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Minute lesions of alveolar damage in lungs of patients with stable idiopathic pulmonary fibrosis
Author(s) -
Emura Iwao,
Usuda Hiroyuki,
Togashi Kenichi,
Satou Kazuhiro
Publication year - 2015
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.12631
Subject(s) - medicine , pathology , diffuse alveolar damage , lung , exacerbation , fibrosis , alveolar epithelium , pulmonary fibrosis , pulmonary alveolus , hypoxia (environmental) , alveolar wall , extravasation , respiratory disease , epithelium , chemistry , organic chemistry , acute respiratory distress , oxygen
Aims To investigate the mechanisms underlying the acute exacerbation of idiopathic pulmonary fibrosis, and in particular the role of minute lesions of alveolar damage. Methods and results We examined surgical lung biopsy samples from 38 patients with stable idiopathic pulmonary fibrosis, and evaluated the association between the foci and development of acute exacerbation. Mild extravasation, probably resulting from lung injury and intra‐alveolar oedema fluid, were observed in narrow areas of architecturally intact lung tissue. Minute lesions of alveolar damage were detected in these areas. Alveolar epithelial cells in these lesions were injured. Hypoxia‐inducible factor‐2α‐positive macrophages, tumour necrosis factor‐α‐positive macrophages and neutrophils had accumulated in alveolar spaces in and around these lesions. Cases were classified into patients without (17) and with (21) minute lesions of alveolar damage. Development to acute exacerbation (five cases) occurred only in patients with minute lesions of alveolar damage ( P = 0.03). Conclusions The formation of minute lesions of alveolar damage may be initiated by hypoxia, and such lesions play important roles in the development of acute exacerbation.