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• W4387248888 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 7 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Cigarette smoking has been known to increase the risk of lung cancer and chronic obstructive pulmonary disease (COPD). It also increases the risk of other uncommon pathologies in smoking-related interstitial lung diseases (ILD) including pulmonary langerhans cell histiocytosis (PLCH), desquamative interstitial pneumonia (DIP) and respiratory bronchiolitis-associated interstitial disease (RB-ILD). In some cases, these subsets share histological features which can be linked to a PLCH diagnosis with RB/DIP-like changes (1). We present a case report of a patient with PLCH and DIP histological features CASE PRESENTATION: A 65-year-old male with a history of COPD, pulmonary nodules, cardiovascular disease, prior stroke, and current tobacco use with a 75 pack-year history was evaluated for dyspnea, a chronic nonproductive cough, and wheezing. Pulmonary function tests (PFTs) were consistent with moderate airflow obstruction. Lung volumes demonstrated no restriction, air trapping and unchanged after bronchodilator administration; diffusion capacity was mildly reduced. High resolution computed tomography (HRCT) noted diffuse bilateral emphysema, mediastinal lymphadenopathy, areas of bizarre-shaped cysts bilaterally, and multiple patchy nodular densities throughout, the largest measuring 1.1cm in the left lower lobe with possible cavitation (Fig. 1 and 2). Positron emission tomography showed no metabolic activity in the suspected nodule. He underwent rigid bronchoscopy with endobronchial ultrasound-guided biopsy, transbronchial cryo-probe biopsy and bronchial alveolar lavage (BAL). Microscopic evaluation of the biopsy revealed small lymphocytosis, erythrocytes and scant histiocytes to diagnose DIP. A small accumulation of CD1a and S-100 cells were appreciated in one of three biopsies, however cytology was absent for malignant cells. These findings were consistent with unique overlap of both DIP and PLCH histopathology with radiologic imaging indicating PLCH. DISCUSSION: Differentiating smoking-related ILD subsets is based upon radiographic imaging, biopsy and histopathology. Early-stage PLCH imaging of small irregular centrilobular nodules may evolve to late-stage findings of bizarre cystic airspace disease of upper-middle lobe predominance. PLCH immunohistochemistry demonstrates CD1a expression and nonspecific S100 protein expression. DIP evaluation with BAL will demonstrate many yellow-brown granulated alveolar macrophages. Imaging will show diffuse areas of ground glass opacities (GGOs) with subpleural lower lobe predominance. When differentiating these subsets, there may be varying disease overlap given their similar etiology. The extent of RB-ILD/DIP-like changes can be quantified with the amount of interstitial thickening and GGOs on imaging (1). Serial imaging and PFTs are important to monitor disease progression, and clinicians must be cautioned against anchoring bias when nodularities may not always remain benign in evolving ILD. This case showed clear radiographic evidence of PLC, however DIP diagnosis via cryoprobe biopsy shows there is probable heterogeneity in smoking-related ILDs. Further studies are needed to investigate the prognosis of combined smoking-related diseases. CONCLUSIONS: This case demonstrates the disease overlap in smoking-related ILD with tissue pathology and radiologic imaging as identifying markers. The severity of the combined disease is not well studied, especially if there is no overlap in HRCT imaging. Given that both are smoking-related ILDs, smoking cessation is the primary management with continued symptom and HRCT monitoring. REFERENCE #1: Vassallo, R., Jensen, E. A., Colby, T. V., Ryu, J. H., Douglas, W. W., Hartman, T. E., & Limper, A. H. (2003). The overlap between respiratory bronchiolitis and desquamative interstitial pneumonia in pulmonary Langerhans cell histiocytosis. Chest, 124(4), 1199–1205. https://doi.org/10.1378/chest.124.4.1199 REFERENCE #2: Chakraborty RK, Basit H, Sharma S. Desquamative Interstitial Pneumonia. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526079/ REFERENCE #3: Hagmeyer L, Randerath W. Smoking-related interstitial lung disease. Dtsch Arztebl Int. 2015 Jan 23;112(4):43-50. doi: 10.3238/arztebl.2015.0043. PMID: 25797422; PMCID: PMC4335489. DISCLOSURES: No relevant relationships by Emil Abramian No relevant relationships by Frederick Gmora No disclosure on file for Nicholas Hinds No relevant relationships by Osawevheniyare Iyamu-Osagiede No relevant relationships by Samantha Tauscher" @default.
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• W4387248888 title "A MIXED SMOKING-RELATED LUNG DISEASE PICTURE: A CASE OF PULMONARY LANGERHANS CELL HISTIOCYTOSIS AND DESQUAMATIVE INTERSTITIAL PNEUMONIA" @default.
• W4387248888 doi "https://doi.org/10.1016/j.chest.2023.07.2198" @default.
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