Nakano S, Sato F, Koide O, Nikaido Y, Miyazaki N
J UOEH. 1987 Jun 1;9(2):201-7. doi: 10.7888/juoeh.9.201.
An autopsy case of a 75-year-old female with lymphoid interstitial pneumonia with monoclonal gammopathy of IgA kappa type is reported. The patient was admitted to UOEH Hospital suffering from a cough, sputum and fever. After examining a specimen of transbronchial lung biopsy and chest X ray films, lymphoid interstitial pneumonia was suspected. Serum immunological examination showed monoclonal IgA kappa type hypergammaglobulinemia. Marked clinical and radiological improvement was attained after prednisolone administration. After 16 months, however, the patient deteriorated and expired on January 21, 1986. On postmortem examination, a number of plasma cells as well as lymphoid cells were seen to have infiltrated in the thickened interalveolar septa and the parenchyme of the lymph nodes throughout the whole body. The architecture of lymph nodes remained preserved, while the cortex as well as the medulla was almost completely replaced by plasma cells and lymphoplasmacytoid cells. Immunohistochemical examination demonstrated the presence of IgA kappa in the plasma cells and some of the lymphoplasmacytoid cells in both lymph nodes and lungs. These findings suggest that the proliferating plasma cells and lymphoplasmacytoid cells were in neoplastic or preneoplastic states and support the hypothesis that lymphoid interstitial pneumonia may be an expression of the systemic lymphoproliferative disorders in the lung.
报告了一例75岁女性IgA κ型单克隆丙种球蛋白病合并淋巴间质性肺炎的尸检病例。患者因咳嗽、咳痰和发热入住国立环境研究所医院。经支气管肺活检标本及胸部X光片检查后，怀疑为淋巴间质性肺炎。血清免疫学检查显示单克隆IgA κ型高丙种球蛋白血症。给予泼尼松龙治疗后，临床和影像学有明显改善。然而，16个月后，患者病情恶化，于1986年1月21日死亡。尸检发现，增厚的肺泡间隔和全身淋巴结实质中有大量浆细胞和淋巴细胞浸润。淋巴结结构保留，但皮质和髓质几乎完全被浆细胞和淋巴浆细胞样细胞取代。免疫组化检查显示，淋巴结和肺中的浆细胞及部分淋巴浆细胞样细胞中有IgA κ存在。这些发现提示，增殖的浆细胞和淋巴浆细胞样细胞处于肿瘤性或肿瘤前状态，支持淋巴间质性肺炎可能是系统性肺淋巴增殖性疾病一种表现的假说。
