title: Late BCNU lung: a light and ultrastructural study on the delayed effect of BCNU on the lung parenchyma.
abstract: We describe eight patients who developed interstitial pulmonary fibrosis following BCNU (carmustine) therapy for cerebral tumours. The fibrosis presented 12-17 (mean 14) years after exposure to the drug. A distinctive pattern of pulmonary fibrosis with involvement of the apices and subpleural areas was seen in one patient dying of the disease. Light microscopy showed interstitial elastosis and intra-alveolar fibrosis which was often focal with an associated mild lymphoplasmacytic infiltrate, intra-alveolar oedema, macrophages, and some neutrophils. Ultrastructural studies showed electron lucency of type I pneumocytes, with breaks in the cytoplasmic membranes leaving a bare basement membrane. Degenerative change was also seen in endothelial cell cytoplasm along with lipofuscin deposition. While BCNU pulmonary fibrosis has been described up to 2 years after treatment, this complication so late after therapy, though rare, has important implications for the follow-up of patients receiving this drug.
authors.affiliation: Department of Pathology, Wythenshawe Hospital, Manchester, U.K.
authors.forename: P S
authors.initials: PS
authors.lastname: Hasleton
authors.forename: B R
authors.initials: BR
authors.lastname: O'Driscoll
authors.forename: P
authors.initials: P
authors.lastname: Lynch
authors.forename: A
authors.initials: A
authors.lastname: Webster
authors.forename: S J
authors.initials: SJ
authors.lastname: Kalra
authors.forename: H R
authors.initials: HR
authors.lastname: Gattamaneini
authors.forename: A A
authors.initials: AA
authors.lastname: Woodcock
authors.forename: L W
authors.initials: LW
authors.lastname: Poulter
mesh_terms: D001254:Astrocytoma / Q000188:drug therapy; D001706:Biopsy; D001932:Brain Neoplasms / Q000188:drug therapy; D002330:Carmustine / Q000009:adverse effects* / Q000627:therapeutic use; D004806:Ependymoma / Q000188:drug therapy; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000648:ultrastructure; D008527:Medulloblastoma / Q000188:drug therapy; D008854:Microscopy, Electron; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000473:pathology*; D013997:Time Factors
chemical_list: D002330:Carmustine