AIMS:The histopathology of the Sauropus androgynus (SA)-constrictive bronchiolitis obliterans (BO) is still controversial. A recent report using pneumonectomy specimens showed that the major histopathology was obliterative arteriopathy with segmental necrosis of small bronchi instead of constrictive BO as previously described. METHODS AND RESULTS:We analysed semiquantitatively and immunohistochemically the histopathology of one pneumonectomy and four biopsies specimens of SA-associated lung disease. We found a significant number of constrictive and obliterative bronchioles 1 mm or less in diameter and segmental inflammatory destruction with complete luminal obliteration of the bronchi less than 3 mm in diameter in the pneumonectomy specimen (37% and 25%, respectively). Fibromuscular intimal sclerosis of the bronchial arteries was identified in 15% of the bronchi 4 mm or less in diameter. The inflammation in these airways was composed predominantly of T-lymphocytes, macrophages, mast cells and eosinophils. They were present throughout the evolutionary stages of the bronchiolitis ranging from early oedematous to the late fibrotic obliterative stage. Double immunohistochemical stains revealed negative proliferative cell nuclear antigen for most of the T-lymphocytes and macrophages but positive for fibroblasts. CONCLUSIONS:A more accurate histopathological designation of the SA-associated lung disease should be constrictive obliterative bronchitis/bronchiolitis, with the participation of T-lymphocytes, macrophages, mast cells, eosinophils and fibroblasts in its morphogenesis. The persistent accumulation of inflammatory cells was mediated predominantly by continued recruitment to the site of injury from the bloodstream, resulting eventually in the irreversible fibrosis of the bronchioles and the bronchi less than 3 mm in diameter. Obliterative arteriopathy is suspected of being only an indirect contributing factor.

译文

目的:雄性Sauropus androgynus(SA)收缩性毛细支气管炎(BO)的组织病理学仍存在争议。最近的一项使用肺切除术标本的报告显示,主要的组织病理学是闭塞性动脉病伴小支气管节段性坏死,而不是如前所述的狭窄性BO。
方法和结果:我们半定量和免疫组织化学分析了1例肺切除术和4例SA相关性肺疾病的活检标本的组织病理学。我们发现在肺切除术标本中,直径不超过1 mm的许多收缩性和闭塞性细支气管以及节段性炎症破坏以及支气管的完全腔内闭塞小于3 mm的直径(分别为37%和25%)。在直径4mm或更小的支气管中,有15%的支气管动脉纤维内膜硬化。这些气道中的炎症主要由T淋巴细胞,巨噬细胞,肥大细胞和嗜酸性粒细胞组成。它们存在于细支气管炎的整个进化阶段,从早期水肿到晚期纤维化闭塞阶段。双重免疫组织化学染色显示,大多数T淋巴细胞和巨噬细胞的增殖细胞核抗原为阴性,而成纤维细胞为阳性。
结论:与SA相关的肺部疾病的更准确的组织病理学指征应为缩窄性闭塞性支气管炎/细支气管炎,并在其形态发生过程中参与T淋巴细胞,巨噬细胞,肥大细胞,嗜酸性粒细胞和成纤维细胞的参与。炎症细胞的持续积累主要是通过从血液中持续募集到受伤部位来进行的,最终导致细支气管和直径小于3 mm的支气管发生不可逆的纤维化。怀疑闭塞性动脉病只是间接的促成因素。

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