Myers J L, Katzenstein A L
Division of Surgical Pathology, University of Alabama, Birmingham.
Am J Pathol. 1988 Jul;132(1):102-9.
The ultrastructural features of idiopathic bronchiolitis obliterans-organizing pneumonia (BOOP) were studied in 9 patients. As expected, the characteristic air space fibrosis was composed of spindled fibroblasts and myofibroblasts arranged concentrically within an electron-lucent stroma. In 6 patients there was evidence of incorporation of air space fibrosis into the interstitium. A surprising finding in all patients was the presence of extensive epithelial damage involving peribronchiolar alveolar septa. Necrosis and sloughing of alveolar lining cells resulted in denuding of epithelial basal laminae. Complex infoldings and deep invaginations of the denuded basal laminae into alveolar septa were common. These ultrastructural changes involving the interstitium are similar to those occurring in the interstitial pneumonias, and suggest that BOOP also results from acute epithelial injury. The different clinical manifestations and prognosis of these entities may relate to the peribronchiolar localization of the epithelial damage in BOOP compared with more diffuse involvement of distal lung in the interstitial pneumonias.
对9例特发性闭塞性细支气管炎并机化性肺炎（BOOP）患者的超微结构特征进行了研究。正如预期的那样，特征性的气腔纤维化由梭形成纤维细胞和平滑肌成纤维细胞组成，它们在电子透亮的基质中呈同心排列。6例患者有气腔纤维化融入间质的证据。所有患者中一个令人惊讶的发现是存在广泛的上皮损伤，累及细支气管周围的肺泡间隔。肺泡衬里细胞的坏死和脱落导致上皮基膜裸露。裸露的基膜向肺泡间隔的复杂折叠和深陷很常见。这些累及间质的超微结构变化与间质性肺炎中发生的变化相似，提示BOOP也由急性上皮损伤引起。这些疾病不同的临床表现和预后可能与BOOP中上皮损伤位于细支气管周围有关，而间质性肺炎中远端肺受累更为弥漫。
