Lung - nontumor - Desquamative interstitial pneumonitis (DIP)

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Lung-nontumor

Other interstitial pneumonitis / fibrosis

Desquamative interstitial pneumonitis (DIP)

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 24 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Usually adults with insidious onset of shortness of breath, progressing to respiratory insufficiency; also cough, cyanosis and clubbing
● Cause unknown
● Mean survival of 12 years, mortality 28%
● 90% are current or past cigarette smokers; male:female = 2:1
● Patients who stop smoking +/- steroid therapy have good prognosis
● Associated with collagen vascular disease, positive ANA (similar to UIP)
● Xray: bilateral, lower lobe, ground glass infiltrates

Treatment
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● Steroids (respond better than UIP)

Micro description
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● Diffuse collections of intraalveolar macrophages containing lipid and PAS+ granules (originally thought to be desquamated pneumocytes)
● Type II pneumocyte hyperplasia, acute and chronic inflammatory cells
● May be focal interstitial fibrosis
● No necrosis, no hyaline membranes and no fibrin

Virtual slides
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DIP

Positive stains
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● PAS after diastase, iron

EM description
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● Type II pneumocytes contain lamellar bodies (surfactant)
● May be phagocytosed by macrophages

Differential diagnosis
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● DIP reaction to Langerhans cell histiocytosis
● Extrinsic allergic alveolitis
● Asbestosis
● Respiratory bronchiolitis

End of Lung-nontumor > Other interstitial pneumonitis / fibrosis > Desquamative interstitial pneumonitis (DIP)

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