Sections of the lung from a patient with Wegener's granulomatosis who presents clinically with hemoptysis are most likely to show
The pulmonary hemorrhagic syndromes are characterized by hemorrhage within the alveoli, which may be severe enough to produce hemoptysis. Several of these diseases are associated with blood vessel abnormalities, namely inflammation of the vessels (angiitis). Necrotizing granulomatous aeritis affecting the upper and lower respiratory tracts and the kidneys is seen in patients with Wegener's granulomatosis. These areas of necrosis are characteristically large and serpiginous, and exhibit peripheral palisading of macrophages. In patients with Wegener's granulomatosis, the nose, sinus, antrum, and trachea often exhibit ulcerations. Originally the disease was lethal, but the prognosis is now much improved by immunosuppressive drugs. Eosinophilic granulomatous aeritis occurs in some patients with asthma who have eosinophilic pulmonary infiltrates; this abnormality is called Churg-Strauss syndrome. The areas of necrosis are not large and serpiginous as in Wegener's. Granulomatous inflammation centered around bronchi (bronchocentric granulomatosis) is often related to allergic pulmonary aspergillosis. Lymphomatoid granulomatosis is a disease of middleaged people that is characterized by an angiocentric and angioinvasive infiltrate of atypical lymphoid cells. Goodpasture's syndrome is characterized by the development of a necrotizing hemorrhagic interstitial pneumonitis and rapidly progressing glomerulonephritis because of antibodies directed against the capillary basement membrane in alveolar septa and glomeruli. A linear IgG immunofluorescence pattern is present, which is characteristic of a type II hypersensitivity reaction. The prognosis for Goodpasture's syndrome has been markedly improved by intensive plasma exchange to remove circulating anti-basement membrane antibodies and by immunosuppressive therapy to inhibit fuher antibody production Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.
Large, serpiginous necrosis with peripheral, palisading macrophages
Atypical lymphocytes invading blood vessels
Granulomatous inflammation of blood vessels with numerous eosinophils
Granulomatous inflammation of bronchi with Aspergillus
miscellaneous