Infiltration Of Lung Parenchyma Research Articles

The radiological spectrum of pulmonary lymphoproliferative disease

Pulmonary lymphoproliferative disorders (LPD) are characterised by abnormal proliferation of indigenous cell lines or infiltration of lung parenchyma by lymphoid cells. They encompass a wide spectrum of focal or diffuse abnormalities, which may be classified as reactive or neoplastic on the basis of cellular morphology and clonality. The spectrum of reactive disorders results primarily from antigenic stimulation of bronchial mucosa-associated lymphoid tissue (MALT) and comprises three main entities: follicular bronchiolitis, lymphoid interstitial pneumonia and (more rarely) nodular lymphoid hyperplasia. Primary parenchymal neoplasms are most commonly extranodal marginal zone lymphomas of MALT origin (MALT lymphomas), followed by diffuse large B-cell lymphomas (DLBCLs) and lymphomatoid granulomatosis (LYG). Secondary lymphomatous parenchymal neoplasms (both Hodgkin and non-Hodgkin lymphomas) are far more prevalent than primary neoplasms. Acquired immune deficiency syndrome (AIDS)-related lymphoma (ARL) and post-transplantation lymphoproliferative disorder (PTLD) may also primarily affect the lung parenchyma. Modern advances in treatments for AIDS and transplant medicine are associated with an increase in the incidence of LPD and have heightened the need to understand the range of imaging appearance of these diseases. The multidetector CT (MDCT) findings of LPD are heterogeneous, thereby reflecting the wide spectrum of clinical manifestations of these entities. Understanding the spectrum of LPD and the various imaging manifestations is crucial because the radiologist is often the first one to suggest the diagnosis and has a pivotal role in differentiating these diseases. The current concepts of LPD are discussed together with a demonstration of the breadth of MDCT patterns within this disease spectrum.

Functional variant ANXA11 R230C: true marker of protection and candidate disease modifier in sarcoidosis

In the recent genome-wide association study the polymorphisms of annexin A11 (ANXA11) gene were associated with susceptibility to sarcoidosis. Beside the replication of this finding and analysis of local ANXA11 expression in bronchoalveolar lavage cells, we wondered whether 'leading' ANXA11 rs1049550 (R230C) variant might also be related to the clinical manifestation of sarcoidosis. The study included 245 Czech patients with sarcoidosis and 254 healthy control subjects. The frequency of ANXA11(*)T allele was significantly lower in patients with sarcoidosis (35%) compared with controls (42%, P=0.04, odds ratio=0.77). Furthermore, ANXA11(*)T allele was less frequent in patients with the infiltration of lung parenchyma by comparison with those with isolated hilar lymphadenopathy (P=0.01). In line with the previous observation, ANXA11 mRNA expression was not deregulated in sarcoidosis and was independent from rs1049550 variant. In conclusion, ANXA11 rs1049550 single nucleotide polymorphism is the susceptibility marker in sarcoidosis, at least in Caucasians. Its role as a disease modifier should be independently replicated.

Large chest wall hydatid cyst — An unusual presentation

A large chest wall hydatid cyst extending into the thoracic cavity and causing atelectasis of part of right lung is reported. Presenting symptoms were chest pain and swelling chest wall. Computed tomographic Scan led to diagnosis of chest wall hydatid cyst extending into the thorax. On thoracotomy, cyst was found to originate from chest wall with extension into the thoracic cavity without infiltration of lung parenchyma and with collapse of underlying lobe of the lung. Multiple cysts were enucleated along with resection of part of rib. Post-operative recovery was uneventful.

Cathepsin-k expression in pulmonary lymphangioleiomyomatosis

Lymphangioleiomyomatosis is a rare and progressive lung cystic disease, caused by the infiltration of lung parenchyma by mesenchymal cells characterized by co-expression of contractile proteins and melanocytic markers. The pathogenesis of lymphangioleiomyomatosis is determined by mutations affecting tuberous sclerosis complex (TSC) genes, with eventual deregulation of the Rheb/mTOR/p70S6K pathway, and the potential therapeutic activity of mTOR inhibitors is currently under investigation. To better understand the molecular mechanisms involved in the pathogenesis of lymphangioleiomyomatosis, we investigated the expression of cathepsin-k (a papain-like cysteine protease with high matrix-degrading activity). The rationale of this choice was based on the recent demonstration that mTOR inhibitors can regulate major functional activities of osteoclasts, including the expression of cathepsin-k. The immunohistochemical study included 12 cases of lymphangioleiomyomatosis. Twelve angiomyolipomas and several lung diseases (sarcoidosis, organizing pneumonia, usual interstitial pneumonia, emphysema) were investigated as controls. In all lymphangioleiomyomatosis cases, strong cathepsin-k immunoreactivity was demonstrated, restricted to lymphangioleiomyomatosis cells. Similar expression levels were observed in renal angiomyolipomas. These observations extend the knowledge regarding the immunophenotypic profile of lymphangioleiomyomatosis cells, and provide a useful new marker for diagnosis in difficult cases (eg, in small transbronchial biopsies). The strong expression of such a potent papain-like cysteine protease in lymphangioleiomyomatosis cells can significantly contribute to the progressive remodelling of lung parenchyma observed in this deadly disease, with eventual formation of lung cysts. It is possible to speculate that mTOR inhibitors may exert part of their action by limiting the destructive remodelling of lung structure.

Expression of cyclooxygenase-2 in swine naturally infected with Actinobacillus pleuropneumoniae.

Cyclooxygenase-2 (COX-2) was detected and localized in 15 pigs with naturally occurring pleuropneumonia using a 437-base pair digoxigenin-labeled cDNA probe in an in situ hybridization protocol. Histopathologic changes in the acute stage were characterized by coagulative necrosis of lung parenchyma, hemorrhage, vascular thrombosis, edema, fibrin deposition, and infiltration of lung parenchyma by neutrophils and alveolar macrophages in nine pigs. In chronic lesions, a thick layer of granulation tissue surrounded foci of pulmonary necrosis in six pigs. All 15 pigs infected with Actinobacillus pleuropneumoniae, confirmed by bacterial isolation, had distinct positive hybridization signals for COX-2 in bronchial, bronchiolar epithelial cells, alveolar macrophages, neutrophils, and type I pneumocytes. COX-2 expression was detected primarily in neutrophils from pigs with acute lesions and primarily in alveolar macrophages from pigs with chronic lesions. The results suggest that a prostanoid product of COX-2 is an important component of the inflammatory response to acute and chronic A. pleuropneumoniae infection.

Expression of Cyclooxygenase-2 in Swine Naturally Infected with Actinobacillus pleuropneumoniae

Cyclooxygenase-2 (COX-2) was detected and localized in 15 pigs with naturally occurring pleuropneumonia using a 437–base pair digoxigenin-labeled cDNA probe in an in situ hybridization protocol. Histopathologic changes in the acute stage were characterized by coagulative necrosis of lung parenchyma, hemorrhage, vascular thrombosis, edema, fibrin deposition, and infiltration of lung parenchyma by neutrophils and alveolar macrophages in nine pigs. In chronic lesions, a thick layer of granulation tissue surrounded foci of pulmonary necrosis in six pigs. All 15 pigs infected with Actinobacillus pleuropneumoniae, confirmed by bacterial isolation, had distinct positive hybridization signals for COX-2 in bronchial, bronchiolar epithelial cells, alveolar macrophages, neutrophils, and type I pneumocytes. COX-2 expression was detected primarily in neutrophils from pigs with acute lesions and primarily in alveolar macrophages from pigs with chronic lesions. The results suggest that a prostanoid product of COX-2 is an important component of the inflammatory response to acute and chronic A. pleuropneumoniae infection.

Effects of a new antiallergic drug, VUF-K-8788, on infiltration of lung parenchyma by eosinophils in guinea pigs and eosinophil-adhesion to human umbilical vein endothelial cells (HUVEC).

Airway inflammation and reversible airway obstruction are hallmarks of bronchial asthma. In this study, we investigated the effects of a new antiallergic drug, 7-[3-[4-(2-quinolinylmethyl)-1-piperazinyl]-propoxy]-2,3-dihydro-4H-1,4-benzothiazin-3-one (VUF-K-8788), on histopathological changes in lung parenchyma of guinea pigs during late-phase asthmatic reaction (LAR), and on eosinophil-adhesion to human umbilical vein endothelial cells (HUVEC). Repeated exposure to ovalbumin of sensitized guinea pigs induced inflammatory phenomena such as hyperplasia of airway epithelial cells, perivascular edema and infiltration of lung parenchyma by eosinophils. VUF-K-8788 inhibited these histopathological phenomena at 10 mg/kg p.o. Moreover, the eosinophil-adherence to HUVEC was inhibited by VUF-K-8788 at the concentration of 10-30 microM. In conclusion, this inhibitory effect of VUF-K-8788 on eosinophil-adherence might contribute to the prevention of LAR and infiltration by eosinophils in the experimental asthmatic model in guinea pigs.

The Role of Chemotherapy in Polymorphonuclear Phagocytosis in Pneumonia

The efficacy of the host defense system is a determining factor for the outcome of antimicrobial events in infected patients. The neutrophil granulocyte plays a key role in the lung’s defense against bacterial invasion and in the absence of a sufficient attraction of functionally intact neutrophils in the lung, following bacterial challenge, severe pulmonary infection may result. The involvement of phagocytes in pneumonia is well known: infiltration of lung parenchyma by neutrophils occurs within a short time in response to infection and is followed by an influx of monocytes.We investigated the effects of antimicrobial therapy in pneumonia on polymorphonuclear neutrophil (PMN) phagocytosis.

Pneumothorax in patients with acquired immunodeficiency syndrome

Case histories of 25 consecutive patients with acquired immunodeficiency syndrome in whom pneumothorax developed from January 1985 to the present are reviewed. Spontaneous pneumothorax developed in 10 patients. All patients had a documented pulmonary infection. Four of 10 died, either of progressive respiratory failure or of concurrent infection. Patients with asymptomatic spontaneous pneumothorax can be safely observed. Patients with symptomatic pneumothorax should initially undergo tube thoracostomy. If an air leak persists, thoracotomy, stapling of blebs, and pleurodesis can be safely performed. Because of the prevalence of bilateral disease, a median sternotomy incision is recommended. Two patients underwent surgical treatment. Diffuse bullous disease associated with infiltration of lung parenchyma by Pneumocystis carinii pneumonia was identified in both. Both patients survived and were discharged. Patients whose pneumothorax developed while they were undergoing mechanical ventilation for respiratory failure induced by Pneumocystis carinii pneumonia had a 92.3% mortality rate. In all patients surviving for longer than 7 days after development of the initial pneumothorax, a contralateral pneumothorax later developed. Severe concurrent disease made the patients poor operative candidates. However, in the absence of concurrent illness, if a persistent large air leak is believed to contribute significantly to respiratory failure, surgical intervention may be indicated.

Retrosternal Infiltration in Malignant Lymphoma

It is generally agreed that there are no uniformly pathognomonic roentgenologic signs of intrathoracic lymphomas, and that many different types of change may be encountered (9). Previously, investigators (5, 9) have classified the changes generally encountered into six groups: (1) mediastinal tumor; (2) hilar lymphonodular masses; (3) diffuse infiltration of lung parenchyma; (4) isolated nodules in the parenchyma; (5) pleural infiltration; (6) pleural effusion. In our cases of the intrathoracic lymphoma group, we have occasionally observed a retrosternal infiltration, occurring alone or in conjunction with one or several of the usually noted localizations of lymphoma, but not previously described as such. It has been found with and without associated sternal involvement and pre-sternal edema, and in all types of cases classified under the broad heading of malignant lymphoma. Pathology Lymphoid tissue involvement is the common denominator of the lymphoma group and, as Wolpaw et al. (10) have stated, “…the ...