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Stefania C, Angela B, Stefania C, Antonio C, Andrea AS, Gianrocco M, Tiziana S, Luca RB. Idiopathic pulmonary fibrosis and intestinal disorders: An observational study. Ann Diagn Pathol 2023; 62:152072. [PMID: 36529590 DOI: 10.1016/j.anndiagpath.2022.152072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Idiopathic pulmonary fibrosis (IPF) is a chronic respiratory disease characterized by a progressive decline in lung function and a specific histopathologic pattern defined as usual interstitial pneumonia. Early diagnosis and new therapeutic protocols have contributed to a reduction in disease progression. Thus, some patients may develop extrapulmonary diseases including malignancies and chronic pathologies. The aim of this study was to investigate the frequency of intestinal disorders such as polyps, colorectal carcinoma (CRC), and chronic inflammatory bowel disease (IBD) in patients with IPF. METHODS From the database of 189 patients with IPF (148 males, 78.3 %; 41 females, 21.7 %) residing in the district of Modena, we identified 44 patients (36 males, 81.8 %; 8 females, 18.2 %) with a histologically confirmed intestinal disease. RESULTS Intestinal polyps were detected in 41 cases (93.2 %), of which 4 were associated with CRC and 1 with IBD; 1 patient had only CRC (2.3 %), and 2 patients had only IBD (4.5 %). Both males and females developed bowel disease, but males seemed to have a higher number of polyps and high-grade adenomas with a predisposition to malignant transformation. CONCLUSIONS As patients with IPF may present with intestinal diseases that can evolve into malignancies in some cases, they should undergo appropriate follow-up and targeted colorectal screening. Thus, colorectal pathologies should not take a back seat. These preliminary results encourage further research to select suitable patients for specific diagnostic and therapeutic procedures in order to prolong survival and improve the quality of life.
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Affiliation(s)
- Caramaschi Stefania
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Bertani Angela
- Department of Specialized Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | - Cerri Stefania
- Center for Rare Lung Disease, Department of Specialized Medicine, Respiratory Disease Unit, University Hospital of Modena, Modena, Italy
| | - Colecchia Antonio
- Department of Specialized Medicine, Gastroenterology Unit, University Hospital of Modena, Modena, Italy
| | | | - Manco Gianrocco
- Department of Surgery, University Hospital of Modena, Modena, Italy
| | | | - Reggiani Bonetti Luca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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Use of Next-Generation Sequencing to Support the Diagnosis of Familial Interstitial Pneumonia. Genes (Basel) 2023; 14:genes14020326. [PMID: 36833253 PMCID: PMC9957248 DOI: 10.3390/genes14020326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Familial interstitial pneumonia (FIP) is defined as idiopathic interstitial lung disease (ILD) in two or more relatives. Genetic studies on familial ILD discovered variants in several genes or associations with genetic polymorphisms. The aim of this study was to describe the clinical features of patients with suspected FIP and to analyze the genetic variants detected through next-generation sequencing (NGS) genetic testing. A retrospective analysis was conducted in patients followed in an ILD outpatient clinic who had ILD and a family history of ILD in at least one first- or second-degree relative and who underwent NGS between 2017 and 2021. Only patients with at least one genetic variant were included. Genetic testing was performed on 20 patients; of these, 13 patients had a variant in at least one gene with a known association with familial ILD. Variants in genes implicated in telomere and surfactant homeostasis and MUC5B variants were detected. Most variants were classified with uncertain clinical significance. Probable usual interstitial pneumonia radiological and histological patterns were the most frequently identified. The most prevalent phenotype was idiopathic pulmonary fibrosis. Pulmonologists should be aware of familial forms of ILD and genetic diagnosis.
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Cooper WA, Mahar A, Myers JL, Grainge C, Corte TJ, Williamson JP, Vallely MP, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Lau EMT, Raghu G, Troy LK. Cryobiopsy for Identification of Usual Interstitial Pneumonia and Other Interstitial Lung Disease Features. Further Lessons from COLDICE, a Prospective Multicenter Clinical Trial. Am J Respir Crit Care Med 2021; 203:1306-1313. [PMID: 33285079 DOI: 10.1164/rccm.202009-3688oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; DlCO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).
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Affiliation(s)
- Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Annabelle Mahar
- Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology
| | - Jeffrey L Myers
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christopher Grainge
- Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Tamera J Corte
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
| | - Jonathan P Williamson
- Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.,Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Michael P Vallely
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Lai
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ellie Mulyadi
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul J Torzillo
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Martin J Phillips
- Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia.,Respiratory and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and
| | - Edmund M T Lau
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ganesh Raghu
- Division of Pulmonary, Sleep, and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Lauren K Troy
- Respiratory and Sleep Medicine, and.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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