Lymphoid Interstitial Pneumonia (LIP) Revisited

Author:

Fraune Christoph1ORCID,Churg Andrew2,Yi Eunhee S.3,Khoor Andras4,Kelemen Katalin5,Larsen Brandon T.5,Butt Yasmeen M.5,Smith Maxwell L.5,Gotway Michael B.6,Ryu Jay H.7,Tazelaar Henry D.5

Affiliation:

1. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

2. Department of Pathology, University of British Columbia, Vancouver, BC, Canada

3. Department of Laboratory Medicine and Pathology

4. Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL

5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale

6. Department of Diagnostic Radiology, Mayo Clinic, Phoenix, AZ

7. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN

Abstract

The use of lymphoid interstitial pneumonia (LIP) as a diagnostic term has changed considerably since its introduction. Utilizing a multi-institutional collection of 201 cases from the last 20 years that demonstrate features associated with the LIP rubric, we compared cases meeting strict histologic criteria of LIP per American Thoracic Society (ATS)/European Respiratory Society (ERS) consensus (“pathologic LIP”; n=62) with cystic cases fulfilling radiologic ATS/ERS criteria (“radiologic LIP”; n=33) and with other diffuse benign lymphoid proliferations. “Pathologic LIP” was associated with immune dysregulation including autoimmune disorders and immune deficiency, whereas “radiologic LIP” was only seen with autoimmune disorders. No case of idiopathic LIP was found. On histology, “pathologic LIP” represented a subgroup of 70% (62/88) of cases with the distinctive pattern of diffuse expansile lymphoid infiltrates. In contrast, “radiologic LIP” demonstrated a broad spectrum of inflammatory patterns, airway-centered inflammation being most common (52%; 17/33). Only 5 cases with radiologic cysts also met consensus ATS/ERS criteria for “pathologic LIP.” Overall, broad overlap was observed with the remaining study cases that failed to meet consensus criteria for “radiologic LIP” and/or “pathologic LIP.” These data raise concerns about the practical use of the term LIP as currently defined. What radiologists and pathologist encounter as LIP differs remarkably, but neither “radiologic LIP” nor “pathologic LIP” present with sufficiently distinct findings to delineate such cases from other patterns of diffuse benign lymphoid proliferations. As a result of this study, we believe LIP should be abandoned as a pathologic and radiologic diagnosis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Pathology and Forensic Medicine,Surgery,Anatomy

Reference21 articles.

1. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001;Am J Respir Crit Care Med,2002

2. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias;Travis;Am J Respir Crit Care Med,2013

3. Surgical pathology of non-neoplastic lung disease;Katzenstein;Major Probl Pathol,1982

4. Lymphocytic interstitial pneumonia;Panchabhai;Clin Chest Med,2016

5. Lymphoid interstitial pneumonia and other benign lymphoid disorders;Arcadu;Semin Respir Crit Care Med,2016

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