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Link to original content: https://pubmed.ncbi.nlm.nih.gov/36495281
Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease - PubMed Skip to main page content
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. 2023 Feb 1;159(2):146-157.
doi: 10.1093/ajcp/aqac144.

Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease

Susan J Vehar  1 , Ruchi Yadav  2 , Sanjay Mukhopadhyay  3 , Avantika Nathani  4 , Leslie B Tolle  4
Affiliations

Smoking-Related Interstitial Fibrosis (SRIF) in Patients Presenting With Diffuse Parenchymal Lung Disease

Susan J Vehar et al. Am J Clin Pathol. .

Abstract

Objectives: To describe the clinical, radiologic, and pathologic findings in cases where smoking-related interstitial fibrosis (SRIF) was diagnosed in surgical lung biopsy specimens from patients with clinical and imaging features of diffuse parenchymal lung disease (DPLD).

Methods: Cases were included in this study if patients had clinical and imaging evidence of DPLD and surgical lung biopsy specimens revealed SRIF. A dedicated multidisciplinary conference was held to correlate clinical, radiologic, and pathologic findings.

Results: Six cases met inclusion criteria; all six (five women/one man, aged 42-57 years, mean age 47 years) were either current smokers (five of six) or ex-smokers (one of six) and were evaluated for respiratory symptoms and abnormal pulmonary function tests, most commonly reduced forced vital capacity (n = 3) and diffusing capacity for carbon monoxide (n = 6). The most common imaging abnormalities were bilateral ground-glass opacities, which correlated with histopathologic SRIF. Follow-up of up to 10 years showed stable or improved clinical symptoms, pulmonary function tests, and radiologic findings with smoking cessation (three patients) or a decrease in smoking (three patients). No specific treatments were given, and those treated with empiric corticosteroid tapers did not show discernible responses.

Conclusions: SRIF can present as clinically meaningful diffuse parenchymal lung disease in relatively young heavy smokers, characterized by bilateral ground-glass opacities and a stable clinical course.

Keywords: Desquamative interstitial pneumonia; Diffuse parenchymal lung disease; Interstitial lung disease; Respiratory bronchiolitis; Smoking-related interstitial fibrosis.

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Figures

FIGURE 1
FIGURE 1
Radiologic findings in smoking-related interstitial fibrosis. A, B, Case 2 (44-year-old woman, 15 pack-year current smoker). High-resolution axial computed tomography (CT) (A) and nonenhanced coronal CT (B) demonstrate bilateral multifocal patchy ground-glass opacities in the upper lobes with bronchial wall thickening. C, D, Case 3 (48-year-old woman, 32 pack-year current smoker with forced vital capacity 63% predicted, diffusing capacity for carbon monoxide 33% predicted). Nonenhanced axial CT at diagnosis (C) and 89 months later (D) demonstrates diffuse ground-glass opacities in both lungs with bronchial wall thickening. Note stability of imaging abnormalities over more than 7 years.
FIGURE 2
FIGURE 2
Correlation of ground-glass opacities (GGOs) and histopathologic smoking-related interstitial fibrosis (SRIF). Representation of right surgical lung biopsy SRIF and bilateral lung radiologic GGOs using a semiquantitative scoring system to describe tissue involvement. Of note, case 6 was a single lower lobe sample.
FIGURE 3
FIGURE 3
Radiologic semiquantification of emphysema and respiratory bronchiolitis (RB) in patients with smoking-related interstitial fibrosis. Representation of bilateral computed tomography findings of emphysema and RB using a semiquantitative scoring system. GGO, ground-glass opacity.
FIGURE 4
FIGURE 4
A-D, Smoking-related interstitial fibrosis: radiologic findings with pathologic correlates. A, A 42-year-old woman, 20 pack-year current smoker (case 4). Nonenhanced axial computed tomography (CT) demonstrates bilateral symmetric, peripheral, lower lobe–predominant ground-glass opacities with bronchial wall thickening. B, Surgical lung biopsy specimen, right lower lobe, from same patient. Alveolar septa are mildly thickened by “ropey” interstitial fibrosis (arrowheads). Arrows indicate filling of airspaces by numerous pigmented macrophages (H&E, ×10). C, A 46-year-old man, 45 pack-year ex-smoker (case 1). Enhanced axial CT demonstrates bilateral mid-to-lower lung-predominant patchy ground-glass opacities with bronchial wall thickening and mosaic attenuation. D, Pathology corresponding to C. Surgical lung biopsy specimen, right lower lobe. Alveolar septal thickening (interstitial fibrosis, black arrows) in this lobe is patchy. Note near-normal lung (arrowhead) adjacent to fibrotic areas. The airspaces in the fibrotic areas contain several macrophages (white arrow) but the nonfibrotic lung does not (H&E, ×4).
FIGURE 5
FIGURE 5
A-F, Smoking-related interstitial fibrosis (SRIF): imaging and pathology in upper, middle, and lower lobes. All images are from case 1. A, Nonenhanced axial computed tomography (CT) of the right upper lobe demonstrates peripheral ground-glass opacities and trivial centrilobular emphysema. B, On pathologic examination, there is diffuse interstitial thickening by fibrosis, mimicking nonspecific interstitial pneumonia (H&E, ×2). C, Nonenhanced axial CT of the middle lobe demonstrates subtle peripheral ground-glass opacities. D, Pathology of right middle lobe shows patchy SRIF (black arrow). Note alveolar macrophages (white arrow). Lung on the other side of the interlobular septum is normal (arrowhead) (H&E, ×2). E, Nonenhanced axial CT of the right lower lobe demonstrates peripheral ground-glass opacities, bronchial wall thickening, and a microcystic space. F, SRIF thickens alveolar septa (arrow) in a patchy fashion in the lobule above the interlobular septum. The lobule below the interlobular septum is nonfibrotic (arrowhead) (H&E, ×2).
FIGURE 6
FIGURE 6
Serial spirometry. A, SRIF longitudinal FVC%predicted. B, SRIF longitudinal DLCO%predicted. DLCO, diffusing capacity for carbon monoxide; FVC, forced vital capacity; SRIF, smoking-related interstitial fibrosis.
FIGURE 7
FIGURE 7
A-I, Imaging follow-up in smoking-related interstitial fibrosis. All images are from case 5 (48-year-old woman). A, D, G, Upper, middle and lower lobes from initial computed tomography (CT), showing nodular bronchocentric ground-glass opacities. B, E, H, Upper, middle, and lower lobes from CT at approximately 4 years of follow-up, showing resolution of ground-glass opacities. C, F, I, CT at nearly 8 years (95 months) of follow-up, showing stable findings.
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