Breakdown of lung framework and an increase in pores of Kohn as initial events of emphysema and a cause of reduction in diffusing capacity.
OBJECTIVE
Pulmonary emphysema is the pathological prototype of chronic obstructive pulmonary disease and is also associated with other lung diseases. We considered that observation with different approaches may provide new insights for the pathogenesis of emphysema.


METHODS
We reviewed tissue blocks of the lungs of 25 cases with/without emphysema and applied a three-dimensional observation method to the blocks. Based on the three-dimensional characteristics of the alveolar structure, we considered one face of the alveolar polyhedron as a structural unit of alveoli and called it a framework unit (FU). We categorized FUs based on their morphological characteristics and counted their number to evaluate the destructive changes in alveoli. We also evaluated the number and the area of pores of Kohn in FUs. We performed linear regression analysis to estimate the effect of these data on pulmonary function tests.


RESULTS
In multivariable regression analysis, a decrease in the number of FUs without an alveolar wall led to a significant decrease in the diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO per unit alveolar volume, and an increase in the area of pores of Kohn had a significant effect on an increase in residual capacity.


CONCLUSIONS
A breakdown in the lung framework and an increase in pores of Kohn are associated with a decrease in DLCO and DLCO per unit alveolar volume with/without emphysema.
Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Department of Pathology.
Akira
A
Yoshikawa
Clinical Research Center, Nagasaki University Hospital, Nagasaki; Division of Biostatistics, Kurume University School of Medicine, Fukuoka.
Shuntaro
S
Sato
Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Department of Pathology.
Tomonori
T
Tanaka
Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Department of Pathology; Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka.
Mikiko
M
Hashisako
Department of Pathology, Hyogo Prefectural Awaji Medical Center, Sumoto; Department of Pathology.
Yukio
Y
Kashima
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Tomoshi
T
Tsuchiya
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Naoya
N
Yamasaki
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Takeshi
T
Nagayasu
Clinical Research Center, Nagasaki University Hospital, Nagasaki.
Hiroshi
H
Yamamoto
Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Department of Pathology; Department of Pathology.
Junya
J
Fukuoka
D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D015999:Multivariate Analysis; D016062:Porosity; D011650:Pulmonary Alveoli / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology* / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D012129:Respiratory Function Tests; D014797:Vital Capacity
COPD; lung; pathogenesis; pathology; pulmonary function
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