General Information
The Yale Pulmonary Pathology Service encompasses the entire spectrum
of diagnostic services on biopsies and resections from the lung and
mediastinum. The service, directed by Robert
Homer, M.D., Ph.D., provides specialized expertise in the
pathologic diagnosis of inflammatory and neoplastic conditions of the
lung. Techniques utilized include routine histopathology, immunohistochemistry,
in situ hybridization, flow cytometry, and electron microscopy. Our
goal is to provide outstanding service to clinicians and patients through
accurate diagnosis, quick turnaround time, and frequent personal communication.
HIGHLIGHTS
• Four expert pulmonary pathologists with specialized training
and ongoing continuous quality improvement activities, and a pediatric
pathologist
with expertise in congenital and acquired pulmonary lesions found
predominantly in childhood
• Availability of after hours, weekend, and rush biopsy processing
in appropriate medical circumstances
• Consultation on outside pathologic material
• Ability to develop and utilize new diagnostic tests as
clinically needed
Areas of Expertise
• Interstitial lung disease: special expertise in the diagnosis
and management of interstitial lung disease, including distinguishing
among idiopathic pulmonary fibrosis and its variants
•
Evaluation of occupational lung disease
•
Acute lung injury: evaluation of biopsies of acutely injured lung especially
in context of immunosuppression such as transplantation and HIV, in
patients suspected of having vasculitis (Wegener’s granulomatosis),
or for pulmonary hemorrhage syndromes (Goodpasture’s)
•
Pulmonary vascular disease (pulmonary hypertension)
•
Pulmonary neoplasia: from common neoplasms such as squamous cell carcinoma,
adenocarcinoma, large cell carcinoma and small cell carcinoma, evaluation
of metastatic tumors, and evaluation of less common neuroendocrine
neoplasms, rare mesenchymal lesions, and lymphomas
•
Pleural and mediastinal tumors including mesothelioma
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About Asbestosis
Asbestos refers to a group of minerals that, when crushed, break into
fibers rather than dust, and consist of hydrated fibrous silicates.
Chrysotile (white asbestos) is the only serpentine asbestos, while
the amphiboles include crocidolite (blue asbestos) and amosite (brown
asbestos). These three forms include virtually all used commercially.
It has been estimated that from 1940 to 1979 in the United States alone,
over 27 million workers were exposed to asbestos at work.
 The
minimal criteria for the pathologic diagnosis of asbestosis (pulmonary
fibrosis due to asbestos) are pulmonary fibrosis plus the presence
of asbestos bodies. Asbestos bodies can be seen in tissue sections
directly, or an iron stain can enhance their appearance.
 Inhaled asbestos that is retained in the lung can become coated with
a proteinaceous iron-containing material. The core of asbestos bodies
in human lungs are more likely to be an amphibole fiber than a chrysotile,
perhaps due to better clearance of the latter. Most asbestos fibers
in the lung stay uncoated, however, and are undetectable except by
phase or electron microscopy.
 Mesothelioma is one of the most feared consequences of asbestos exposure.
As seen here from a surgical resection specimen, the tumor surrounds
and compresses the lung. Histologically, mesothelioma mimics other
tumors including lung cancer, metastatic carcinoma and sarcoma. Both
immunohistochemistry and electron microscopy can be used to help make
the distinction.
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Frequently Asked Questions
What clinical information will assist in the evaluation of the lung
biopsy?
Radiologic evaluation is always useful and frequently critical. Depending
on the case, additional information such as serologic markers (ANCA,
ANA, Jo-1), pulmonary function testing, and general clinical history
are useful in assisting in the interpretation of the lung biopsy.
Can the biopsy assess the risk of progression and the potential for
response to therapy?
The lung biopsy provides significant information relative to the
risk of progression by examining the degree of interstitial scarring.
The
potential to respond to therapy is generally based on the histologic
subtype of pulmonary fibrosis.
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People
Robert
Homer, M.D., Ph.D., Associate Professor of Pathology and Attending
Pathologist, YNHH; Director of Anatomic Pathology, VA Connecticut Healthcare
System. Clinical interests: lung pathology and immunopathology.
David L.
Rimm, M.D., Ph.D., is Associate Professor of Pathology and
Attending Pathologist, YNHH. He is also Director, Yale Comprehensive
Cancer Center Tissue Microarray Facility. Clinical interests: molecular
diagnostics and cell biology.
Raymond Yesner, M.D., is Professor Emeritus of Pathology and Senior
Research Scientist. Clinical interests: lung cancer and prognostic
factors in prostate cancer.
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