title: An international collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients.
abstract: BACKGROUND
  Recent studies have shown strong evidence that bronchiolitis obliterans is the major long-term sequelae of exposure to sulfur mustard (SM). This study is the first to examine the histopathologic spectrum of changes in a large number of surgical lung biopsies from patients exposed to SM.
  
  
  METHODS
  Fifteen patients with chronic respiratory disease from mustard gas exposure were divided into severe (6 cases) and mild exposure (9 cases). All had surgical (open or thoracoscopic) lung biopsy, pulmonary function tests (PFTs) and chest high-resolution computed tomography scan (HRCT).
  
  
  RESULTS
  The mean age of the cases was 43.8+/-9.6 (range 33-65). All patients had dyspnea and cough as the two main complaints. Only one patient was a smoker. Thirteen patients had normal PFTs, while one had obstruction and one had mild restriction. Six (66.6%) patients in the mild exposure and 3 (50%) in the severe exposure group showed evidence of more than 25% air trapping on chest HRCT. Among the mild group, 3 had features of constrictive bronchiolitis and another had features suggestive of this (bronchiolectasis and mucus stasis). The next most common finding was a mild-to-moderate chronic cellular bronchiolitis (3 patients). Two among the 6 in the severe group showed constrictive bronchiolitis and one showed features suggestive of constrictive bronchiolitis.
  
  
  CONCLUSIONS
  We conclude that about half of patients had diagnostic constrictive bronchiolitis, or bronchiolectasis and mucus stasis consistent with more proximal luminal compromise. The fact that there were no differences between the low- and high-dose groups suggests that effects of SM are not solely dependent on the severity of exposure. The results also indicate that the diagnosis of chronic lung disease due to SM may be difficult. Surgical lung biopsy may be helpful in difficult cases, as constrictive (obliterative) bronchiolitis can be present in symptomatic patients with normal PFTs and chest HRCT.
authors.affiliation: Research Center of Chemical Injuries, Baqiyatallah Medical Science University, Mollasadra Street, PO Box 19945-546, Tehran, Iran. mghanei@excite.com <mghanei@excite.com>
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ghanei
authors.forename: Henry D
authors.initials: HD
authors.lastname: Tazelaar
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.forename: Ali Amini
authors.initials: AA
authors.lastname: Harandi
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Peyman
authors.forename: Hassan Mohammad Hosseini
authors.initials: HM
authors.lastname: Akbari
authors.forename: Hassan
authors.initials: H
authors.lastname: Shamsaei
authors.forename: Moslem
authors.initials: M
authors.lastname: Bahadori
authors.forename: Jafar
authors.initials: J
authors.lastname: Aslani
authors.forename: Azam
authors.initials: A
authors.lastname: Mohammadi
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D002619:Chemical Warfare Agents / Q000633:toxicity*; D002908:Chronic Disease; D018450:Disease Progression; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007391:International Cooperation; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009151:Mustard Gas / Q000633:toxicity*; D012140:Respiratory Tract Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity / Q000187:drug effects; D014857:Warfare
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas