Bosken C H, Myers J L, Greenberger P A, Katzenstein A L
Department of Pathology, University of Alabama, Birmingham.
Am J Surg Pathol. 1988 Mar;12(3):216-22. doi: 10.1097/00000478-198803000-00007.
We describe the pathologic features in surgically excised lung tissue specimens from 18 cases of allergic bronchopulmonary aspergillosis (ABPA). The main abnormalities involved bronchi and bronchioles. All cases showed bronchocentric granulomatosis (BCG), mucoid impaction of bronchi (MIB), or both. The impacted mucin of MIB contained large numbers of eosinophils and Charcot-Leyden crystals. A distinctive exudative bronchiolitis was present distal to areas of BCG in 13 cases. This lesion was characterized by filling of bronchiolar lumens with necrotic neutrophils and eosinophils in a basophilic mucinous exudate. A peribronchiolar chronic inflammatory infiltrate was seen in 15 cases; eosinophils were prominent in 10 of these cases. Foci of eosinophilic pneumonia were seen in 13 cases, and noninvasive fungal hyphae were identified in 14. We conclude that the finding of BCG or MIB, or a combination of both, especially in conjunction with tissue eosinophilia, should suggest the diagnosis of ABPA. When noninvasive fungal hyphae are also present, the changes are diagnostic of ABPA or a related allergic fungal reaction.
我们描述了18例变应性支气管肺曲霉病（ABPA）手术切除肺组织标本的病理特征。主要异常累及支气管和细支气管。所有病例均表现为支气管中心性肉芽肿（BCG）、支气管黏液嵌塞（MIB）或两者皆有。MIB中受嵌塞的黏液含有大量嗜酸性粒细胞和夏科-莱登结晶。13例在BCG区域远端存在一种独特的渗出性细支气管炎。该病变的特征是细支气管腔内充满嗜碱性黏液性渗出物中的坏死中性粒细胞和嗜酸性粒细胞。15例可见支气管周围慢性炎性浸润；其中10例嗜酸性粒细胞显著。13例可见嗜酸性肺炎病灶，14例鉴定出非侵袭性真菌菌丝。我们得出结论，发现BCG或MIB，或两者同时存在，特别是伴有组织嗜酸性粒细胞增多时，应提示ABPA的诊断。当同时存在非侵袭性真菌菌丝时，这些改变可诊断为ABPA或相关的变应性真菌反应。
