Abstract:
:Pulmonary alveolar proteinosis (PAP) is a rare condition in which pulmonary macrophages fail to clear surfactant, resulting in the alveolar accumulation of lipoproteinaceous debris. The histopathology of PAP is typified by diffuse filling of terminal airways with eosinophilic, PAS/diastase (PAS/D)-positive acellular material. We present five patients who showed histopathological changes in the lungs consistent with mild PAP. However, these cases were notable for the abundance of degenerating alveolar macrophages, weak PAS staining of lipoproteinaceous material and paucity of lamellated bodies on ultrastructural examination. Only one patient showed the CT finding of mosaiform 'crazy-paving' and the opalescent bronchoalveolar lavage fluid characteristic of PAP. In one case, therapeutic lung lavage based on a presumptive diagnosis of PAP exacerbated respiratory distress. Three patients showed partial or near-complete resolution of disease in response to high-dose corticosteroid therapy, a treatment approach that is generally ineffective in PAP. We conclude that distinguishing 'variant alveolar lipoproteinosis' from classical PAP is clinically important. Despite the otherwise typical appearance of lipoproteinaceous alveolar material in lung biopsies, the presence of degenerating foamy macrophages and atypical histochemical, ultrastructural and radiographic features suggest a steroid-responsive form of proteinosis that is likely pathogenetically distinct and may not be amenable to whole-lung lavage.
journal_name
Pathol Intjournal_title
Pathology internationalauthors
Nishino M,Medoff BD,Mark EJ,Matsubara O,O'Donnell WJ,Currier PF,Kradin RLdoi
10.1111/j.1440-1827.2011.02710.xsubject
Has Abstractpub_date
2011-09-01 00:00:00pages
509-17issue
9eissn
1320-5463issn
1440-1827journal_volume
61pub_type
杂志文章abstract::The findings of a 20 year old woman with lymphadenopathy that was probably caused by an acute human herpesvirus-6 (HHV-6) infection are reported. She clinically demonstrated various signs of acute infection such as a high fever, skin rash, liver dysfunction, leukocytosis, an elevation of the erythrocyte sedimentation ...
journal_title:Pathology international
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journal_title:Pathology international
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journal_title:Pathology international
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