Bronchocentric Granulomas in MAC Disease

Granulomatous inflammation of the airways in MAC disease causes bronchiolitis obliterans and bronchiectasis. Bronchocentric granulomas occur in a variety of diseases including allergic bronchopulmonary aspergillosis (ABPA), other fungal and mycobacterial diseases, echinococcosis, rheumatoid arthritis, and Wegener's granulomatosis. The term "bronchocentric granulomatosis" should be reserved for the histologic changes found in ABPA [1,2].

Figure 1. Bronchiolocentric Granuloma

Here, an airway (marked by the pulmonary artery and two small residual lumens) has been almost completely obliterated by granulomatous inflammation, represented by a few multinucleated giant cells, fibroblasts, and a lymphoid infiltrate. Note that the inflamed area (lumen, airway wall, and surrounding tissue) exceeds the size of the previous bronchiole (bronchiole and artery should be the same size).

giantairway1airway2

 

Find a multinucleated giant cell.

Find the two residual airway lumens.

Figure 2. Bronchiectasis

Here, the bronchocentric granulomatous inflammation shows central necrosis and cavitation. The wall of the cavity has collagenous scar and a heavy lymphoid infiltrate. Giant cells are absent. The lumen is larger than the accompanying artery indicating bronchiectasis. The artery shows eccentric intimal thickening. (Elastic van Gieson stain)

 

References

1. Myers J, Katzenstein A-L. Granulomatous infection mimicking bronchocentric granulomatosis. Am J Surg Pathol 1986; 10:317-322. Abstract

2. Myers J. Bronchocentric granulomatosis. Disease or diagnosis? Chest 989; 96:3-4.

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Multinucleated giant cell

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Residual airway

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