interstitial Pneumonia: Materials and Methods

The medical record of two index patients with PLCH associated with marked RB/DIP-like changes on biopsy were reviewed and summarized. To further characterize the relationship between RB/DIP and PLCH, we searched the Mayo Clinic database and identified 10 additional cases for which both surgical lung biopsy specimens and HRCT scans were available for review. These 10 cases were part of a previously reported series. Patients with transbronchoscopic biopsy-proven PLCH were excluded from the study because the limited amount of tissue was believed to be inadequate for the purpose of the study. Two additional cases (with available lung biopsy and HRCT) were identified while conducting the study (during 1999). All lung biopsies were performed within 3 months of the CT scan. The diagnosis of PLCH was established by light microscopy in all cases. fully
The use of immunostains in some cases was confirmatory but not considered necessary for the diagnosis. Immunostaining was utilized in four cases (all four positive for S-100 staining, and two were positive using both CD1a and S-100 immunostains). Electron microscopy was not utilized in any of the cases. A total of 14 patients were included in this study. The medical records were reviewed and data regarding smoking history, and results of pulmonary function testing (all performed in our laboratory using standard techniques) were recorded. All human studies were approved by the institutional review board.
All HRCT scans were reviewed in a blinded fashion by two radiologists (E.A.J. and T.E.H.), and scored to quantify various defined radiographic abnormalities including areas of ground-glass attenuation, cysts, and nodules. The severity of lesions were scored by a 0-to-3 point system (0 = absent, 1 = mild, 2 = moderate, 3 = severe involvement).