Diagnosis of diffuse panbronchiolitis by transbronchial lung cryobiopsy

Area of Science:

• Pulmonology
• Thoracic Surgery
• Pathology

Background:

• Diffuse panbronchiolitis (DPB) is a chronic airway inflammatory disease.
• Accurate diagnosis often relies on histopathological examination of lung tissue.
• Traditional transbronchial lung biopsy (TBLB) may yield limited tissue samples.

Observation:

• A 70-year-old male presented with cough, and imaging revealed a central tumor, left pleural effusion, and right-sided diffuse granular shadows.
• Chest CT showed bronchial wall thickening and numerous granular shadows, raising suspicion for DPB.
• Both TBLB and transbronchial lung cryobiopsy (TBLC) were performed for tissue acquisition.

Findings:

• TBLB yielded a small 1 mm specimen with lymphocyte infiltration but no significant fibrosis or elastic fiber changes.
• TBLC obtained a larger 6 mm specimen, revealing inflammatory cell infiltration and fibrosis around bronchioles, along with hypertrophied elastic fibers.
• Histopathological analysis of TBLC specimens confirmed the diagnosis of diffuse panbronchiolitis (DPB).

Implications:

• Transbronchial lung cryobiopsy (TBLC) offers a significant advantage in obtaining adequate tissue for diagnosing DPB.
• Larger biopsy samples from TBLC improve the accuracy of histopathological assessment in diffuse lung diseases.
• Cryobiopsy is a valuable tool for diagnosing DPB, interstitial pneumonia, and lung cancer.