Clinicopathological study of diffuse panbronchiolitis--with special reference to relationship between the clinical duration and respiratory bronchiolar lesions

Abstract

Fifteen autopsy cases of diffuse panbronchiolitis, with clinical disease duration ranging from 2 months to 56 years since appearance of cough and sputum, were analyzed by reconstruction study using serial sections, with particular regard to the respiratory bronchiolar lesions and clinical duration. In addition, proximal bronchi and bronchioles were examined focusing on dilatation, round cell infiltration and goblet cell metaplasia, and peribronchiolar emphysematous lesions were graded according to the degree of alveolar destruction. Morphological changes of the respiratory bronchioles were classified into five types. Active lesions, with lymphoplasmocytic and xanthoma cell infiltration were classified into three types according to the presence and the size of intraluminal granulation tissue. Scar lesions showing marked fibrohyalinous change were classified into two types, those with and without respiratory bronchiolar stenosis. Active lesions decreased and scar lesions increased with clinical duration. Respiratory bronchiolar lesions were distributed almost equally from the upper lobe to the lower lobe. In these fifteen autopsy cases, the total number of respiratory bronchiolar lesions did not vary with disease duration. Emphysematous lesions increased with clinical duration, and showed a relationship to the presence of scar lesions with stenosis. Bronchiolar dilatation was prominent in cases with a long clinical course. Segmental and subsegmental bronchial dilatation were recognized mainly in the middle, lingula and lower lobes, but there was no relationship between clinical duration and bronchiolar dilatation.