Respiratory Bronchiolitis-Associated Interstitial Lung Disease and Its Relationship to Desquamative Interstitial Pneumonia
Section snippets
MATERIAL AND METHODS
We identified 18 open-lung biopsy specimens that showed only respiratory bronchiolitis in patients with interstitial lung disease from our consultation files, the Charles B. Carrington Memorial Pulmonary Pathology Teaching Collection, and the files of the Thoracic Services of Boston University Medical Center. The histologic changes associated with respiratory bronchiolitis (described subsequently in this article) were thought to be the only histologic findings to explain the clinical
CLINICAL FINDINGS
The clinical features of the 18 patients with RB/ILD and the 36 patients with DIP are compared in Table 1. In both groups, the disease was chronic; symptoms persisted a mean of 2.2 years and 2.4 years in patients with RB/ILD and DIP, respectively. All patients with RB/ILD were cigarette smokers; only three patients with DIP had no smoking history.
Usually, abnormal chest roentgenographic findings (72% of those with RB/ILD and 89% of those with DIP) led to lung biopsy. In five patients with
HISTOPATHOLOGIC FINDINGS
RB/ILD is an inflammatory process that involves the membranous and respiratory bronchioles. The bronchioles show a mild mononuclear inflammatory infiltrate in the submucosa associated with fibrous scarring that extends into the surrounding alveolar walls in stellate fashion (Fig. 2). This change is often associated with anthracotic pigment within histiocytes entrapped in the peribronchiolar fibrous tissue. The airway epithelium shows foci of goblet cell metaplasia and metaplastic cuboidal
DISCUSSION
Cigarette smoking has traditionally been associated with chronic bronchitis and emphysema; occasionally, however, it may also be a cause of interstitial lung disease.2, 7, 8, 15 The main histologic finding in these cases is prominent respiratory bronchiolitis, a mild form of which is almost universally present in cigarette smokers but usually is an insignificant lesion.10 Our observations and those of Myers and associates2 have contributed to the data that indicate smoking is a possible cause
ACKNOWLEDGMENT
We thank Sandra McCoy and Mary Ann Mient for editorial and secretarial assistance.
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This study was supported in part by Research Career Award HL 1173 from the National Heart, Lung, and Blood Institute and the Pathology Education and Research Fund.