Zusammenfassung
Zwei als diffuse interstitielle Pneumonie (D.I.P.) diagnostizierte Lungenbiopsien wurden elektronenmikroskopisch untersucht zwecks Bestimmung der die Alveolarwand bekleidenden und der frei im Alveolarraum liegenden Zellen. Die Alveolarwände waren vorwiegend mit granulären Pneumocyten besetzt. Diese waren nach Diastaseein wirkung PAS-negativ. Die frei im Alveolarraum liegenden Zellen waren hauptsächlich Diastase-resistente, PAS-positive phagocytäre Pneumocyten, untermischt mit abgelösten granulären Pneumocyten. Manchmal waren die phagocytären Pneumocyten durch verflochtene pseudopodienartige Fortsätze miteinander verbunden. Außer der zweifachen Zellreaktion (Hyperplasie und Ablösung von granulären Pneumocyten, Gruppen von phagocytären Pneumocyten in den Alveolarräumen), waren feinstrukturelle Veränderungen an den Capillaren nachweisbar sowie lymphocytäre, plasmacytäre und eosinophile Infiltrate im interstitiellen Gewebe der Alveolarwände. Die dadurch hervorgerufene Verbreiterung der Blut-Luftschranke scheint einer der für die in beiden Fällen nachgewiesene verringerte Lungendiffusionskapazität verantwortlichen Faktoren zu sein.
Summary
Two biopsies of lung diagnosed as D.I.P. were studied by electrom microscopy to ascertain the type of cells lining the alveoli and of those lying free in the alveolar spaces. The alveoli were lined predominantly by granular pneumocytes that were P.A.S.-negative after diastase digestion. In contrast, the free intraluminal cells were mostly phagocytic pneumocytes mixed with desquamated granular pneumocytes and were diastase resistant P.A.S.-positive. Sometimes the phagocytic pneumocytes were joined by intertwining pseudopodial-like processes. In addition to that dual cellular reaction (hyperplasia and desquamation of granular pneumocytes, with groups of phagocytic pneumocytes in the alveolar spaces), there were ultrastructural changes in capillaries and infiltrates of lymphocytes, plasma cells and eosinophils in the interstitial tissue of the alveolar wall. We believe that these alterations in the blood-air barrier are one of the factors responsible for the reduced pulmonary diffusing capacity recorded in the two cases presented.
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Supported by the Illinois Tuberculosis Association.
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Leroy, E.P. The blood-air barrier in desquamative interstitial pneumonia (D.I.P.). Virchows Arch. Abt. A Path. Anat. 348, 117–130 (1969). https://doi.org/10.1007/BF00544319
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DOI: https://doi.org/10.1007/BF00544319