Journal Information
Vol. 10. Issue 4.
Pages 331-345 (July - August 2004)
Share
Share
Download PDF
More article options
Vol. 10. Issue 4.
Pages 331-345 (July - August 2004)
CASO CLÍNICO/CLINICAL CASE
Open Access
Pneumonite intersticial não específica: entidade clínico-patológica, padrão histológico ou apenas grupo heterogéneo de pneumonites intersticiais não classificadas?
Nonspecific interstitial pneumonitis: a clinicopathologic entity, histologic pattern or unclassified group of heterogeneous interstitial pneumonitis?
Visits
8670
António Morais*, M. Conceição Souto Moura**, M. Rosa Cruz***, Isabel Gomes*
* Serviço de Pneumologia, Hospital de S. João.Alameda Prof. Hernâni Monteiro 4202-451 - Porto.
** Serviço de Anatomia Patológica, Hospital de S. João.Alameda Prof. Hernâni Monteiro 4202-451 - Porto.
*** Serviço de Cirurgia Torácica do Hospital São João, Serviço de Pneumologia. Alameda Prof. Hernâni Monteiro 4202-451 - Porto.
This item has received

Under a Creative Commons license
Article information
RESUMO

A pneumonite intersticial não específica (NSIP), descrita pela primeira vez em 1994 por Katzenstein e Fiorelli, apresenta-se como uma eventual entidade clínico-patológica individualizável dentro do grupo das pneumonites intersticiais idiopáticas (IIP). Aliada a alterações histológicas distintas, apresenta

uma evolução clínica mais favorável, com consequente melhor prognóstico do que a fibrose pulmonar idiopática (IPF), grupo onde geralmente estas alterações eram incluídas. Estas diferenças levam a que, apesar das dúvidas que ainda envolvem a NSIP, o seu reconhecimento seja importante, uma vez que as atitudes clínicas e terapêuticas se diferenciam da IPF. A NSIP engloba padrões histológicos diferentes, dividindo-se nomeadamente em casos de predomínio inflamatório (tipo celular) ou de predomínio fibroso (tipo fibrosante), com os últimos a evidenciarem uma maior gravidade e pior prognóstico do que os primeiros. Os autores descrevem dois casos de NSIP, seguidos de uma revisão e discussão do tema.

REV PORT PNEUMOL 2004; X (4): 331-345

Palavras chave:
pneumonites intersticiais idiopáticas
pneumonite intersticial não específica: tipo celular
tipo fibrosante
ABSTRACT

Nonspecific interstitial pneumonitis (NSIP) initially described by Katzenstein and Fiorelli in 1994, seems to be a distinct clinicopathologic entity among idiopathic interstitial pneumonitis (IIP). Besides different histologic features from other IIP, NSIP is characterized by a better long-term outcome, asso

ciated with a better steroids responsiveness than idiopathic pulmonar fibrosis (IPF), where usually were included. Thus, differentiating NSIP from other IIP, namely IPF is very significant, since it has important therapeutic and prognostic implications. NSIP encloses different pathologies, namely those with inflammatory predominance (cellular subtype) or fibrous predominance (fibrosing subtype). NSIP is reviewed and discussed by the authors, after two clinical cases description.

REV PORT PNEUMOL 2004; X (4): 331-345

Key words:
idiopathic interstitial pneumonitis
non-specific interstitial pneumonitis
cellular subtype
fibrosing subtype
Full text is only aviable in PDF
BIBLIOGRAFIA
[1.]
American Thoracic Society/ European Respiratory Society.
International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias.
Am J Respir Crit Care Med, 165 (2002), pp. 277-304
[2.]
American Thoracic Society/European Respiratory Society.
Idiopathic pulmonary fibrosis: diagnosis and treatment. International Consensus Statement.
Am J Respir Crit Care Med, 161 (2000), pp. 646-664
[3.]
A.A. Liebow.
The interstitial pneumonias.
Frontiers of pulmonary radiology, 1, pp. 102-141
[4.]
A.L. Katzenstein, J. Myers.
Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification.
Am J Respir Crit Care Med, 157 (1998), pp. 1301-1315
[5.]
A.L. Katzenstein, R. Fiorelli.
Nonspecific Interstitial Pneumonia/Fibrosis.
Am J Surg Pathol, 18 (1994), pp. 136-147
[6.]
J. Myers, C.J.F. Veal, M.S. Shin, A.L. Katzenstein.
Respiratory bronchiolitis causing interstitial lung disease: a clinicopathologic study of 6 cases.
Am J Respir Crit Care Med, 135 (1987), pp. 880-884
[7.]
W.D. Travis, K.O. Devaney, L.M. Weiss, T.J. O’ Leary, F.P. Ognibene, M.B. Rosen, M.J. Cohen, J. Shelhamer.
Lymphoid pneumonias in 50 adult patients infected with the human immunodeficiency vírus: lymphocytic interstitial pneumonitis versus nonspecific interstitial pneumonias.
Hum Pathol, 23 (1992), pp. 529-541
[8.]
J. Batungwanayo, H. Taelman, S. Lucas, J. Bogaerts, D. Alard, A. Kagame, P. Blanche, J. Clerinx, P. Van de Perre, S. Allen.
Pulmonary disease associated with the human immunodeficiency vírus in Kingali, Rwanda. A fiberoptic bronchoscopic study of 111 cases of undetermined etiology.
Am J Respir Crit Care Med, 149 (1994), pp. 1591-1596
[9.]
N.T. Feldman, J.E. Pennington, M.G. Ehrie.
Transbronchial lung biopsy in the compromised host.
JAMA, 238 (1977), pp. 1377-1379
[10.]
C. Rubino, M.E. Hill, M.E.R. O’ Brien, D. Cunningham.
Idiopathic pneumonia syndrome after high dose chemotherapy for relapsed Hodkin’s disease.
Br. J Cancer, 75 (1997), pp. 1044-1048
[11.]
S. Nagai, M. Kitaichi, H. Itoh, K. Nishimura, T. Izumi, T.V. Colby.
Idiopathic nonspecific interstitial pneumonia/ fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP.
Eur Respir J, 12 (1998), pp. 1010-1019
[12.]
J.A. Bjoraker, J.H. Ryu, M.K. Edwin, J.L. Myers, H.D. Tazelaar, D.R. Schroeder, K.P. Offord.
Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis.
Am J Respir Crit Care Med, 157 (1998), pp. 199-203
[13.]
V. Cottin, A.V. Donsbeck, D. Revel, R. Loire, J.F. Cordier.
Nonspecific Interstitial Pneumonia- Individualization of a Clinicopathologic Entity in a series of 12 patients.
Am J Respir Crit Care Med, 158 (1998), pp. 1286-1293
[14.]
W.D. Travis, K. Matsui, J. Moss, V.J. Ferrans.
Idiopathic Nonspecific Interstitial Pneumonia: prognostic significance of cellular and fibrosing patterns.
Am J Surg Path, 24 (2000), pp. 19-33
[15.]
Z.D. Daniil, Nicholson, D.M. Hansell, T.V. Colby.
A Histologic Pattern of Nonspecific Interstitial Pneumonia is Associated with a Better Prognosis Than Usual Intertitial Pneumonia in Patients with Cryptogenic Fibrosing Alveolitis.
Am J Respir Crit Care Med, 160 (1999), pp. 899-905
[16.]
K.R. Flaherty, T.V. Colby, G.B. Towes, B.H. Gross, A. Jain, R.L. Strawderman III, A. Flint, J.P. Lynch III, F.J. Martinez.
Histopathologic Variability in Usual and Nonspecific Interstitial Pneumonias.
Am J Respir Crit Care Med, 164 (2001), pp. 1722-1727
[17.]
A.G. Nicholson, T.V. Colby, R.M. Dubois, D.M. Hansell, A.U. Wells.
The prognostic significance of the Histologic Pattern of Interstitial Pneumonia in Patients Presenting with Clinical Entity of Cryptogenic Fibrosing Alveolitis.
Am J Respir Crit Care Med, 162 (2000), pp. 2213-2217
[18.]
J.L. Myers.
NSIP, UIP and the ABCs of idiopathic interstitial pneumonias.
Eur Respir J, 12 (1998), pp. 1003-1004
[19.]
R.L. Rhia, E.E. Duhig, B.E. Clarke, R.H. Steele, R.E. Slaughter, P.V. Zimmerman.
Survival of patients with biopsy-proven usual interstitial pneumonia and nonspecific interstitial pneumonia.
Eur Respir J, 19 (2002), pp. 1114-1118
[20.]
K.R. Flaherty, F.J. Martinez, W. Travis, J.P. Lynch III.
Nonspecific Interstitial Pneumonia.
Semin Respir Crit Care Med, 22 (2001), pp. 423-433
[21.]
AKSAMIT TR. Nonspecific Interstitial Pneumonitis. Pulmonary Diseases- Part II, Mayo Internal Medicine Board Review, pag. 899.
[22.]
C.S. Park, S.W. Park, G.I. Lim, S.T. Uh, J.S. Park, S.Y. Jin, C.H. Kang.
Nonspecific Interstitial Pneumonia/ Fibrosis: clinical manifestations, histologic and radiologic features.
Korean J Intern Med, 11 (1996), pp. 122-132
[23.]
T. Johkoh, N.L. Muller, T.V. Colby, H. Taniguchi, Kondo K. Fujimoto, M. Kinoshita, H. Arakawa, H. Yamada, M. Suga, M. Ando Koyama, H. Nakamura.
Nonspecific interstitial pneumonia: correlation between thin section CT findings and pathologic subgroups in 55 patients.
Radiology, 225 (2002), pp. 199-204
[24.]
S.L. Macdonald, M.B. Rubens, D.M. Hansell, S.J. Copley, S.R. Desai, R.M. Du Bois, A.G. Nicholson, T.V. Colby, A.U. Wells.
Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances and diagnostic accuracy of thin-section CT.
Radiology, 221 (2001), pp. 600-605
[25.]
O. Nishiyama, Y. Kondoh, H. Tanigushi, K. Yamaki, R. Suzuki, T. Yoko, K. Takagi.
Serial high resolution CT findings in nonspecific interstitial pneumonia/ fibrosis.
J Comput Assist Tomogr, 24 (2000), pp. 41-46
[26.]
E.Y. Kim, K.S. Lee, M.P. Chung, O.J. Kwon, T.S. Kim, J.H. Hwang.
Nonspecific interstitial pneumonia with fibrosis: serial high resolution CT findings with functional correlation.
Am J Roentgenol, 173 (1999 Oct), pp. 949-953
[27.]
T.S. Kim, K.S. Lee, M.P. Chung, J. Han, J.S. Park, J.H. Hwang, O. Kwon, C.H. Rhee.
Nonspecific interstitial pneumonia with fibrosis: high resolution CT and pathologic findings.
Am J Roentgenol, 171 (1998), pp. 1645-1650
[28.]
J. Fujita, I. Yamadori, I. Suemitsu, T. Yoshinouchi, Y. Ohtsuki, Y. Yamaji, T. Kamei, M. Kobayashi, Y. Nakamura, J. Takahara.
Clinical features of nonspecific interstitial pneumonia.
Respir Med, 93 (1999), pp. 113-118
[29.]
J.S. Park, K.S. Lee, J.S. Kim, C.S. Park, Y.L. Suh, D.L. Choi, K.J. Kim.
Nonspecific interstitial pneumonia with fibrosis: radiographic and CT findings in seven patients.
Radiology, 195 (1995), pp. 645-648
[30.]
M. Akira, G. Inoue, S. Yamamoto, M. Sakatani.
Nonspecific interstitial pneumonia: findings on sequential CT scans of nine patients.
Thorax, 55 (2000), pp. 854-859
[31.]
S. Nagai, M. Kitaichi, T. Izumi.
Classification and recent advances in idiopathic interstitial pneumonia.
Curr Opin Pulm Med, 4 (1998), pp. 256-260
[32.]
Park CS, Chung SW, Ki SY, Lim G-I, Uh ST, Kim YH, Choi DI, Park JS, Lee DW, Kitaichi M. Increased Levels of Interleukin-6 Are Associated with Lym phocytosis in Bronchoalveolar Lavage Fluids of Idiopathic Nonspecific Interstitial Pneumonia.
[33.]
D. Bouros, A. Wells, A. Nicholson, T. Colby, V. Polychronopoulos, P. Pantelidis, P. Haslam, D. Vassilakis, C. Black, R. Du Bois.
Histopathologic Subsets of Fibrosing Alveolitis in Patients with Systemic Sclerosis and Their Relationship to Outcome.
Am J Respir Crit Care Med, 165 (2002), pp. 1578-1579
[34.]
D.S. Kim, B. Yoo, J.S. Lee, E.K. Kim, C.M. Lim, S.D. Lee, Y. Koh, W.S. Kim, W.D. Kim, T.V. Colby, M. Kitiaichi.
The major histopathologic pattern of pulmonary fibrosis in scleroderma is nonspecific interstitial pneumonia.
Sarcoidosis Vasc Diffuse Lung Dis, 19 (2002), pp. 121-127
[35.]
N. Nanki, J. Fujita, Y. Yamaji, H. Maeda, T. Kurose, M. Kaji, K. Satoh, K. Miyatani, I. Yamadori, Y. Ohtsuki, T. Ishida.
Nonspecific Interstitial pneumonia/ fibrosis completely recovered by adding cyclophosphamide to corticosteroids.
Intern Med, 41 (2002), pp. 867-870
Copyright © 2004. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?