Original ArticlesLung Transplantation for Bronchopulmonary Dysplasia in Adults A Clinical and Pathologic Study of 3 CasesLiu, Natalia MD*; Cummings, Oscar W. MD*; Lagstein, Amir MD†; Hage, Chadi A. MD‡; Chan, Kevin M. MD§; Zhang, Chen MD, PhD*Author Information Departments of *Pathology and Laboratory Medicine ‡Internal Medicine, Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN Departments of †Pathology §Internal Medicine, Division of Pulmonary and Critical Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI Part of this study was presented as an abstract at the Annual Meeting of United States and Canadian Academy of Pathology (USCAP) 2018, Vancouver, BC, Canada. C.Z.: is the guarantor of the content of the manuscript, including the data and analysis. C.Z., N.L., O.W.C., and A.L.: performed the microscopic examination. C.A.H. and K.M.C.: provided patients’ clinical data. C.Z. and N.L.: contributed to data analysis and interpretation. All authors contributed to study design and manuscript preparation. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Chen Zhang, MD, PhD, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 West, 11th Street, Indianapolis, IN 46202 (e-mail: [email protected]). The American Journal of Surgical Pathology: April 2020 - Volume 44 - Issue 4 - p 509-515 doi: 10.1097/PAS.0000000000001438 Buy Metrics Abstract Bronchopulmonary dysplasia (BPD) is usually seen in premature infants who require mechanical ventilation and oxygen therapy for acute respiratory distress. Although most patients wean from oxygen therapy by the ages of 2 to 3, rehospitalization for respiratory problems is common in these patients in adulthood. There have been few studies that document the long-term outcomes of BPD survivors and information about the pulmonary function and radiographic findings of adult BPD are limited. Data on pathologic features of adult BPD are scarce. Three adult patients who underwent recent lung transplantation for BPD from 2 institutions were identified. Clinical data including clinical presentation, chest radiographic images, pulmonary function tests, cardiac catheterization, and echocardiography were retrieved from the electronic medical records. Hematoxylin and eosin and selective elastic stained sections of the explant lungs were examined. CD31 immunohistochemical stain is performed on representative sections. All 3 cases had similar clinical and radiologic features including the history of prematurity and long-term mechanical ventilation after birth, hyperexpanded lungs with air trapping and mosaic attenuation on chest computed tomographic scan, severe obstructive changes on pulmonary function test, and pulmonary hypertension. Pathologic examination showed common features including enlarged and simplified alveoli, peribronchial, subpleural, and interlobular septal fibrosis, narrowing/obliteration of the small airways by elastosis and muscular hypertrophy, thickening of venous walls by fibromuscular hyperplasia, and bronchitis/bronchiolitis. Cholesterol granulomas were seen in 2 cases. The common pathologic findings in the lungs explain the clinical and radiologic findings. Future studies are warranted to further characterize the clinical and pathologic features of adult BPD to develop optimal management strategies for these patients. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.