Service de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
Service de Pathologie, Groupement hospitalier est, Hospices de Lyon, Université Claude Bernard Lyon Est, Lyon, France.
Histopathology. 2018 Nov;73(5):832-842. doi: 10.1111/his.13697. Epub 2018 Aug 19.
Non-infectious pulmonary complications (NIPCs) occur frequently following allogeneic haematopoietic stem cell transplantation (HSCT). As there is no consensus on the description of the related pulmonary pathological lesions, pathologist reports and clinical conclusions are largely inconsistent in routine practice. The aim of our study was to provide an accurate overview of post-allogeneic HSCT NIPCs from a large number of lung biopsies.
We reviewed 61 lung biopsies in patients with an NIPC, including 51 surgical lung biopsies, four post-mortem biopsies and six lung explants. We found both bronchiolar (n = 59) and alveolar/interstitial pathologies (n = 27). We describe two types of bronchiolar lesions: bronchiolectasies (n = 37) and fibrous and cellular lesions with luminal narrowing (n = 43). We found a wide spectrum of airway/interstitial pathologies that were labelled using the terminology of the 2013 American Thoracic Society and European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs), including the following: organising pneumonia (OP, n = 8), non-specific interstitial pneumonia (NSIP, n = 9), diffuse alveolar damage (DAD, n = 6), lymphoid interstitial pneumonia (LIP, n = 1) and pleuroparenchymal fibroelastosis (PPFE, n = 2), as well as one instance of associated PPFE and NSIP.
Interstitial pathology was associated with bronchiolar lesions in 41% of the cases reviewed (n = 25). Lung airway and interstitial inflammation was still present in lung explants from patients who underwent lung transplantation for post-allogeneic HSCT end-stage respiratory insufficiency. Herein, we describe a wide spectrum of pathological lung lesions encountered in post-allogeneic HSCT NIPCs.
异基因造血干细胞移植（HSCT）后常发生非感染性肺部并发症（NIPC）。由于对相关肺部病理损伤的描述尚未达成共识，因此在常规实践中，病理学家报告和临床结论在很大程度上不一致。本研究的目的是从大量肺活检中提供异基因 HSCT 后 NIPC 的准确概述。
我们回顾了 61 例 NIPC 患者的肺活检，包括 51 例手术肺活检、4 例尸检活检和 6 例肺移植。我们发现了支气管（n=59）和肺泡/间质病变（n=27）。我们描述了两种类型的支气管病变：支气管扩张（n=37）和伴有管腔狭窄的纤维和细胞病变（n=43）。我们发现了广泛的气道/间质病变，使用 2013 年美国胸科学会和欧洲呼吸学会（ATS/ERS）特发性间质性肺炎（IIP）分类术语进行了标记，包括以下内容：机化性肺炎（OP，n=8）、非特异性间质性肺炎（NSIP，n=9）、弥漫性肺泡损伤（DAD，n=6）、淋巴间质肺炎（LIP，n=1）和胸膜肺弹力纤维增生症（PPFE，n=2），以及一例与 NSIP 相关的 PPFE。
在我们回顾的病例中（n=25），41%的间质性病变与支气管病变相关。在因异基因 HSCT 终末期呼吸衰竭而接受肺移植的患者的肺移植中，仍存在肺气道和间质炎症。在此，我们描述了异基因 HSCT 后 NIPC 中遇到的广泛的肺部病变。
