SURGICAL PATHOLOGY OF THE LUNG IN CHRONIC GRANULOMATOUS-DISEASE
SURGICAL PATHOLOGY OF THE LUNG IN CHRONIC GRANULOMATOUS-DISEASE
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DOI：
10.1093/ajcp/102.5.684
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发表时间：
1994-11-01
影响因子：
3.5
通讯作者：
TRAVIS, WD
中科院分区：
文献类型：
--
作者：
MOSKALUK, CA;POGREBNIAK, HW;TRAVIS, WD
本文报告20例慢性肉芽肿病（CGD）32例开胸肺标本的病理学特征。切除材料中存在的炎症模式各不相同，但每种情况下都存在肉芽肿成分。在78%的标本中，发现了一种独特的肉芽肿形式：一个由栅栏组织细胞包围的嗜酸性微脓肿。在四个标本中，嗜酸性粒细胞也被发现内的微囊泡。这一特征仅在真菌感染的病例中发现。18例（56%）标本经培养发现真菌，其中17例（94%）标本经组织病理学检查也发现真菌。9例（28%）常规细菌培养阳性，1例非典型分枝杆菌培养阳性。在任何病例中，这些微生物均未在组织切片的特殊染色中前瞻性识别。单纯真菌感染（41%）比单纯细菌感染（14%）更常见脓肿形成。与早期报道相反，具有巨细胞的良好肉芽肿不是真菌感染的特异性。在这个系列中，它们存在于57%的纯细菌感染病例中。一部分患者在手术前接受γ干扰素治疗或粒细胞输注。粒细胞输注与炎症的组织病理学无差异，但γ干扰素治疗与坏死性肉芽肿性炎症的减少有关。此外，在接受长期类固醇治疗的CGD患者中描述了一例重度巨细胞病毒肺炎。
The pathologic features in pulmonary specimens are reported from 32 open thoracotomies of 20 patients with chronic granulomatous disease (CGD). The pattern of inflammation present in the resected material varied, but a granulomatous component was present in each case. In 78% of the specimens, a distinctive form of granuloma was found: a neutrophilic microabscess surrounded by palisading histiocytes. In four specimens eosinophils were also found within the microabscesses. This feature was found exclusively in cases of fungal infection. Fungal organisms were found by culture in 18 specimens (56%) and in 17 of these specimens (94%), they also were seen by histopathology. In 9 cases (28%) routine bacterial cultures were positive, and in one case an atypical Mycobacterium was cultured. These organisms were not prospectively identified on special stains of histologic sections in any of the cases. Abscess formation was found more commonly in pure fungal infections (41%) than in pure bacterial infections (14%). In contrast to earlier reports, well-formed granulomas with giant cells were not specific for fungal infections. In this series, they were present in 57% of cases with pure bacterial infections. A subset of the patients received gamma interferon therapy or granulocyte transfusions before the surgical procedures. No differences in the histopathology of the inflammation were associated with granulocyte transfusions, but gamma interferon therapy,vas associated with a reduction in necrotizing granulomatous inflammation. Additionally, one case of severe cytomegalovirus pneumonitis is described in a CGD patient receiving chronic steroid therapy.