Fang Fang, Xu Xiao-mao, Zhang Wei, Pang Jian-xin, Liu Dong-ge, Wang Chen
Department of Pathology, Beijing Hospital, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2012 Sep 25;92(36):2546-9.
To enhance the understandings of clinical, radiological and pathological features of hypersensitivity pneumonitis (HP).
Six HP cases with pathological data, clinical and radiological data were retrospectively analyzed during the period from February 2009 to September 2011 at Beijing Hospital of Ministry of Health. There were 2 males and 4 females with a mean age of 51.5 years (range: 38-61). Clinically, the patients presented with chronic cough, shortness of breath and dyspnea (n = 2). The disease course was 1-8 months. Five cases had fed pigeons and other contact histories. Specimens obtained by transbronchial lung biopsy (n = 3) and open lung biopsy (n = 3) were paraffin embedded and stained by hematoxylin and eosin, special stains and immunohistochemistry.
Four cases had subacute HP and 2 cases chronic HP. Three cases of subacute HP underwent transbronchial lung biopsy. One case of subacute HP and 2 cases of chronic HP were diagnosed by open lung biopsy. High-resolution computed tomography of lungs showed diffuse ground glass and patch shadow along the bronchial and centrilobular distributions. There was a predominance of upper half zone. Typical visible mosaic syndrome was present. There was poorly formed granuloma without cheesy necrosis. With an insidious medical history and complicated radiological features, chronic HP cases were characterized by pulmonary interstitial fibrosis. There were usual interstitial pneumonitis (UIP)-like fibrosis and fibrosis with an airway-centered distribution type. The lesions were distributed around bronchioles. Continuous bridge fibrosis might be present. There were bronchiolar metaplasia of peribronchiolar alveoli, poorly formed granuloma and multinucleated giant cells in interstitium. Schaumann body was identified in 1 case.
Because of its diverse clinical, radiological and pathological features, HP may be easily confused with other interstitial lung diseases. Aggregate analyses yield a definite diagnosis.
提高对过敏性肺炎（HP）临床、影像学及病理特征的认识。
回顾性分析2009年2月至2011年9月期间在北京卫生部北京医院确诊的6例有病理资料、临床及影像学资料的HP患者。其中男性2例，女性4例，平均年龄51.5岁（范围：38 - 61岁）。临床上，患者表现为慢性咳嗽、气短和呼吸困难（2例）。病程为1 - 8个月。5例有饲养鸽子及其他接触史。经支气管肺活检（3例）及开胸肺活检（3例）获取的标本进行石蜡包埋，苏木精-伊红染色、特殊染色及免疫组化。
4例为亚急性HP，2例为慢性HP。3例亚急性HP行经支气管肺活检。1例亚急性HP及2例慢性HP经开胸肺活检确诊。肺部高分辨率计算机断层扫描显示沿支气管及小叶中心分布的弥漫性磨玻璃影及斑片状阴影。上肺野为主。可见典型的马赛克征。有形成不良的肉芽肿，无干酪样坏死。慢性HP病例病史隐匿，影像学表现复杂，以肺间质纤维化为特征。有普通型间质性肺炎（UIP）样纤维化及以气道为中心分布型的纤维化。病变分布于细支气管周围。可能存在连续的桥接纤维化。细支气管周围肺泡有细支气管化生，间质中有形成不良的肉芽肿及多核巨细胞。1例发现舒曼小体。
由于HP临床、影像学及病理特征多样，易与其他间质性肺疾病混淆。综合分析有助于明确诊断。
