普通型间质性肺炎的形态学表现和病理诊断

Histologic features and pathologic diagnosis in usual interstitial pneumonia

目的 探讨普通型间质性肺炎(UIP)的病理形态特点,以及开胸肺活组织检查的意义和适应证。方法 对5例UIP(尸解1例和肺活检4例)的HE及组织化学染色的病理形态、以及临床、影像学和预后的资料进行分析。结果 其病理表现有肺泡间质炎、成纤维细胞灶、间质纤维化和蜂窝肺,并伴细支气管上皮化生和Ⅱ型细胞增生,以及灶性肺泡内巨细胞聚集。上述改变为不均匀的分布。结论 UIP的病理特点为低倍镜下的形态不一致性,并且为新老病变共存。对于影像表现不典型和能耐受开胸手术的患者,开胸肺活组织检查的病理诊断是必要的。但UIP的病理诊断过程要密切结合临床和影像学的检查。

Objective To study the pathologic features, differential diagnosis and role of open lung biopsies ( OLB ) in usual interstitial pneumonia (UIP). Method The authors reviewed the pathologic, clinical and radiologic features of five cases of UIP (one autopsy case and four OLB cases) , with follow-up information. Results The typical histologic features were a non-uniform distribution of alveolar inflammation, fibroblastic foci, interstitial fibrosis and honeycomb changes. There also was associated metaplasia of bronchiolar epithelium, type H pneumocyte hyperplasia and accumulation of alveolar macrophages. Conclusions Characteristically, UIP exhibits temporal heterogeneity under low-power light microscopy, which includes changes in both the early and end stages. Open lung biopsy is an important diagnostic adjunct for suitable patients with atypical radiologic features on computerized tomography. Correlation between clinical, radiologic and pathologic findings is also essential for a correct diagnosis.