Airway Disease

The following two pictures were taken from another patient. The first two (A & B) show two aspects of the same lesion.

A

What is the rounded structure to the left of the airway?

B

 

Name the lesion shown in A & B.

Answer

 

This lesion (C) is from the patient presented here.

C

This elastic van Gieson-stained section shows a structure at the left surrounded by two elastic layers and a structure at the right with a remnant of a single elastic layer (arrow). Which structure is the airway and what is the diagnosis of the airway disease?

What clinical symptoms and signs may be associated with this lesion? Answers

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Answer: Constrictive, follicular bronchiolitis (follicular bronchiolitis): The rounded structure to the left of the airway represents an expansion of the bronchus-associated lymphoid tissue (BALT) that is present to some degree in most lungs. Several features of the lesion are apparent here [1].

A

 

1) lymphoepithelium (lymphocytes in epithelium adjacent to the lymphoid tissue)

2) dome area between the germinal center and the epithelium--composed of B cells with IgA

3) germinal center--composed of B cells with surface IgM

4) mantle zone--composed of B cells with IgA and T cells (CD4>CD8)

This inflammatory proliferation constricts the airway to some degree (in B more than in A) and predisposes to infection, suggested by the luminal exudate in A.

Constrictive, follicular bronchiolitis (follicular bronchiolitis): This bronchiole is markedly constricted by the surrounding lymphoid tissue, which is confined to the airway interstitium.

 

Reference

1. Sato A, Hayakawa H, Uchiyama H, Chida K. Cellular distribution of bronchus-associated lymphoid tissue in rheumatoid arthritis. Am J Respir Crit Care Med 1996; 154:1903-1907.

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Answer: Which structure is the airway and what is the diagnosis of the airway disease?

What clinical symptoms and signs may be associated with this lesion?

Constrictive, cicatricial bronchiolitis: Fibrous tissue obliterates the lumen of this bronchiole, which can be identified by its location next to an artery (left) and by the presence of residual airway elastic tissue (arrow). In this case there is no follicular lymphoid hyperplasia although there is a chronic inflammatory infiltrate between the bronchiole and the vessel. Note the marked narrowing of the artery by intimal fibrosis and inflammation.

Symptoms are similar in both types of bronchiolitis. There is gradual progression of cough and dyspnea over months to years with minimal sputum except during infections. Airflow limitation not relieved by bronchodilators is present. There may also be a restrictive abnormality. Plain radiographs may be normal. HRCT shows prominence of bronchioles (tree-in-bud pattern) and some dilation of bronchi. Expiratory HRCTs show mosaic attenuation due to patchy air trapping.

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Clinical summary Image 5

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