Usual Interstitial Pathologist

In a previous blog post, I noted that the term “usual interstitial pneumonia”, coined by Leibow and Carrington and long considered the “sine qua non” of idiopathic pulmonary fibrosis (IPF), was originally used by them to describe what we would now call organizing phase diffuse alveolar damage (DAD), essentially the direct opposite to today’s approach. I left open the question of where the modern definition arose.   While multiple older articles describe small series on histology of IPF, the histologic language of those papers is hard to interpret in the modern era.  The earliest reference I can find to a relatively modern description is Crystal’s 1976 series of 29 patients seen at NIH (1) .  Fortunately, this paper includes color illustrations allowing us to actually see the disease under consideration. By any criteria, these images are instantly recognizable as classic idiopathic pulmonary fibrosis / usual interstitial pneumonia.  The most important concep...

As I have indicated in a previous blog post, IPF has been historically considered as a chronic relentlessly progressive fibrotic lung disease.  Diagnostically, it has been characterized by a particular gross and microscopic appearance the latter of which is summarized as “usual interstitial pneumonia” (UIP).  At one point, the association between these two was sufficient that the ATS recognized UIP as the essential underlying substrate of the IPF. How did this association come about? Universally, the phrase UIP is credited to the Yale pathologists Averill Leibow and Charles Carrington from a review article published in 1969. (Ironically, Leibow had already left Yale for UCSD when that article was published. He left after being passed over for Chairman at Yale. The history of Yale pathology is another story entirely and possibly a topic for another blog post.) Like many classic papers, this is much more commonly cites than read. I have also been guilty of this same oversight. W...