Abstract
Atypical adenomatous hyperplasia (AAH) and peribronchiolar metaplasia (PBM) are two entities that show alveolar accentuation histologically. While AAH is a precursor to invasive lung adenocarcinoma, PBM is a reactive process thought to be a reparative, post-inflammatory response to small airway injury. Thus, differentiating these findings is of clinical importance as AAH carries risk of malignant progression while PBM does not have such potential.
AAH may be seen on high-resolution computed tomography (CT) as a subtle ground-glass opacity nodule lacking a solid component, while PBM is typically not detected radiographically. Histologically, AAH is characterized by a proliferation of hobnailed pneumocytes with varying atypia growing along non-thickened alveolar septa. A background of inflammation and fibrosis is not present. In contrast, the cells of PBM are indistinguishable from bland, ciliated respiratory epithelium. PBM is often accompanied by small airway-centric fibrosis and inflammation; it is a common histologic finding in various interstitial lung disorders.
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Chandler, C.M., Xu, H. (2022). Atypical Adenomatous Hyperplasia Versus Peribronchiolar Metaplasia. In: Xu, H., Ricciotti, R.W., Mantilla, J.G. (eds) Practical Lung Pathology. Practical Anatomic Pathology. Springer, Cham. https://doi.org/10.1007/978-3-031-14402-8_4
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