Nodular Amiodarone Lung Disease : The American Journal of Surgical Pathology (original) (raw)

Original Articles

Ruangchira-Urai, Ruchira MD* †; Colby, Thomas V. MD‡; Klein, Julianne MD§; Nielsen, G. Petur MD*; Kradin, Richard L. MD*; Mark, Eugene J. MD*

*Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

‡Department of Pathology, Mayo Clinic, Scottsdale, AZ

†Department of Pathology, Siriraj Hospital Mahidol University, Bangkok, Thailand

§Department of Pathology, St Boniface General Hospital, Winnipeg, Manitoba, Canada

Correspondence: Eugene J. Mark, MD, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (e-mail: [email protected]).

Abstract

The antiarrhythmic drug amiodarone accumulates in many organs of the body. Amiodarone lung disease (ALD) most commonly manifests clinically as an interstitial pneumonitis. The few reports of nodular ALD generally have been in the clinical and radiographic literature. No detailed histopathologic analysis of nodular ALD is available. We report 4 patients with nodular ALD, all of whom had excision of a nodule and none had a preoperative diagnosis of ALD. The radiographic suspicion before excisional biopsy in all 4 cases was malignancy. The initial pathologic suspicion in all 4 cases was either an abscess or vasculitis. In 3 of the 4 cases, where the dosages were known, each patient received 800 mg/d for 7 or more months. All cases have strikingly similar histopathology, with vacuolated histiocytes massed within alveoli to form macroscopic nodules with tissue breakdown. Ultrastructural examination of lung and peripheral nerve in 1 case showed the characteristic inclusions of amiodarone in the cytoplasm of swollen histiocytes. Vacuolated histiocytes filled with these inclusions indicate the effect of the drug, but in these 4 cases there was tissue destruction, which indicated disease. The necrotizing nature of the massed histiocytes in the absence of infection or obstruction suggests the correct etiologic diagnosis even when the history of administration of the drug is not available at initial review.