Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases

Our plain-English summary of Peribronchiolar metaplasia: a common histologic lesion in diffuse lung disease and a rare cause of interstitial lung disease: clinicopathologic features of 15 cases, by J. Fukuoka, T.J. Franks, T.V. Colby, et al (The American Journal of Surgical Pathology, 2005).

The study

• Authors: J. Fukuoka, T.J. Franks, T.V. Colby, K.R. Flaherty, J.R. Galvin, D. Hayden, B.R. Gochuico, E.A. Kazerooni, F. Martinez, W.D. Travis
• Journal: The American Journal of Surgical Pathology
• Published: 2005;29(7):948-54
• Type of article: Review
• Cited by: 81 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peribronchiolar metaplasia (PBM) is a histologic lesion consisting of peribronchiolar metaplasia (PBM) of bronchiolar-type epithelium. Although widely recognized, PBM has received little attention in the pathologic literature and is not known to have clinical significance. We identified 15 cases in which PBM was the only major histologic finding in surgical lung biopsies from patients with interstitial lung disease (PBM-ILD), and we reviewed the clinical, imaging, and pathologic findings. The mean age was 57 years (range, 44-74 years) with 13 females and 2 males. One patient had been a welder with fume and asbestos exposure; another had pigeon exposure. Smoking history was available for 13 patients: three current smokers, one cocaine user, two former smokers, and seven never smokers. Three patients had collagen vascular disease. One had elevated serum antinuclear antibody titers. Pulmonary function data were available for 10 patients: one obstructive, five restrictive, two mixed obstructive and restrictive, and two normal. Computerized tomography in 7 patients showed mosaic attenuation in 3 patients and air trapping in 1 patient; no bronchiectasis, septal lines, or honeycombing were seen in any cases. All 11 patients with available follow-up are alive; 4 of them have experienced symptomatic improvement (follow-up, 0.6-6.9 years; mean, 2.4 years). PBM was found focally in other interstitial lung diseases, which were assessed for this lesion: 59% of usual interstitial pneumonia (17 of 29), 50% of nonspecific interstitial pneumonia (10 of 20), desquamative interstitial pneumonia (3 of 6), hypersensitivity pneumonitis (9 of 18), and 11% of respiratory bronchiolitis (2 of 18). In summary, PBM is a common histologic finding in various interstitial lung disorders. It is rarely the sole major lung biopsy finding in patients presenting with interstitial lung disease (PBM-ILD). Patients are mostly older women, with mild symptoms and CT findings. Survival appears to be favorable.

In plain English

This report described 15 patients with clinical signs of interstitial lung disease whose surgical lung biopsies showed peribronchiolar metaplasia (PBM) as the only major finding. PBM is a change in which airway-type lining cells grow onto the air-sac walls around small airways. The cases came from the archives of four institutions and were collected between 1997 and 2003. Thirteen patients were women and 2 were men, aged 44 to 74 years. One patient had worked as a welder with toxic fume and asbestos exposure, and no asbestos bodies were found in that patient's biopsy. All 11 patients with follow-up (0.6 to 6.9 years) were alive, and 5 had improved symptoms. The authors also examined biopsies from 91 patients with five other lung diseases. They found PBM in 17 of 29 patients with usual interstitial pneumonia and 2 of 18 with respiratory bronchiolitis-interstitial lung disease. The authors concluded that PBM is a common incidental finding in various interstitial lung diseases that rarely may be the sole cause of the disease. They noted the series was small.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinicopathologic case series (review of biopsies, clinical, lung function and CT findings), with a comparison of how often PBM appeared in biopsies from other interstitial lung diseases
• Who was studied: 15 patients with interstitial lung disease whose surgical lung biopsies showed PBM as the sole major lesion. The cases came from the archives of the Armed Forces Institute of Pathology (6), the University of Michigan (3), the National Heart, Lung and Blood Institute (1) and Mayo Clinic Scottsdale (5), collected non-consecutively between 1997 and 2003. Biopsies from 91 patients with other interstitial lung diseases were also examined for comparison.
• Exposure: The study did not examine a specific exposure. Among the 15 patients, one had worked as a welder with toxic fume and asbestos exposure (no fiber type named), and one had pigeon exposure.
• Main results:
  • Of the 15 PBM patients, 13 were female and 2 were male. Ages ranged from 44 to 74 years, with a mean of 56.7 years.
  • Of the 13 PBM patients with a smoking history, 3 were current smokers, 1 smoked cocaine, 2 were former smokers and 7 had never smoked.
  • In the one patient with asbestos exposure, no asbestos bodies were found in the biopsy. Across the PBM cases, no remarkable pigment deposits or polarized particles were seen.
  • Follow-up was available for 11 PBM patients and ranged from 0.6 to 6.9 years (mean 2.4 years). All 11 were alive, and the text reports that 5 had improved symptoms.
  • Lung function data were available for 10 PBM patients. Results were obstructive in 1, restrictive in 4, probably restrictive in 1, mixed obstructive and restrictive in 2, and normal in 2.
  • On CT, mosaic attenuation was seen in 3 PBM patients, and another patient had mild lobular air trapping on expiration. No bronchiectasis, honeycombing or centrilobular nodules were seen.
  • In the PBM cases, the share of bronchioles affected ranged from 37% (7 of 19 bronchioles in one case) to 100% (in 4 cases), with a median of 78.1%.
  • In biopsies from patients with other interstitial lung diseases, PBM was found in:
• usual interstitial pneumonia: 17 of 29 (58.6%)
• nonspecific interstitial pneumonia: 10 of 20 (50%)
• desquamative interstitial pneumonia: 3 of 6 (50%)
• hypersensitivity pneumonitis: 9 of 18 (50%)
• respiratory bronchiolitis-interstitial lung disease: 2 of 18 (11.1%)
• The authors' conclusion: The authors concluded that PBM is a common incidental finding in various interstitial lung diseases but rarely may be the sole cause of interstitial lung disease. They described these patients as mostly older women with mild symptoms and CT findings, and said survival appears favorable on the available data.
• Limitations the authors state:
  • The series was small and follow-up was relatively short.
  • Mosaic attenuation and air trapping may have been underreported, because not all patients had high-resolution CT or expiratory imaging.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial Lung Disease, Epithelium, Asbestos Exposure, Collagen, Honeycombing, Interstitial, Pneumonitis, Biopsy.

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