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Nikaido T, Tanino Y, Sato Y, Togawa R, Watanabe N, Wang X, Fukuhara N, Harigane R, Saito K, Kazama K, Yamada R, Sato R, Tomita H, Rikimaru M, Suzuki Y, Minemura H, Saito J, Kanazawa K, Yamamoto T, Hashimoto Y, Hebisawa A, Shibata Y. The first lichen planus case coexisting bronchiolitis obliterans without malignant tumors. Pathol Int 2024; 74:352-355. [PMID: 38651922 DOI: 10.1111/pin.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Takefumi Nikaido
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Natsumi Watanabe
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Xintao Wang
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoko Fukuhara
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Rina Harigane
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koshi Saito
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kentaro Kazama
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryuki Yamada
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Riko Sato
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hikaru Tomita
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yasuhito Suzuki
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junpei Saito
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akira Hebisawa
- Clinical Research Center, National Hospital Organization Tokyo National Hospital, Kiyose, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
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Hsieh PI, Chen HW, Yeh HN, Lam MC, Lo PY, Huang WH, Shih CH, Lin CH. Constrictive bronchiolitis obliterans with a presumptive etiology of preceding feline herpesvirus infection in a cat. BMC Vet Res 2022; 18:258. [PMID: 35790990 PMCID: PMC9254555 DOI: 10.1186/s12917-022-03368-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/30/2022] [Indexed: 11/02/2022] Open
Abstract
Abstract
Background
Bronchiolar disorders are rarely recognized in cats. Constrictive bronchiolitis obliterans is characterized by concentric peribronchiolar fibrosis and inflammation of the bronchioles, but the underlying causes remain poorly understood in current small animal medicine.
Case presentation
A 9-year-old cat presented with paroxysmal tachypnea, infrequent cough and persistent labor breathing. Thoracic radiography showed lung hyperinflation and bronchointerstitial pattern, and pulmonary function assessment revealed flow limitation in the late-expiratory phase and poor response to short-acting bronchodilator. Dorsally distributed subpleural ground glass opacities with distinct margin and tree-in-bud opacities were observed on lung high-resolution computed tomography. The cat underwent bronchoalveolar lavage (BAL) and showed severe neutrophilic inflammation. Feline herpesvirus was the only pathogen detected in the BAL fluid. Multiple therapeutic attempts were unsuccessful and the cat died 8 weeks after the initial presentation. Necropsy revealed the infiltration of inflammatory cells, obstruction of the bronchiolar lumen, and submucosal concentric fibrosis suggesting constrictive bronchiolitis obliterans. Combining the pre- and post-mortem findings, as well as the time from symptom onset or BAL to necropsy, constrictive bronchiolitis obliterans was possibly triggered by a preceding feline herpesvirus infection in this case.
Conclusions
The history of nonvaccinated status, lower airway neutrophilic inflammation, and presence of feline herpesvirus in the BAL fluid without coexistence of other pathogens led to the presumption that constrictive bronchiolitis obliterans was induced by a preceding feline herpesvirus infection in this cat. The pathological changes of bronchiolitis obliterans induced by a preceding feline herpesvirus infection could be different from that of cats with acute herpesvirus pneumonia, such as intranuclear inclusions would disappear over time and were no longer found 7–10 days after inoculation. The presence of patchy distribution of subpleural ground glass opacities on lung high-resolution computed tomography should raise the suspicion of peribronchiolar fibrosis. Clinical awareness of bronchiolar disorders as a differential diagnosis is important in cats with lung hyperinflation and labored breathing who show poor reversibility to bronchodilator.
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3
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Chen W, Zhao L, Guo L, Zhao L, Niu H, Lian H, Dai H, Chen J, Wang C. Clinical and pathological features of bronchiolitis obliterans requiring lung transplantation in paraneoplastic pemphigus associated with Castleman disease. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:173-181. [PMID: 35060328 PMCID: PMC9060127 DOI: 10.1111/crj.13465] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 01/09/2023]
Abstract
Summary at a glance Bronchiolitis obliterans in paraneoplastic pemphigus associated with Castleman disease possesses the progressive nature even when it is treated with intensive medical therapy. Antibodies were at least in low titers before the Lung transplant and remain negative after the procedure. Explanted lungs showed coexistence of cellular destructive bronchiolitis and constrictive bronchiolitis. Background Bronchiolitis obliterans (BO) in paraneoplastic pemphigus (PNP) associated with Castleman disease (CD) possesses the progressive nature of pulmonary disease even when it is treated with intensive medical therapy. Lung transplantation (LT) offers an acceptable form of treatment. Methods We conducted a retrospective study of two cases of BO in PNP associated with CD who underwent LT between March 2017 and March 2020 at the China‐Japan Friendship Hospital. We also included one case from the literature. Results In this patient series, PNP was the primary clinical presentation in all patients, and it was accompanied by respiratory symptoms before/after CD excision. In spite of being treated with various combinations of immunosuppressive and anti‐inflammatory agents, the patients had great or total improvement in mucosal erosions, whereas their pulmonary function test (PFT) deteriorated gradually or sharply. The duration times from disease onset to timing of LT were 1, 2 and 5 years. All antibodies were negative or were present at low titers before the LT procedure and remain negative after the procedure. The histopathological features of explanted lungs showed cellular and coexistent destructive bronchiolitis and constrictive bronchiolitis in two cases. Granulation with numerous foamy macrophages, scattered giant cells and cholesterol clefts were especially prominent in case one. Conclusion BO in PNP associated with CD had poor clinical outcomes. LT was preferable choice in end‐stage BO when PNP and CD were controlled.
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Affiliation(s)
- Wenhui Chen
- Department of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ling Zhao
- Department of Pathology, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lijuan Guo
- Department of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Li Zhao
- Department of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Hongtao Niu
- National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Huifang Lian
- Department of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Jizhong Energy Fengfeng Group Hospital, Handan, China
| | - Huaping Dai
- National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jingyu Chen
- Department of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
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4
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Homma S, Ebina M, Kuwano K, Goto H, Sakai F, Sakamoto S, Johkoh T, Sugino K, Tachibana T, Terasaki Y, Nishioka Y, Hagiwara K, Hashimoto N, Hasegawa Y, Hebisawa A. Intractable diffuse pulmonary diseases: Manual for diagnosis and treatment. Respir Investig 2021; 59:8-33. [PMID: 32622842 DOI: 10.1016/j.resinv.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
This manual has been compiled by a joint production committee with the Diffuse Lung Disease Assembly of the Japanese Respiratory Society (JRS) to provide a practical manual for the epidemiology, diagnosis, and treatment of intractable diffuse pulmonary diseases. The contents are based upon the results of research into these diseases by the Diffuse Pulmonary Diseases Study Group (principal researcher: Sakae Homma) supported by the FY2014-FY2016 Health and Labor Sciences Research Grant on Intractable Diseases. This manual focuses on: 1) pulmonary alveolar microlithiasis, 2) bronchiolitis obliterans, and 3) Hermansky-Pudlak Syndrome with interstitial pneumonia. As these are rare/intractable diffuse lung diseases (2 and 3 were first recognized as specified intractable diseases in 2015), there have not been sufficient epidemiological studies made, and there has been little progress in formulating diagnostic criteria and severity scales; however, the results of Japan's first surveys and research into such details are presented herein. In addition, the manual provides treatment guidance and actual cases for each disease, aiming to assist in the establishment of future modalities. The manual was produced with the goal of enabling clinicians specialized in respiratory apparatus to handle these diseases in clinical settings and of further advancing future research and treatment.
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Affiliation(s)
- Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Diseases Research, School of Medicine, Toho University, Tokyo, Japan.
| | - Masahito Ebina
- Department of Respiratory Medicine in the 1st Internal Medicine, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan.
| | - Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan.
| | - Teruo Tachibana
- Department of Internal Medicine, Aizenbashi Hospital, Osaka, Japan.
| | - Yasahiro Terasaki
- Department of Pathology (Analytic Human Pathology), Nippon Medical School, Tokyo, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Jichi Medical University, Saitama, Japan.
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan.
| | - Akira Hebisawa
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
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5
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Gazourian L, Ash S, Meserve EEK, Diaz A, Estepar RSJ, El-Chemaly SY, Rosas IO, Divo M, Fuhlbrigge AL, Camp PC, Ho VT, Bhatt AS, Goldberg HJ, Sholl LM, Washko GR. Quantitative computed tomography assessment of bronchiolitis obliterans syndrome after lung transplantation. Clin Transplant 2017; 31. [PMID: 28244139 DOI: 10.1111/ctr.12943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bronchiolitis obliterans syndrome (BOS) is a clinical manifestation of chronic allograft rejection following lung transplantation. We examined the quantitative measurements of the proximal airway and vessels and pathologic correlations in subjects with BOS. METHODS Patients who received a lung transplant at the Brigham and Women's Hospital between December 1, 2002 and December 31, 2010 were included in this study. We characterized the quantitative CT measures of proximal airways and vessels and pathological changes. RESULTS Ninety-four (46.1%) of the 204 subjects were included in the study. There was a significant increase in the airway vessel ratio in subjects who developed progressive BOS compared to controls and non-progressors. There was a significant increase in airway lumen area and decrease in vessel cross-sectional area in patients with BOS compared to controls. Patients with BOS had a significant increase in proximal airway fibrosis compared to controls. CONCLUSIONS BOS is characterized by central airway dilation and vascular remodeling, the degree of which is correlated to decrements in lung function. Our data suggest that progressive BOS is a pathologic process that affects both the central and distal airways.
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Affiliation(s)
- Lee Gazourian
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Samuel Ash
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily E K Meserve
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Alejandro Diaz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Souheil Y El-Chemaly
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ivan O Rosas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Miguel Divo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Anne L Fuhlbrigge
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Phillip C Camp
- Department of Medicine, Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Lung Transplant Program, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Vincent T Ho
- Department of Medical Oncology, Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ami S Bhatt
- School of Medicine and Departments of Medicine and Genetics, Stanford University, Stanford, CA, USA
| | - Hilary J Goldberg
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Lung Transplant Program, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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6
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Consensus statements for medical practice: Biological agents and lung disease [Abridged English translation by the Japanese Respiratory Society]. Respir Investig 2017; 55:229-251. [PMID: 28427750 DOI: 10.1016/j.resinv.2017.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/22/2017] [Indexed: 02/08/2023]
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Montesi SB, Nance JW, Harris RS, Mark EJ. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 17-2016. A 60-Year-Old Woman with Increasing Dyspnea. N Engl J Med 2016; 374:2269-79. [PMID: 27276565 DOI: 10.1056/nejmcpc1516452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sydney B Montesi
- From the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
| | - John W Nance
- From the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
| | - R Scott Harris
- From the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
| | - Eugene J Mark
- From the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Medicine (S.B.M., R.S.H.), Radiology (J.W.N.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
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9
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Sugino K, Hebisawa A, Uekusa T, Hatanaka K, Abe H, Homma S. Bronchiolitis obliterans associated with Stevens-Johnson Syndrome: histopathological bronchial reconstruction of the whole lung and immunohistochemical study. Diagn Pathol 2013; 8:134. [PMID: 23919759 PMCID: PMC3751748 DOI: 10.1186/1746-1596-8-134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/30/2013] [Indexed: 11/16/2022] Open
Abstract
This study presents an extremely rare case of constrictive bronchiolitis obliterans (BO) associated with Stevens-Johnson Syndrome (SJS) provides the morphological and immunohistochemical features using histopathological bronchial reconstruction technique. A 27-year-old female developed progressive dyspnea after SJS induced by taking amoxicillin at the age of 10. Finally, she died of exacerbation of type II respiratory failure after 17 years from clinically diagnosed as having BO. Macroscopic bronchial reconstruction of the whole lungs at autopsy showed the beginning of bronchial obliterations was in the 4th to 5th branches, numbering from each segmental bronchus. Once they were obliterated, the distal and proximal bronchi were dilated. Microscopic bronchial reconstruction demonstrated the localization of obliteration was mainly from small bronchi to membranous bronchioli with intermittent airway luminal narrowing or obliteration. Moreover, CD3-, CD20-, and CD68-positive cells were found in the BO lesions. CD34- and D2-40-positive cells were mainly distributed in the peribronchiolar lesions and bronchiolar lumens, respectively. SMA- and TGF-β-positive cells were seen in the fibrous tissue of BO lesions.
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Affiliation(s)
- Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center, Omorinishi 6-11-1, Ota-ku, Tokyo 143-8541, Japan.
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10
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Kambouchner M. [The small airways: normal histology and the main histopathological lesions]. Rev Mal Respir 2013; 30:286-301. [PMID: 23664287 DOI: 10.1016/j.rmr.2012.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 12/24/2012] [Indexed: 01/15/2023]
Abstract
Lesions of the small airway are observed in a wide variety of pulmonary conditions, most of which are due to infection, tobacco and connective tissue diseases. They are sometimes isolated or, more often, associated with involvement of other pulmonary structures such as the bronchi, the lung parenchyma and the pleura. The pathological spectrum of the bronchiolar response to injury is relatively limited. Thus, the same lesion is observed in various clinical settings. There is no correlation between the severity of the small airway involvement seen by the pathologist and the clinical and functional manifestations of bronchiolitis. The causes of bronchiolitis may be classified on a clinical basis, on aetiology or on histological appearance, yet no single classification appears to be suitable. An integrated clinical, radiological, functional and histological approach is needed. As they are seen by the pathologist microscopically, small airway lesions may be subdivided into three categories: (1) simple nonspecific lesions (bronchiolitis - cellular, follicular, granulomatous, obliterative, constrictive) that are never exclusively related to one clinical picture, (2) or displaying a more specific pattern like the respiratory bronchiolitis of the smoker or the histolgical changes of asthma, (3) bronchiolar lesions in conditions described as "interstitial", predominantly centrilobular, involving the small airways and the lung parenchyma, and visible radiologically. After recalling the normal histological appearances of the bronchioles, this review describes the diversity of the histopathological lesions of the small airways.
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Affiliation(s)
- M Kambouchner
- Service d'anatomie pathologique, hôpital Avicenne, AP-HP, 125, route de Stalingrad, 93009 Bobigny cedex, France.
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11
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Abstract
RATIONALE Bronchiolitis obliterans syndrome (BOS) is a late, non-infectious pulmonary complication following hematopoietic stem cell transplantation (HSCT). There is minimal data published on quantitative radiologic characterization of airway remodeling in these subjects. OBJECTIVES To examine quantitative measurements of airway morphology and their correlation with lung function in a cohort of patients who underwent HSCT and developed BOS. METHODS All adult patients who underwent allogeneic HSCT at the Dana-Farber Cancer Institute/Brigham and Women's Hospital (n = 1854) between January 1st 2000 and June 30th 2010 were screened for the development of BOS. Clinically acquired high resolution CT (HRCT) scans of the chest were collected. For each subjects discrete measures of airway wall area were performed and the square root of wall area of a 10-mm luminal perimeter (Pi10) was calculated. MEASUREMENTS AND MAIN RESULTS We identified 88 cases of BOS, and 37 of these patients had available HRCT. On CT scans obtained after BOS diagnosis, the Pi10 decreased (consistent with airway dilation) as compared with pre-BOS values (p < 0.001). After HSCT the Pi10 correlated with FEV(1)% predicted (r = 0.636, p < 0.0001), and RV/TLC% predicted (r = -0.736, p < 0.0001), even after adjusting for age, sex and total lung capacity (p < 0.0001 for both). CONCLUSIONS On HRCT scan BOS is characterized by central airway dilation, the degree of which is correlated to decrements in lung function. This is opposite of what has been previously demonstrated in COPD and asthma that quantitative measure of proximal airway wall thickening directly correlate with pulmonary function. Our data suggests that the pathologic process affecting the central airways is different from the pathology observed in the distal airways. Further work is needed to determine if such change can be used as a sensitive and specific tool for the future diagnosis and staging of BOS.
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Early pathologic findings of bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a proposal from a case. Case Rep Hematol 2012; 2012:957612. [PMID: 22957280 PMCID: PMC3432330 DOI: 10.1155/2012/957612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/19/2012] [Indexed: 11/17/2022] Open
Abstract
Bronchiolitis obliterans (BO) is one of the serious, noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Early diagnosis of BO is usually difficult because patients are often asymptomatic at an initial stage of the disease and pathologic findings are available mostly at the late stages. Therefore, the diagnosis of the disease is based on the pulmonary function test using the National Institute of Health consensus criteria. Here, we report a case of slowly progressive BO. A biopsy specimen at an early stage demonstrated alveolar destruction with lymphocyte infiltration in bronchial walls and mild narrowing of bronchioles without fibrosis, those were strongly indicative of initial pathologic changes of BO. Definitive BO followed, which was proven by both clinical course and autopsy. While alloreactive lymphocytes associated with chronic graft-versus-host disease are believed to initiate BO, we present a rare case that directly implies such a scenario.
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