title: Two forms of diffuse alveolar damage in the lungs of patients with acute respiratory distress syndrome.
abstract: Acute respiratory distress syndrome is a severe disease, the treatment and pathophysiology of which are not completely established. The pathology of acute respiratory distress syndrome involves diffuse alveolar damage, which comprises severe alveolar epithelial cell damage, hyaline membrane formation, and festinate myofibroblast proliferation and fibrosis in the intra-alveolar spaces. We performed a clinicopathologic investigation of 26 autopsy cases of diffuse alveolar damage. Three cases of them were diagnosed as acute interstitial pneumonia that is idiopathic illness and resembles pathologically organizing diffuse alveolar damage. Immunohistochemical staining for types I and IV collagen, alpha-smooth muscle actin, and Ki-67 was carried out, and the sites of myofibroblast proliferation and type I collagen production were examined. All diffuse alveolar damage cases in the proliferative phase showed intra-alveolar myofibroblast proliferation. When diffuse alveolar damage was diagnosed pathologically as being due to severe infection, all 7 patients showed multiple organ dysfunction syndrome, whereas only 2 of 7 patients showed interstitial myofibroblast proliferation. When diffuse alveolar damage was attributed to tumor treatment with chemotherapy or to drug toxicity, 3 of 16 patients showed multiple organ dysfunction syndrome; 15 of 16 showed interstitial myofibroblast proliferation, 3 of 3 acute interstitial pneumonia patients did not show multiple organ dysfunction syndrome; and 3 of 3 acute interstitial pneumonia showed marked interstitial myofibroblast proliferation. These results suggest that the pathophysiologic mechanism of diffuse alveolar damage caused by severe infection is one of systemic circulation disturbance, although the mechanism underlying diffuse alveolar damage due to tumor with chemotherapy or drug toxicity appears to involve interstitial pneumonia-like lesions that are similar to acute interstitial pneumonia.
authors: Department of Analytic Human Pathology, Nippon Medical School, Graduate School of Medicine, Tokyo 113-8602, Japan.
authors: Dedong
authors: D
authors: Kang
authors: Tomoko
authors: T
authors: Nakayama
authors: Mayuko
authors: M
authors: Togashi
authors: Masuki
authors: M
authors: Yamamoto
authors: Mikiko
authors: M
authors: Takahashi
authors: Shinobu
authors: S
authors: Kunugi
authors: Masamichi
authors: M
authors: Ishizaki
authors: Yuh
authors: Y
authors: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007239:Infections / Q000150:complications; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000209:etiology* / Q000473:pathology*; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents