肺サルコイドーシス肉芽腫に見られる壊死の成因について
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概要
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Many papers have been published on the pathology of the pulmonary sarcoid granulom. In spite of that a few are concerned only about the pulmonary arterial changes, not about the venous changes.<BR>In 1967-1968 we have reported the pulmonary venous sarcoid granulornogi.<BR>In generally the necrosis in the tuberculous lesion is common, b ut rarely in sarcoidosis.<BR>Its report of Prof. Dr. Oka and Dr. Iwai that there are patho-histelogical difference between the necrosis in these two diseases, i. e. characteristic localisation of necrosis and attitude of arginophilic fibers in them.<BR>But there is no paper about the pathogenesis of necrosis.<BR>New findings of the pathogenesis of necrosis of pulmonary sarcoid granulom are reported in this paper.<BR>Case: Mr. T. S.31 years old, male, the desk. B. H. L., soft nodular lesions in both upper lobe and left lower lobe (S<SUB>6</SUB>) (Fig.1, 2) Tuberculin reaction Kveim test negative, scalen node biopsy, “reticulosis”, culture of tubercle bacilli, fungus and other bacteria negative.<BR>Details of clinical observation are reported in another paper.<BR>It is postulated the following conclusions by the patho h istological findings of the biopsy materials of pulmonary sarcoidosis.<BR>(1) Some vascular granulom of lung project in the lumen of pulmonary vein. (see Fig.3∼6) and some others press the vessel wall from outside. (see Fig.5, 6) Thereby the resu lts are the stenosis of the vessel (see Fig.3∼6) and furthermore may occurs stasis of blood flow, so-called “sludged blood”.<BR>(2) Sarcoid g ranulom of the pulmonary vessel wall slowly injure and destroy the elastic fibers and collagen fibers (see Fig.3-10) and some time occurs degeneration, desquamation of endothelium. (see Fig.5, 8)<BR>(3) Injuries of the endothelium means the loss of heparin.<BR>(4) Above mentioned three factors, i. e. the stasis of blood flow, injuries of the endothelium and loss of heparin may be the most important factors of thrombus formation.<BR>(5) It is postulated that the necrosis of the pulmonary sarcoid granulom is ishemic necrosis caused by coagulation thrombosis. (see Fig.11, 13-16).
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