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Weatherald J, Dorfmüller P, Perros F, Ghigna MR, Girerd B, Humbert M, Montani D. Pulmonary capillary haemangiomatosis: a distinct entity? Eur Respir Rev 2020; 29:29/156/190168. [PMID: 32461209 DOI: 10.1183/16000617.0168-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/09/2020] [Indexed: 01/08/2023] Open
Abstract
Pulmonary capillary haemangiomatosis (PCH) is a rare and incompletely understood histopathological finding characterised by abnormal capillary proliferation within the alveolar interstitium, which has long been noted to share many overlapping features with pulmonary veno-occlusive disease (PVOD). But are PCH and PVOD distinct entities that occur in isolation, or are they closely intertwined manifestations along a spectrum of the same disease? The classic clinical features of both PCH and PVOD include signs and symptoms related to pulmonary hypertension, hypoxaemia, markedly impaired diffusion capacity of the lung and abnormal chest imaging with ground glass opacities, septal lines and lymphadenopathy. In recent years, increasing evidence suggests that the clinical presentation, histopathological features, genetic substrate and pathobiological mechanisms of PCH and PVOD are overlapping and usually indistinguishable. The discovery of biallelic mutations in the eukaryotic translation initiation factor 2 α kinase 4 (EIF2AK4) gene in heritable PCH and PVOD greatly advanced our understanding of the overlapping nature of these conditions. Furthermore, recognition of PCH and PVOD-like changes in other pulmonary vascular diseases and in conditions that cause chronic pulmonary venous hyper-perfusion or hypertension suggests that PCH/PVOD may develop as a reactive process to various insults or injuries to the pulmonary vasculature, rather than being primary angiogenic disorders.
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Affiliation(s)
- Jason Weatherald
- Dept of Medicine, University of Calgary, Calgary, Canada.,Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Peter Dorfmüller
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Frédéric Perros
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Maria-Rosa Ghigna
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Barbara Girerd
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Marc Humbert
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - David Montani
- Inserm UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France .,Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Seki A, Anklesaria Z, Saggar R, Dodson MW, Schwab K, Liu MC, Charan Ashana D, Miller WD, Vangala S, DerHovanessian A, Channick R, Shaikh F, Belperio JA, Weigt SS, Lynch JP, Ross DJ, Sullivan L, Khanna D, Shapiro SS, Sager J, Gargani L, Stanziola A, Bossone E, Schraufnagel DE, Fishbein G, Xu H, Fishbein MC, Wallace WD, Saggar R. Capillary Proliferation in Systemic-Sclerosis-Related Pulmonary Fibrosis: Association with Pulmonary Hypertension. ACR Open Rheumatol 2019; 1:26-36. [PMID: 31777777 PMCID: PMC6858021 DOI: 10.1002/acr2.1003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective We sought to determine if any histopathologic component of the pulmonary microcirculation can distinguish systemic sclerosis (SSc)‐related pulmonary fibrosis (PF) with and without pulmonary hypertension (PH). Methods Two pulmonary pathologists blindly evaluated 360 histologic slides from lungs of 31 SSc‐PF explants or autopsies with (n = 22) and without (n = 9) PH. The presence of abnormal small arteries, veins, and capillaries (pulmonary microcirculation) was semiquantitatively assessed in areas of preserved lung architecture. Capillary proliferation (CP) within the alveolar walls was measured by its distribution, extent (CP % involvement), and maximum number of layers (maximum CP). These measures were then evaluated to determine the strength of their association with right heart catheterization–proven PH. Results Using consensus measures, all measures of CP were significantly associated with PH. Maximum CP had the strongest association with PH (P = 0.013; C statistic 0.869). Maximum CP 2 or more layers and CP % involvement 10% or greater were the optimal thresholds that predicted PH, both with a sensitivity of 56% and specificity of 91%. The CP was typically multifocal rather than focal or diffuse and was associated with a background pattern of usual interstitial pneumonia. There was a significant but weaker relationship between the presence of abnormal small arteries and veins and PH. Conclusion In the setting of advanced SSc‐PF, the histopathologic feature of the pulmonary microcirculation best associated with PH was capillary proliferation in architecturally preserved lung areas.
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Affiliation(s)
| | | | - Rajeev Saggar
- Banner University Medical Center University of Arizona Phoenix
| | - Mark W Dodson
- Intermountain Medical Center, Murray, Utah and University of Utah School of Medicine Salt Lake City
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dinesh Khanna
- University of Michigan Scleroderma Program Ann Arbor
| | | | - Jeffrey Sager
- Santa Barbara Pulmonary Associates Santa Barbara California
| | - Luna Gargani
- Institution of Clinical Physiology National Research Council Pisa Italy
| | | | | | | | | | - Haodong Xu
- University of Washington School of Medicine Seattle
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