Visscher D, Churg A, Katzenstein A L
Department of Pathology, University of Alabama, Birmingham.
Mod Pathol. 1988 Nov;1(6):415-9.
We describe six examples of nonnecrotizing lung granulomatosis in which there were numerous polarizable crystalline inclusions. The crystals were easily visible in routine H&E-stained slides and were so prominent that the question of a pneumoconiosis or other exogenous source was raised. There was no clinical history to suggest an inhalational source, however, and no patient used intravenous drugs. In one case, an atypical mycobacterial infection was proven to be etiologic, while sarcoidosis was documented in three. A review of 63 additional consecutive lung biopsies and 24 extrapulmonary biopsies showing nonnecrotizing granulomatous inflammation demonstrated crystals in almost two-thirds of cases. X-ray spectroscopy and histochemistry demonstrated that the crystals contained mainly calcium oxalate and calcium carbonate and thus represented products of cellular metabolism. These findings emphasize that crystalline inclusions are common in lung granulomas of varying etiology. They may be numerous, and their presence does not necessarily indicate a pneumoconiosis or other exogenous source.
我们描述了6例非坏死性肺肉芽肿病例，其中有大量可极化的晶体包涵体。这些晶体在常规苏木精-伊红（H&E）染色切片中很容易看到，且非常突出，以至于引发了是否为尘肺或其他外源性病因的疑问。然而，并无临床病史提示存在吸入性病因，且没有患者使用过静脉注射药物。在1例病例中，证实病因是非典型分枝杆菌感染，而在3例中记录为结节病。对另外63例连续的肺活检和24例肺外活检显示非坏死性肉芽肿性炎症的病例进行回顾发现，近三分之二的病例中有晶体。X射线光谱分析和组织化学表明，这些晶体主要含有草酸钙和碳酸钙，因此代表细胞代谢产物。这些发现强调，晶体包涵体在不同病因的肺肉芽肿中很常见。它们可能数量众多，其存在并不一定表明是尘肺或其他外源性病因。
