Biopsy Findings in Acute Pulmonary Histoplasmosis Unusual Histologic Features in 4 Cases Mimicking Lymphomatoid Granulomatosis
Biopsy Findings in Acute Pulmonary Histoplasmosis Unusual Histologic Features in 4 Cases Mimicking Lymphomatoid Granulomatosis
复制标题
DOI：
10.1097/pas.0b013e3181d4388b
复制
发表时间：
2010-04-01
影响因子：
5.6
通讯作者：
Katzenstein, Anna-Luise A.
中科院分区：
文献类型：
--
作者：
Mukhopadhyay, Sanjay;Katzenstein, Anna-Luise A.
肺组织胞浆菌病的大多数例子，包括组织胞浆菌瘤和慢性组织胞浆菌病，以典型的坏死性肉芽肿性炎症为特征。只有播散性组织胞浆菌病被认为是引起不同的反应，包括巨噬细胞摄取生物体而不形成肉芽肿。急性肺组织胞浆菌病的组织学特征还没有很好的描述，因为这种形式的疾病很少活检。我们报告4例急性肺组织胞浆菌病的活检结果，这似乎是这种形式的组织胞浆菌感染所特有的。有3名男性和1名女性，年龄范围为40至68岁。所有人都出现发烧和其他流感样症状。影像学上，3例为孤立性结节性浸润，1例为双侧网状结节性浸润。组织学上，所有4例活检均显示由淋巴细胞和组织细胞组成的结节性实质炎性浸润，填充肺泡腔并扩张相邻的肺泡。3例病例还存在脑实质坏死区域。所有病例均出现由淋巴细胞和组织细胞组成的血管炎，其中3例明显，与1级淋巴瘤样肉芽肿（LYG）相似。正确诊断的提示是淋巴组织细胞浸润（3例）内散在的小坏死性肉芽肿、散在的组织细胞聚集体和少数多核巨细胞。Grocott乌洛托品银染色切片中存在组织胞浆菌酵母，证实了所有诊断。急性肺组织胞浆菌病可引起淋巴组织细胞浸润伴坏死和血管炎，提示LYG。这一观察结果强调了在诊断1级LYG之前检查生物体特殊染色的重要性。
Most examples of pulmonary histoplasmosis, including histoplasmoma and chronic histoplasmosis, are characterized by typical necrotizing granulomatous inflammation. Only disseminated histoplasmosis is recognized as causing a different reaction which consists of ingestion of organisms by macrophages without granuloma formation. The histologic features of acute pulmonary histoplasmosis are not well described as this form of the disease is rarely biopsied. We report the biopsy findings in 4 cases of acute pulmonary histoplasmosis, which seem to be unique to this form of Histoplasma infection. There were 3 men and 1 woman who ranged in age from 40 to 68 years. All presented acutely with fever and other flu-like symptoms. Radiographically, a solitary nodular infiltrate was present in 3 and bilateral reticulonodular infiltrates in one. Histologically, all 4 biopsies showed a nodular parenchymal inflammatory infiltrate composed of lymphocytes and histiocytes filling alveolar spaces and expanding the adjacent interstitium. Areas of parenchymal necrosis were additionally present in 3 cases. Vasculitis composed of lymphocytes and histiocytes was present in all, and was striking in 3, resulting in a resemblance to grade 1 lymphomatoid granulomatosis (LYG). Tip-offs to the correct diagnosis were small necrotizing granulomas scattered within the lymphohistiocytic infiltrate (3 cases), scattered histiocyte aggregates, and a few multinucleated giant cells. The diagnosis was confirmed in all by the presence of Histoplasma yeasts in Grocott methenamine silver-stained slides. Acute pulmonary histoplasmosis may cause a lymphohistiocytic infiltrate with necrosis and vasculitis that is suggestive of LYG. This observation emphasizes the importance of examining special stains for organisms before diagnosing grade 1 LYG.