Mukhopadhyay Sanjay, Katzenstein Anna-Luise A
Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA.
Am J Surg Pathol. 2007 May;31(5):752-9. doi: 10.1097/01.pas.0000213418.08009.f9.
Aspiration of particulate matter is a well-recognized complication in debilitated patients at autopsy but is not widely recognized in surgical pathology material. We have encountered a surprising number of cases on biopsy or resection specimens, and most were unsuspected clinically and pathologically. This study was undertaken to clarify clinical and pathologic features that facilitate the diagnosis of food/particulate matter aspiration pneumonia. Fifty-nine patients were identified with an average age of 57 (range 26 to 85), and a male/female ratio of 2:1. Common presenting symptoms (information available in 36 cases) included dyspnea (14), fever (9), and cough (6). A history of recurrent pneumonia was present in 9. Radiographic data were available in 34 cases. Bilateral infiltrates or nodules were found in 17 cases, whereas the changes were unilateral in 17. Solitary nodules clinically suspicious for neoplasm were present in 13. Aspiration was suspected clinically in only 4 of the 45 cases in which the clinical impression or differential diagnosis was stated. Predisposing factors for aspiration were identified in 32 patients, including esophageal or gastric causes (19), drug use (10), and neurologic conditions (6). Histologically, bronchiolitis obliterans-organizing pneumonia was present in 52 (88%) cases, usually in combination with multinucleated giant cells, acute bronchopneumonia/bronchiolitis, and/or suppurative granulomas. Foreign material was identified in all cases, including most commonly vegetable or food remnants (54 cases), and less often talc or microcrystalline cellulose (7), crospovidone (4), and kayexalate (2). Particulate matter aspiration pneumonia is a more common cause of lung infiltrates and nodules than generally appreciated. The diagnosis should be suspected when multinucleated giant cells, acute bronchopneumonia/bronchiolitis, and/or suppurative granulomas are found in a background of bronchiolitis obliterans-organizing pneumonia. The presence of foreign material confirms the diagnosis.
在尸检中，颗粒物质吸入是虚弱患者中一种广为人知的并发症，但在外科病理材料中并未得到广泛认识。我们在活检或切除标本中遇到了数量惊人的病例，而且大多数病例在临床和病理上都未被怀疑。本研究旨在阐明有助于诊断食物/颗粒物质吸入性肺炎的临床和病理特征。共确定了59例患者，平均年龄57岁（范围26至85岁），男女比例为2:1。常见的首发症状（36例可获得相关信息）包括呼吸困难（14例）、发热（9例）和咳嗽（6例）。9例有复发性肺炎病史。34例有影像学资料。17例发现双侧浸润或结节，17例病变为单侧。13例有临床上怀疑为肿瘤的孤立结节。在45例明确了临床印象或鉴别诊断的病例中，只有4例临床怀疑有吸入。在32例患者中确定了吸入的易感因素，包括食管或胃部原因（19例）、药物使用（10例）和神经系统疾病（6例）。组织学上，52例（88%）存在闭塞性细支气管炎-机化性肺炎，通常伴有多核巨细胞、急性支气管肺炎/细支气管炎和/或化脓性肉芽肿。所有病例均发现有异物，最常见的是蔬菜或食物残渣（54例），较少见的是滑石粉或微晶纤维素（7例）、交联聚维酮（4例）和聚苯乙烯磺酸钠（2例）。颗粒物质吸入性肺炎是肺部浸润和结节比一般认识更为常见的原因。当在闭塞性细支气管炎-机化性肺炎背景下发现多核巨细胞、急性支气管肺炎/细支气管炎和/或化脓性肉芽肿时，应怀疑该诊断。异物的存在可确诊。
