Iwata M, Sato A, Kitazawa H, Chida K, Hayakawa H, Akiyama J, Kishimoto H, Okano A, Tanguchi M
Second Department of Internal Medicine, Hamamatsu University School of Medicine.
Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Dec;29(12):1582-90.
The histologic findings of BOOP are nonspecific, and the diagnosis of idiopathic BOOP is one of exclusion. We studied the clinicopathologic features of various lung diseases with histopathological appearance of bronchiolitis obliterans organizing pneumonia (BOOP) pattern in open lung biopsy specimens. The 17 patients with BOOP pattern studied included idiopathic BOOP (n = 7), unclassified interstitial pneumonia (n = 1), collagen vascular disease (n = 3, RA 1, PM/DM 2), hypersensitivity pneumonitis (HP, n = 2), eosinophilic pneumonia (EP, n = 1), multiple lung abscesses (n = 1), limited form of Wegener's granulomatosis (n = 1), and pneumocystis carinii pneumonia associated with adult T cell leukemia (n = 1). There were no differences in clinical symptoms, laboratory data, respiratory function, and cytological findings in bronchoalveolar lavage fluid (BALF) between cases of idiopathic BOOP and other lung diseases. The duration of clinical symptoms was less than one year in 16 patients (one case had no symptoms). Chest X-rays showed bilateral patchy, nodular, or reticular shadows in all cases. Multiple patchy migratory shadows were only observed in cases of idiopathic BOOP or EP. Organizing pneumonia was recognized in the transbronchial lung biopsy specimens of all patients with idiopathic BOOP, HP or EP. Regarding prognosis, relapses occurred in idiopathic BOOP (n = 5), polymyositis, EP, limited form of Wegener's granulomatosis, and Pneumocystis carinii pneumonia. Four patients with idiopathic BOOP relapsed when steroid therapy was decreased or stopped. These findings indicate that idiopathic BOOP should be differentiated from other lung diseases, and these patients should be followed for a long period of time.
闭塞性细支气管炎伴机化性肺炎（BOOP）的组织学表现不具有特异性，特发性BOOP的诊断是一种排除性诊断。我们在开胸肺活检标本中研究了具有闭塞性细支气管炎伴机化性肺炎（BOOP）模式组织病理学表现的各种肺部疾病的临床病理特征。研究的17例具有BOOP模式的患者包括特发性BOOP（n = 7）、未分类的间质性肺炎（n = 1）、胶原血管病（n = 3，类风湿关节炎1例，皮肌炎/多肌炎2例）、过敏性肺炎（HP，n = 2）、嗜酸性粒细胞性肺炎（EP，n = 1）、多发性肺脓肿（n = 1）、局限性韦格纳肉芽肿（n = 1）以及与成人T细胞白血病相关的卡氏肺孢子虫肺炎（n = 1）。特发性BOOP病例与其他肺部疾病在临床症状、实验室数据、呼吸功能以及支气管肺泡灌洗（BALF）的细胞学检查结果方面并无差异。16例患者临床症状持续时间少于1年（1例无症状）。所有病例胸部X线均显示双侧斑片状、结节状或网状阴影。仅在特发性BOOP或EP病例中观察到多发性斑片状游走性阴影。所有特发性BOOP、HP或EP患者的经支气管肺活检标本中均可见机化性肺炎。关于预后，特发性BOOP（n = 5）、多发性肌炎、EP、局限性韦格纳肉芽肿以及卡氏肺孢子虫肺炎出现了复发。4例特发性BOOP患者在激素治疗减量或停药时复发。这些发现表明，特发性BOOP应与其他肺部疾病相鉴别，并且应对这些患者进行长期随访。
