Hebisawa A, Tamura A, Kurashima A, Oobayashi C, Kawamata M, Maeda M, Saiki S, Komatsu H, Yoneda R
Division of Clinical Laboratory, National Tokyo Hospital.
Nihon Kokyuki Gakkai Zasshi. 1998 Apr;36(4):330-7.
We examined lung specimens that fulfilled the pathological criteria of Bosken and were obtained from 5, patients with allergic bronchopulmonary aspergillosis/mycosis (ABPA/M). A finding common to all 5 was the presence of hard mucous plugs containing numerous eosinophils and fungal hyphae in the bronchi, showing central bronchiectasis. Bronchocentric granulmatosis with tissue eosinophilia (4 cases), xanthogranulomatous lesions (3 cases), eosinohilic pneumonia (2 cases) and organizing pneumonia (3 cases) were recognized only in bronchi distal to the mucous plugs (BMP). Almost normal lung parenchyma could be seen in some areas distal to the BMP. We found clusters of degenerated eosinophils (CDE) showing a "fir-tree like structure" and fungal hyphae in both the mucous plugs and the peripheral lesions. Most CDEs were free in the exudate and were not engulfed by macrophages. The presence of fungi in the mucous plugs may have caused marked inflammation in the wall around the BMP, which may have made the walls fragile and caused central bronchiectasis. The fungi in the mucous plugs may have caused the peripheral lesions via aerogenous dissemination. For this reason, we conclude that ABPA/M is an infectious disease, and that the primary lesion in ABPA/M is the formation of mucous plugs. Therefore, the presence of mucous plugs containing fungi and many eosinophils is diagnostic of ABPA/M.
我们检查了符合博斯肯病理标准的肺标本，这些标本取自5例变应性支气管肺曲霉病/真菌病（ABPA/M）患者。所有5例患者的一个共同发现是，支气管内存在含有大量嗜酸性粒细胞和真菌菌丝的硬黏液栓，显示出中心性支气管扩张。仅在黏液栓（BMP）远端的支气管中发现了伴有组织嗜酸性粒细胞增多的支气管中心性肉芽肿（4例）、黄色肉芽肿性病变（3例）、嗜酸性粒细胞性肺炎（2例）和机化性肺炎（3例）。在BMP远端的一些区域可见几乎正常的肺实质。我们在黏液栓和周围病变中均发现了呈“枞树形结构”的退化嗜酸性粒细胞簇（CDE）和真菌菌丝。大多数CDE游离于渗出物中，未被巨噬细胞吞噬。黏液栓中真菌的存在可能导致了BMP周围壁的明显炎症，这可能使壁变得脆弱并导致中心性支气管扩张。黏液栓中的真菌可能通过空气传播导致周围病变。因此，我们得出结论，ABPA/M是一种感染性疾病，且ABPA/M的主要病变是黏液栓的形成。因此，含有真菌和许多嗜酸性粒细胞的黏液栓的存在可诊断ABPA/M。
