Chest
Selected ReportsEpithelial Necrosis and Alveolar Collapse in the Pathogenesis of Usual Interstitial Pneumonia
Section snippets
CASE REPORT
A 68-year-old white man was referred to our institution for evaluation of increasing dyspnea. Physical examination revealed diffuse rales bilaterally and there was clubbing of his fingers and toes. A chest roentgenogram showed coarse reticular opacities throughout both lungs associated with moderate volume loss. He underwent thoracotomy with biopsy of the left upper lobe. The lung biopsy specimen was routinely processed for light and electron microscopy.
Light Microscopy
The lung showed typical histologic features of UIP characterized by a variegated low magnification appearance in which relatively normal lung alternated with zones of interstitial inflammation, fibrosis, and honeycomb change. The areas of interstitial fibrosis consisted mainly of end-stage, mature fibrosis with dense collagen deposition. There were also scattered small foci containing less mature fibrosis composed of aggregates of loosely clustered fibroblasts dispersed in a faintly basophilic,
Discussion
The findings in our case suggest that epithelial necrosis and alveolar collapse are important in the pathogenesis of UIP. The epithelial necrosis is confined to small foci that are widely scattered and recognized histologically by the presence of loosely aggregated interstitial fibroblasts (fibroblastic foci). Similar areas can be found in most examples of UIP.2, 4 Alveolar collapse also occurs in the fibroblastic foci and likely results from the epithelial necrosis. Ultrastructurally, alveolar
REFERENCES (5)
Pathogenesis of “fibrosis” in interstitial pneumonia: An electron microscopic study
Hum Pathol
(1985)- et al.
Interstitial lung diseases of unknown cause: Disorders characterized by chronic inflammation of the lower respiratory tract
N Engl J Med
(1984)
Cited by (124)
Interaction Between Epithelial and Mesenchymal Cells in Interstitial Lung Disease
2021, Encyclopedia of Respiratory Medicine, Second EditionPathology of Idiopathic Pulmonary Fibrosis Assessed by a Combination of Microcomputed Tomography, Histology, and Immunohistochemistry
2020, American Journal of PathologyIdiopathic pulmonary fibrosis: Epithelial-mesenchymal interactions and emerging therapeutic targets
2018, Matrix BiologyCitation Excerpt :In the 1980'–1990's, there was increased focus on the role of secreted factors in the alveolar compartments (i.e. growth factors) on fibroblast activation and proliferation [18]. In parallel, careful pathologic studies by Katzenstein and others [19,20] began to question whether inflammatory cells were primary effectors of disease. Elegant histopathologic studies and electron microscopy demonstrated relative paucity of inflammatory cells, but evidence of epithelial damage/injury nearby what were termed “fibroblastic foci” [20].
Histopathological findings in lung biopsies with usual interstitial pneumonia: Definition of a new classification score for histological fibrotic stages
2024, General Physiology and BiophysicsNeutrophil extracellular traps and pulmonary fibrosis: an update
2023, Journal of Inflammation (United Kingdom)