Pathological Analysis of the Cavitary Wall in Mycobacterium Avium Intracellulare Complex Pulmonary Infection
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概要
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Objective The present study was designed to evaluate the process of cavity formation in Mycobacterium avium intracellulare complex (MAC) lung infection, pathologically and clinically. Methods Using resected lung specimens, we first evaluated the distribution of MAC as well as the distribution of myofibroblasts in MAC lung infection according to several pathological findings classified as bronchiectasis, centrilobular nodules, cavity, nodules, bronchiolitis, or consolidation. Resected lung specimens (9 cases) were evaluated by special staining: Ziehl-Neelsens method and immunohistochemically for CD68 (stain for monocytes and macrophages) and α-smooth muscle actin (stain for myofibroblasts). Chest CT findings were also examined in these 9 patients. In addition, the serial chest CT scans were reviewed in another 3 patients to evaluate the process of cavity formation, radiologically. Results Although extensive granuloma formations were observed in every pathological classification, MAC was demonstrated only in the necrotic tissue of the inner surface of the cavitary wall, which was connected to the airway. Myofibroblasts which expressed α-smooth muscle actin were intensely demonstrated in the cavitary wall compared with other pathological classifications. In the cavitary wall, the layer of epithelioid cells and multinucleated giant cells surrounded necrosis, and the layer of myofibroblasts surrounded the layer of epithelioid cells. Chest CT findings demonstrated that the cavitary walls were relatively thick. The evaluation of serial chest CT scans demonstrated that cavities were formed from previously existing nodules. Conclusions Detection of mycobacteria in the cavitary wall, massive infiltration of myofibroblasts compared with other pathological classifications, and connection to the drainage bronchus, were believed to be important in the process of cavity formation in MAC pulmonary infection.(Internal Medicine 41: 617-621, 2002)
- 社団法人 日本内科学会の論文
- 2002-08-01
著者
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MATSUSHIMA Toshiharu
Kawasaki Medical School
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Matsushima T
Junpukai Kurashiki Daiichi Hospital
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Matsushima Toshiharu
昭和大学 医学部臨床感染症学
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Ishida T
First Department Of Internal Medicine Kagawa Medical University
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Ishii Tomoya
香川医科大学 1内
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Yamadori Ichiro
琉球大学 医学部第一内科
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Yamadori I
National Okayama Medical Center
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FUJITA Jiro
First Department of Internal Medicine, Kagawa Medical University
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ISHIDA Toshihiko
First Department of Internal Medicine, Kagawa Medical University
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Okada Yuhei
Division Of Pathology Matsuyama-shimin Hospital
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OHTSUKI Yuji
Kochi Medical Shcool
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SHIGETO Eriko
National Hiroshima Hospital
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SUEMITSU Ichizo
Okayama University Medical School
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YAMADORI Ichiro
Okayama University Medical School
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SHIODE Masahiro
Uwajima Municipal Hospital
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NISHIMURA Kazutaka
National Ehime Hospital
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HIRAYAMA Takeshi
National Ehime Hospital
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YAMADORI Ichiro
National Okayama Medical Center
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SHIODE Masahiko
Uwajima Municipal Hospital
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Fujita Jiro
First Department Of Internal Medicine Kagawa Medical University
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Ishii Tomoya
First Department Of Internal Medicine Kagawa Medical University
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Ishida Toshihiko
First Department Of Internal Medicine Division Of Endocrinology And Metabolism Hematology Rheumatolo
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Hirayama Takeshi
National Cancer Center Research Institute
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Fujita Jiro
Department Of Medicine And Therapeutics Control And Prevention Of Infectious Diseases Faculty Of Med
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Fujita Jiro
松山市民病院 臨床病理検査室
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Ohtsuki Y
Division Of Pathology Matsuyama-shimin Hospital
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Matsushima Toshiharu
The Division Of Respiratory Diseases Department Of Medicine Kawasaki Medical School
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Fujita Jiro
Department Of Medicine And Therapeutics Control And Prevention Of Infectious Diseases Faculty Of Med
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Yamadori Ichiro
Department Of Clinical Pathology Okayama Medical Center
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OHTSUKI Yuji
Kochi Medical School
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