Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Histopathology. 2020 Sep;77(3):453-459. doi: 10.1111/his.14135. Epub 2020 Jul 2.
Reports of respiratory illnesses among soldiers returning from Southwest Asia have been described. During deployment to Southwest Asia, soldiers are exposed to various respiratory hazards, including dust storms, smoke from burn pits and industrial air pollutants. A few studies have reported increased rates of constrictive bronchiolitis and asthma in these patients. We sought to expand upon the pathological findings in this cohort.
Lung biopsies from veterans of Southwest Asia were identified and re-reviewed. All patients had undergone pulmonary function tests and chest high-resolution CT imaging with no significant findings. Overall, 59 patients with a history of inhalational exposure to at least one of the following were identified: smoke from burn pit, dust storm and sulphur plant fire. Samples included video-assisted thoracoscopic lung biopsies (57 of 59, 96.6%) and cryobiopsies (two of 59, 3.4%). Patients were predominantly male (54 of 59, 91.5%) with an age range of 24-55 years (mean and median = 35). Non-necrotising, poorly formed granulomas were identified in 22 cases (22 of 59, 37.2%). The granulomas were mainly bronchiolocentric and were associated with chronic lymphoplasmacytic bronchiolitis, similar to hypersensitivity pneumonitis (HP). Pleural reaction in the form of focal chronic lymphocytic pleuritis and/or focal pleural adhesions were seen in 43 of 57 (75.4%) biopsies.
To our knowledge, this is the first study to report pleural reaction as well as features of HP in this population, suggesting that pleural reaction and HP may be part of the spectrum of Southwest Asia deployment-related lung diseases.
有报道称，从西南亚返回的士兵中出现了呼吸道疾病。在部署到西南亚期间，士兵会接触到各种呼吸道危害，包括沙尘暴、燃烧坑的烟雾和工业空气污染物。有几项研究报告称，这些患者的缩窄性细支气管炎和哮喘发病率有所增加。我们试图在这一队列中进一步扩大病理发现。
确定并重新审查了来自西南亚退伍军人的肺活检样本。所有患者均进行了肺功能测试和胸部高分辨率 CT 成像，均无明显发现。总体而言，确定了 59 名有以下至少一种吸入暴露史的患者：燃烧坑烟雾、沙尘暴和硫磺厂火灾。样本包括视频辅助胸腔镜肺活检（59 例中的 57 例，96.6%）和冷冻活检（59 例中的 2 例，3.4%）。患者主要为男性（59 例中的 54 例，91.5%），年龄范围为 24-55 岁（平均值和中位数=35）。22 例（59 例中的 22 例，37.2%）发现非坏死性、形态不良的肉芽肿。这些肉芽肿主要为细支气管中心性，并与慢性淋巴浆细胞性细支气管炎相关，类似于过敏性肺炎（HP）。57 例活检中有 43 例（75.4%）胸膜出现以局灶性慢性淋巴细胞性胸膜炎和/或局灶性胸膜粘连为特征的反应。
据我们所知，这是第一项报告在该人群中胸膜反应以及 HP 特征的研究，表明胸膜反应和 HP 可能是西南亚部署相关肺部疾病谱的一部分。
