Hypersensitivity pneumonitis: histopathology.
BACKGROUND
The classic histopathology of hypersensitivity pneumonitis (HSP) is well known but variations do occur and at times the diagnosis can be difficult. This is particularly true in the chronic stage of the disease.


OBJECTIVE
To review the wide variety of histopathologic changes that can be seen in HSP and to offer a practical approach to diagnosis, including the diagnosis of recently described variants of HSP such as the so-called hot tub lung.


METHODS
This review draws from the author's own experience and a concurrent search of national and international literature.


CONCLUSIONS
The diagnosis of HSP can be made with confidence only in light of clinical, serologic, and radiographic data. A particular challenge for pathologists is the recognition of the disease in its chronic stage. In this stage, the identification of poorly formed granulomas in association with (1) a pattern of homogeneous linear fibrosis and (2) irregular fibrosis in a partially peribronchiolar distribution would facilitate the diagnosis.
Barrios
Roberto J
RJ
Department of Pathology, The Methodist Hospital, Room M227, 6565 Fannin St, Houston, TX 77030, USA. rbarrios@tmhs.org
D000542:Alveolitis, Extrinsic Allergic / Q000473:pathology*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005355:Fibrosis / Q000473:pathology; D006099:Granuloma / Q000473:pathology; D006801:Humans; D019570:Inhalation Exposure; D010340:Pathology, Surgical / Q000379:methods