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Histopathological Examination of Pulmonary and Pleural Biopsies

 Dr Sampurna Roy MD 

 

                                                                                                                      

 

 

Indications and techniques: 

The lung biopsy is widely recognized as a valuable tool for the diagnosis and management of diverse pulmonary disorders.

The transbronchial lung biopsy, open lung biopsy, and video assisted thoracoscopic surgery biopsy are the principal tools that have been developed for obtaining lung tissue for histopathological examination.

Indications: 

Specimens from lungs are taken:

- For the diagnosis, treatment and palliation of neoplasms.

Pleural biopsy is usually taken:

- To help in the differential diagnosis of pleural effusions and pleural tumours.

Other reasons for lung biopsy include:

(i) Assessment of inflammatory lesions such as sarcoidosis , tuberculosis and fungal infections.

(ii) Fibrosing lung diseases and

(iii) Rejection changes in heart / lung transplants.

(iv) Rarely biopsies are taken in the investigation of asthma and its response to treatment.

Techniques: 

A number of techniques are available to obtain pulmonary and pleural tissue for histological diagnosis.

For information on the approach to histopathological reporting and handling of specimens click on the following links:

- Percutaneous Needle and Trucut Biopsy Specimen:

- Bronchial Biopsy Specimen:

- Transbronchial Biopsy Specimen:

- Transbronchial biopsy in lung transplant recipients: 

- Open lung biopsy

- Lobectomy or pneumonectomy specimens for neoplasia and non  neoplastic diseases of the lung:

- Closed pleural biopsy for neoplasm or inflammatory lesions  ; open pleural biopsy and pneumonectomy or pleural

stripping:

- Histopathological reporting of pulmonary parenchymal biopsies:

- Useful chromatic and immuno-stains in pulmonary pathology:

Acp. Best practice no 161. Examination of lung specimens. J Clin Pathol. 2000 Jul;53(7):507-12.

Along with the lung or pleural biopsy specimen following clinical information should be provided by the clinician to the histopathologist :

                                                                                           

Lung Biopsy Specimen:

- Age and sex of the patient ; 

- Clinical signs and symptoms and their duration ;

- History of smoking ;

- History of tuberculosis , systemic malignancy or other diseases (Cushing’s syndrome, diabetes insipidus, hypertrophic osteoarthropathy, rheumatoid arthritis and other connective tissue disease) ;

- Occupation ;

- History of previous instrumentation in the lung ;

- Results of other investigations : (radiological and microbiological) ;

Pleural biopsy specimen:

- Age and sex of the patient ; 

- Clinical signs and symptoms and their duration ;

- Clinical examination -  hilar lymphadenopathy ;

- Occupation (especially history of asbestos exposure) ;

- History of smoking;

- History of tuberculosis or systemic malignancy;

- History of hilar lymphadenopathy ;

- Results of other investigation: ( radiological and microbiological).

Further reading:

[Correlation between the clinical and pathohistologic diagnosis in "small biopsies" of the lung].

Bronchoscopic diagnosis and staging of lung cancer.

Bronchoscopic needle aspiration biopsy.

Bronchoscopy in diffuse lung disease: evaluation by open lung biopsy in nondiagnostic transbronchial lung biopsy. 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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