Clinically occult interstitial fibrosis in smokers: classification and significance of a surprisingly common finding in lobectomy specimens
Clinically occult interstitial fibrosis in smokers: classification and significance of a surprisingly common finding in lobectomy specimens
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DOI：
10.1016/j.humpath.2009.09.003
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发表时间：
2010-03-01
期刊：
影响因子：
3.3
通讯作者：
Dexter, Elizabeth
中科院分区：
文献类型：
--
作者：
Katzenstein, Anna-Luise A.;Mukhopadhyay, Sanjay;Dexter, Elizabeth
这项研究报告了吸烟者中令人惊讶的频繁且通常严重的间质性纤维化的存在，而没有间质性肺病的临床证据。对23例因肿瘤切除的肺叶切除标本（包括20例吸烟者）进行了广泛采样，并半定量检查了间质纤维化、成纤维细胞灶、细支气管周围化生、蜂窝状改变、肺气肿和呼吸性细支气管炎。在20名吸烟者中有12名（60%）发现了超过25%的载玻片间质纤维化，但在3名从不吸烟者中没有发现。3例病例被归类为特定形式的间质性肺病，包括普通型间质性肺炎、朗格汉斯细胞组织细胞增多症和石棉肺各1例。其余9例病例不符合命名的间质性肺病，被认为是吸烟相关间质性纤维化的代表性病例。这种病变的特点是不同程度的肺泡间隔增宽的胶原沉积沿着与肺气肿和呼吸性细支气管炎。纤维化发生在胸膜下和更深的实质。它包围着肺气肿扩大的气腔，但也累及非肺气肿的实质。尽管随访时间较短，但在任何病例中均未记录到临床进展。这些观察结果突出了吸烟者肺叶切除标本中经常遇到的意外纤维化谱。需要进一步的研究来确定吸烟相关间质纤维化的临床意义及其与其他吸烟相关疾病的关系（如果有的话）。然而，重要的是，吸烟相关的间质性纤维化与可能与不良炎症相关的纤维化肺病的特定形式，特别是普通型间质性肺炎相区别。(C)2010年爱思唯尔公司All rights reserved.
This study reports the presence of surprisingly frequent and often severe interstitial fibrosis in cigarette smokers with no clinical evidence of interstitial lung disease. Twenty-three lobectomy specimens excised for neoplasms, including 20 from smokers, were extensively sampled, and examined semi-quantitatively for interstitial fibrosis, fibroblast foci, peribronchiolar metaplasia, honey-comb change, emphysema, and respiratory bronchiolitis. Interstitial fibrosis involving greater than 25% of slides was identified in 12 of 20 smokers (60%), but in none of the three never-smokers. Three cases were classified as specific forms of interstitial lung disease, including one each of usual interstitial pneumonia, Langerhans cell histiocytosis, and asbestosis. The remaining 9 cases did not fit with a named interstitial lung disease and were considered to represent examples of smoking-related interstitial fibrosis. This lesion was characterized by varying degrees of alveolar septal widening by collagen deposition along with emphysema and respiratory bronchiolitis. The fibrosis occurred both in subpleural and in deeper parenchyma. It surrounded enlarged airspaces of emphysema, but it also involved non-emphysematous parenchyma. Clinical progression was not documented in any case, although follow-up was short. These observations highlight the spectrum of unexpected fibrosis that is frequently encountered in lobectomy specimens from cigarette smokers. Additional investigation will be required to determine the clinical significance of smoking-related interstitial fibrosis and its relationship, if any, to other smoking-related diseases. It is important, however, that smoking-related interstitial fibrosis be distinguished from specific forms of fibrosing lung disease that may be associated with poor prognoses, especially usual interstitial pneumonia. (C) 2010 Elsevier Inc. All rights reserved.