Lung Pathology: Fellow Case Report Poster - Lung Pathology |

Human Papillomavirus (HPV) Associated Atypical Squamous Metaplasia in Diffuse Alveolar Damage (DAD) Mimicking Squamous Cell Carcinoma (SCC) FREE TO VIEW

Liliana Fernandez, MD; Bladimir Perez, MD; Valeria Zuñiga, MS; Luz Sua, PhD; Leidys Gutierrez, MD
Author and Funding Information

Fundacion Valle del Lili, Chest Biomedical Research, School of Health Sciences, Universidad Icesi, Cali, Colombia

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):780A. doi:10.1016/j.chest.2016.08.876
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: DAD is a common histological finding in ARDS. It often occurs simultaneously with squamous metaplasia particularly in DAD proliferative phase. Rarely, cytologic atypia resembling SCC can be found1. Additionally, there are reported associations between cytological atypia and the presence HPV. We aimed to describe the case of an HIV (+) patient with rapidly progressive ARDS in whom DAD with extensive atypical squamous metaplasia was found

CASE PRESENTATION: 31-year-old woman with Dx of HIV infection and history suggestive of opportunistic infections that received empirical treatment presented complaining of palpitations, chest pain and dyspnea. Chest CT showed diffuse patchy ground glass opacity. 6 days after admission, thoracotomy and wedge resection biopsy was performed. Histological findings (HF): squamous metaplastic cells (SMC) replacing epithelial surface with cytologic atypia extending through the bronchioles. Also extensive interstitial lymphocyte inflammation was found. Immunohistochemistry (IHC) revealed habitual distribution of lymphocytes (+) CD20 and CD3. Alveolar SMC were (+) for CK AE1-AE3, CK 5/6 and CK7 while alveolar non-SMC were (+) for TTF1 and NAPSIN-A. Neuroendocrine differentiation was ruled-out with CD56 and chromogranin (-). In-situ hybridation (ISH) for HPV and IHC for p16 were (+) in atypical metaplastic cells. Histochemistry stains (HC) were (-) for GOMORI, PAS and Ziehl-Neelsen. IHC for CMV was (-)

DISCUSSION: Histologically, atypical SMC and SCC can be difficult to differentiate. IHC and HC must always be performed in order to rule out primary or metastatic malignancy and infectious diseases. (+) p16 IHC and HPV ISH may support VPH infection associated to atypia in SMC in the context of DAD.

CONCLUSIONS: This case emphasizes the importance of correlating HF with clinical and Rx findings to avoid overinterpreting atypical squamous metaplasia as a malignant process.

Reference #1: 1. Ogino S, Franks TJ, et al (2002). Extensive squamous metaplasia with cytologic atypia in diffuse alveolar damage mimicking squamous cell carcinoma: A report of 2 cases. Human Pathology, 33(10)1052-1054.

DISCLOSURE: The following authors have nothing to disclose: Liliana Fernandez, Bladimir Perez, Valeria Zuñiga, Luz Sua, Leidys Gutierrez

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