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Hypersensitivity Pneumonitis in Adults

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17 Table 6. Histopathological Criteria for the Diagnosis of HP (Other than "Hot-Tub Lung" a ) Matter Typical Sources HP "Disease" Nonfibrotic HP (cellular HP) 2. Cellular bronchiolitis: • Lymphocyte- predominant (lymphs > plasma cells) with no more than focal peribronchiolar lymphoid aggregates with germinal centers • ±Organizing pneumonia pattern with Masson bodies • ±Foamy macrophages in terminal air spaces 2. Cellular bronchiolitis: • Lymphocyte-predominant (lymphs > plasma cells) with no more than focal peribronchiolar lymphoid aggregates with germinal centers • ±Organizing pneumonia pattern with Masson bodies • ±Foamy macrophages in terminal air spaces and Absence of features in any biopsy site to suggest an alternative diagnosis: • Plasma cells > lymphs • Extensive lymphoid hyperplasia • Extensive well-formed sarcoidal granulomas and/or necrotizing granulomas • Aspirated particulates Absence of features in any biopsy site to suggest an alternative diagnosis: • Plasma cells > lymphs • Extensive lymphoid hyperplasia • Extensive well-formed sarcoidal granulomas and/ or necrotizing granulomas • Aspirated particulates 3. Poorly formed nonnecrotizing granulomas: b • Loose clusters of epithelioid cells and/ or multinucleated giant cells ± intracytoplasmic inclusions • Situated in peribronchiolar interstitium, terminal air spaces, and/or organizing pneumonia (Masson bodies) and Absence of features in any biopsy site to suggest an alternative diagnosis: • Plasma cells > lymphs • Extensive lymphoid hyperplasia • Extensive well-formed sarcoidal granulomas and/or necrotizing granulomas • Aspirated particulates (cont'd)

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