Burkhardt A, Gebbers J O, Höltje W J
Dtsch Med Wochenschr. 1977 Feb 25;102(8):281-9. doi: 10.1055/s-0028-1104879.
Histological and electron-microscopic study of the lungs of 15 patients who had been treated with bleomycin for advanced squamous cell carcinoma demonstrated marked histological changes in nine. They were typical of bleomycin effects: alveolitis, intra-alveolar and interstitial oedema, pulmonary hyaline membranes, disseminated intravascular coagulation, intraalveolar and interstitial fibrosis, atelectasis, metaplasia and dysplasia of the alveolar lining cells. These lesions had a focal distribution, preferentially in the subpleural and periseptal regions. Each of these lesions alone is a non-characteristic reaction, but their combination makes it a distinct entity (bleomycin lung). Three different clinical courses were noted: (1) cases with no or little abnormality; (2) acute form during or shortly after bleomycin treatment; (3) chronic, progressive form of bleomycin lung which may end fatally as late as 1 1/2 years after bleomycin treatment had been discontinued. Squamous cell metaplasia is the most characteristic sign of bleomycin lung. It should not be confused with pulmonary metastases. To prove the diagnosis of bleomycin lung often requires systematic histological investigation. A schema of the pathogenesis of the bleomycin lung is proposed in which the formation of microthrombi plays an important part.
对15例晚期鳞状细胞癌患者使用博来霉素治疗后的肺部进行组织学和电子显微镜研究，结果显示其中9例有明显的组织学改变。这些改变是博来霉素作用的典型表现：肺泡炎、肺泡内和间质水肿、肺透明膜、弥漫性血管内凝血、肺泡内和间质纤维化、肺不张、肺泡衬里细胞化生和发育异常。这些病变呈局灶性分布，优先出现在胸膜下和间隔旁区域。这些病变单独来看均为非特异性反应，但它们的组合使其成为一种独特的实体（博来霉素肺）。观察到三种不同的临床病程：（1）无异常或仅有轻微异常的病例；（2）博来霉素治疗期间或治疗后不久出现的急性形式；（3）博来霉素肺的慢性、进行性形式，在停止博来霉素治疗后长达1年半时可能致命。鳞状细胞化生是博来霉素肺最具特征性的表现。不应将其与肺转移相混淆。要确诊博来霉素肺通常需要进行系统的组织学检查。提出了博来霉素肺发病机制的示意图，其中微血栓的形成起重要作用。
