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Clinical Investigations: Interstitial Lung DiseaseMast Cells in Bronchiolitis Obliterans Organizing Pneumonia: Mast Cell Hyperplasia and Evidence for Extracellular Release of Tryptase
Section snippets
Subjects
Light microscopic studies were made of transbronchial lung biopsy specimens and BAL from 11 patients with BOOP (5 men; mean age, 62.8±2.3 years; 4 smokers) without any personal or family history of allergic disease and 17 control subjects (Table 1).
Diagnosis was made on the following: (1) consistent clinical history and radiologic findings, as described;2 (2) typical histologic pattern of BOOP at transbronchial biopsy (the essential pathologic feature was the presence of buds of granulation
Clinical Features, Radiologic Findings, and Pulmonary Function Analyses
All patients were symptomatic at the beginning of the study. Likewise, they showed a characteristic restrictive pattern with a variable decrease of vital capacity (7 patients [64%] had SVC <80% of predicted) and diffusing capacity (8 patients [73%] had Dco/VA <80% of predicted). An obstructive defect (FEV1/FVC ratio <70%) was found in 27% (3/11) of patients with BOOP. Small airway obstruction (FEF25–75 <70%) was found in 82% (9/11) of patients. No differences were observed between smoker and
DISCUSSION
Several cytologic changes were found in BAL fluid from patients with BOOP: total cell numbers were higher, lymphocytes represented the predominant cell type, and mast cells and eosinophil percentages increased significantly. Tryptase levels were higher in BAL fluid from patients with BOOP and correlated positively with mast cell numbers and percentages. Mast cell numbers were increased showing degranulating aspects in transbronchial biopsy specimens from patients with BOOP. These changes, when
ACKNOWLEDGMENTS
We thank Iris Spanevello for expert technical assistance and Elizabeth de Young for the English-language version of this article.
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Partly supported by a grant from Ministero dell'Università e Ricerca Scientifica.