中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2009年
2期
86-90
,共5页
冯瑞娥%施举红%肖雨%刘鸿瑞%田欣伦%余春开%朱元珏
馮瑞娥%施舉紅%肖雨%劉鴻瑞%田訢倫%餘春開%硃元玨
풍서아%시거홍%초우%류홍서%전흔륜%여춘개%주원각
肺泡炎%外源性变应性%肺纤维化%肺疾病%间质性
肺泡炎%外源性變應性%肺纖維化%肺疾病%間質性
폐포염%외원성변응성%폐섬유화%폐질병%간질성
Alveolitis,extrinsic allergic%Pulmonary fibrosis%Lung diseases,interstitial
目的 观察慢性过敏性肺炎的病理形态特征,特别是其引起的肺间质纤维化的特点,并比较其与特发性肺间质纤维化的差异和鉴别.方法 选择2000年10月至2008年1月间lO例慢性过敏性肺炎患者活检组织及临床资料,活检肺组织全部取材,石蜡包埋、HE染色.结果 10例慢性过敏性肺炎患者,男性6例、女性4例,年龄23-59岁,平均47.2岁.主要表现为慢性咳嗽,气短等,病程4个月～6年不等.7例表现为普通性问质性肺炎(UIP)样的纤维化,肺组织内斑片状纤维化,病变沿胸膜下、小叶间隔分布,同时又有细支气管周边病变.7例均有纤维母细胞灶,并可见明显的细支气管周边肺泡上皮的细支气管化生和轻度细支气管炎.3例有轻度蜂窝肺.3例为非特异性间质性肺炎(NSIP)样纤维化,表现为肺泡间隔增宽,间质纤维组织和胶原纤维增生,保留肺泡结构.伴中-重细支气管炎,肺泡间隔可见较多淋巴细胞浸润.未见蜂窝肺结构.1例可见Schaumann小体.慢性过敏性肺炎的UIP样的纤维化与特发性UIP相比,除了间质中有松散的肉芽肿和多核巨细胞以外,表现为:(1)发病年龄较轻;(2)慢性过敏性肺炎CT上病变常同时有中、上肺病变,甚至以中、上肺为主,并可见磨玻璃影和马赛克征;(3)二者病变分布不同,特发性UIP的纤维化主要分布在胸膜下和沿小叶周边分布;而慢性过敏性肺炎的UIP样的纤维化常同时累及胸膜下/小叶周边和细支气管周围(小叶中心);(4)慢性过敏性肺炎的UIP样纤维化蜂窝肺相对较轻;(5)常伴有细支气管上皮化生.慢性过敏性肺炎的NSIP样的肺间质纤维化与特发性NSIP相比,除了间质中有松散的肉芽肿和多核巨细胞以外,二者在病理形态上很难区别.结论 慢性过敏性肺炎可以引起UIP样或NSIP样的间质纤维化.按照目前过敏性肺炎的诊断标准,部分表现为NSIP样的肺间质纤维化的慢性过敏性肺炎患者,有可能被误诊为NSIP,值得注意.
目的 觀察慢性過敏性肺炎的病理形態特徵,特彆是其引起的肺間質纖維化的特點,併比較其與特髮性肺間質纖維化的差異和鑒彆.方法 選擇2000年10月至2008年1月間lO例慢性過敏性肺炎患者活檢組織及臨床資料,活檢肺組織全部取材,石蠟包埋、HE染色.結果 10例慢性過敏性肺炎患者,男性6例、女性4例,年齡23-59歲,平均47.2歲.主要錶現為慢性咳嗽,氣短等,病程4箇月～6年不等.7例錶現為普通性問質性肺炎(UIP)樣的纖維化,肺組織內斑片狀纖維化,病變沿胸膜下、小葉間隔分佈,同時又有細支氣管週邊病變.7例均有纖維母細胞竈,併可見明顯的細支氣管週邊肺泡上皮的細支氣管化生和輕度細支氣管炎.3例有輕度蜂窩肺.3例為非特異性間質性肺炎(NSIP)樣纖維化,錶現為肺泡間隔增寬,間質纖維組織和膠原纖維增生,保留肺泡結構.伴中-重細支氣管炎,肺泡間隔可見較多淋巴細胞浸潤.未見蜂窩肺結構.1例可見Schaumann小體.慢性過敏性肺炎的UIP樣的纖維化與特髮性UIP相比,除瞭間質中有鬆散的肉芽腫和多覈巨細胞以外,錶現為:(1)髮病年齡較輕;(2)慢性過敏性肺炎CT上病變常同時有中、上肺病變,甚至以中、上肺為主,併可見磨玻璃影和馬賽剋徵;(3)二者病變分佈不同,特髮性UIP的纖維化主要分佈在胸膜下和沿小葉週邊分佈;而慢性過敏性肺炎的UIP樣的纖維化常同時纍及胸膜下/小葉週邊和細支氣管週圍(小葉中心);(4)慢性過敏性肺炎的UIP樣纖維化蜂窩肺相對較輕;(5)常伴有細支氣管上皮化生.慢性過敏性肺炎的NSIP樣的肺間質纖維化與特髮性NSIP相比,除瞭間質中有鬆散的肉芽腫和多覈巨細胞以外,二者在病理形態上很難區彆.結論 慢性過敏性肺炎可以引起UIP樣或NSIP樣的間質纖維化.按照目前過敏性肺炎的診斷標準,部分錶現為NSIP樣的肺間質纖維化的慢性過敏性肺炎患者,有可能被誤診為NSIP,值得註意.
목적 관찰만성과민성폐염적병리형태특정,특별시기인기적폐간질섬유화적특점,병비교기여특발성폐간질섬유화적차이화감별.방법 선택2000년10월지2008년1월간lO례만성과민성폐염환자활검조직급림상자료,활검폐조직전부취재,석사포매、HE염색.결과 10례만성과민성폐염환자,남성6례、녀성4례,년령23-59세,평균47.2세.주요표현위만성해수,기단등,병정4개월～6년불등.7례표현위보통성문질성폐염(UIP)양적섬유화,폐조직내반편상섬유화,병변연흉막하、소협간격분포,동시우유세지기관주변병변.7례균유섬유모세포조,병가견명현적세지기관주변폐포상피적세지기관화생화경도세지기관염.3례유경도봉와폐.3례위비특이성간질성폐염(NSIP)양섬유화,표현위폐포간격증관,간질섬유조직화효원섬유증생,보류폐포결구.반중-중세지기관염,폐포간격가견교다림파세포침윤.미견봉와폐결구.1례가견Schaumann소체.만성과민성폐염적UIP양적섬유화여특발성UIP상비,제료간질중유송산적육아종화다핵거세포이외,표현위:(1)발병년령교경;(2)만성과민성폐염CT상병변상동시유중、상폐병변,심지이중、상폐위주,병가견마파리영화마새극정;(3)이자병변분포불동,특발성UIP적섬유화주요분포재흉막하화연소협주변분포;이만성과민성폐염적UIP양적섬유화상동시루급흉막하/소협주변화세지기관주위(소협중심);(4)만성과민성폐염적UIP양섬유화봉와폐상대교경;(5)상반유세지기관상피화생.만성과민성폐염적NSIP양적폐간질섬유화여특발성NSIP상비,제료간질중유송산적육아종화다핵거세포이외,이자재병리형태상흔난구별.결론 만성과민성폐염가이인기UIP양혹NSIP양적간질섬유화.안조목전과민성폐염적진단표준,부분표현위NSIP양적폐간질섬유화적만성과민성폐염환자,유가능피오진위NSIP,치득주의.
Objective To study the pathologic characteristics of chronic hypersensitivity pneumonitis,especially the paUem of pulmonary interstitial fibrosis;and to compare the histologic features with those of idiopathic interstitial pneumonitis.Methods The HE-stained paraffin sections of 10 cases of chronic hypersensitivity pneumonitis encountered during the period from 2000 to 2008 were retrospectively analyzed.Results There were altogether 6 males and 4 females,with age of patients ranging from 23 to 59 years(mean=47.2 years).Clinically,the patients presented with chronic cough and shortness of breath for 4 months to 6 years.Histologically,7 cases showed usual interstitial pneumonitis(UIP)-like fibrosis. Patchy fibrosis was observed under the pleura,adjacent to interlobular septa and around bronchioles.In all of the 7 cases,foci of fibroblastic proliferation,as well as bronchiolar metaplasia of peribronchiolar alveoli and mild bronchiolitis,were noted.Three cases presented with mild honeycomb changes of lung and 3 cases showed non-specific interstitial pneumonitis(NSIP)-like fibrosis,in which the alveolar septa were expanded by fibrous tissue and collagen,with relative preservation of alveolar architecture.Bronehiolitis and lymphocytic infiltrates in alveolar septa were seerL Schaumann bodies were identified in 1 case.In general, patients with chronic hypersemitivity pneumonitis were younger than patients with idiopathic UIP Computed tomography often showed upper and middle lobar involvement and mosaic attenuation.Compared with idiopathic UIP,the UIP-like fibrosis of chronic hypersensitivity pneumonitis often occurred not only under the pleura and adjacent to interlobular septa,but also around bronchioles and was accompanied by bmnchiolar metaplasia.Conclusions Chronic hypersensitivity pneumonitis can mimic other types of lung conditions with interstitial fibrosis.especially UIP and NSIP.As a result,some cades of chronic hypersensitivity pneumonitis may be misdiagnosed as such.
