Immunohistochemical characterisation of pulmonary hyaline membrane in various types of interstitial pneumonia

Sun, Aping; Ohtsuki, Yuji; Fujita, Jiro; Ishida, Toshihiko; Yoshinouchi, Takeo; Kohno, Nobuoki

doi:10.1080/0031302031000082205

Cited by 11 publications

(20 citation statements)

References 14 publications

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“…2 Initial forms of HMs were mostly stained with EMA, SP-A, cytokeratins, and factor VIII antigens as those of membranous HMs. 1 However, as for KL-6, 5 of 15 cases examined were partially definitely negative only in malignant diseases, as shown in Table 3, although these cases included positive ones. Clinicopathologically, there were no definite differences in the clinical course among these negative cases (Tables 1 and 3), although all of the cases examined were autopsied cases.…”

Section: Discussionmentioning

confidence: 93%

“…1,2 It appeared that HMs were originally composed of materials located on the surface of alveolar epithelial cells and their derivatives such as surfactant proteins, the epithelial membrane antigen KL-6, the cytokeratin antigen CK19, and the serum-derived factor of factor VIII-related antigen. 1,2 Detailed immunomorphological and electron microscopy studies of HMs were performed to study the close relationship of HM formation with alveolar mouths (AMs) in interstitial pneumonias, including various kinds of diffuse alveolar damage (DAD), as conducted in this study. A detailed immunohistochemical study of the early stages of HM formation, strictly related to and located at AMs, has not yet been reported.…”

Section: Introductionmentioning

confidence: 99%

“…1 Recently, DAD was categorized into 2 groups: primary (infection) and secondary (chemotherapy or druginduced). 8 In the present study, we employed an immunohistochemical methodology to focus on the initial stages of HM formation in DAD lungs, including primary and/or secondary HMs, to investigate the early morphogenesis of HM formation.…”

Section: Introductionmentioning

confidence: 99%

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Early Stages of Hyaline Membrane Formation Detected in Alveolar Mouths in Diffuse Alveolar-Damage-Associated Diseases

et al. 2015

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To study the early stages of hyaline membrane (HM) formation, diffuse alveolar damage (DAD) was thoroughly investigated using immunohistochemical methods in 15 autopsy cases, which consisted of various types of interstitial pneumonias and pulmonary diseases derived from nonmalignant or malignant diseases. Alveolar mouths (AMs) that were presumed to be normal were ultrastructurally examined in detail, by using pulmonary tissues in the pneumothorax. It is interesting to note that during the initial stages of HM formation in AMs, fragmented eosinophilic masses were closely attached to AMs as irregular fragments or by a cap-like structure. The ultrastructure revealed some distance between the capillary spaces and surface epithelium of the AMs, indicating that the epithelial cells at the AMs might be often easily damaged even by minor stimuli; they can be considered as "locus minoris resistentiae." HMs were found to be formed initially at the site of AMs derived from fragmented eosinophilic masses in not only pulmonary but also extrapulmonary diseases, including both nonmalignant and malignant diseases. These irregular eosinophilic masses, representing the early shape of HMs, were immunohistochemically positive for the epithelial membrane antigens, namely, surfactant protein A and factor VIII antigen, and occasionally for KL-6 and cytokeratins. These results suggested that fragmented irregular masses represent the initial phase of HM formation. Five of 15 cases were focally negative for KL-6 at the initial irregular mass of HMs. Because KL-6 is one of the fundamental components of pulmonary surface elements, it needs to be studied further by detailed clinicopathological examination.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Early Stages of Hyaline Membrane Formation Detected in Alveolar Mouths in Diffuse Alveolar-Damage-Associated Diseases

et al. 2015

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“…Sun et al (29) reported that KL-6 expression is essential for the maturation of alveolar pneumocytes and that KL-6 expression proceeds linearly in alveolar pneumocytes from 23 weeks gestation. The findings from the present study suggest that the division and proliferation of type II pneumocytes, although frequently observed following epithelial cell damage caused by viral infection, fails to yield functionally mature cells that produce KL-6.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Findings of Four Cases of Pure Influenza Virus A Pneumonia

Fujita

Ohtsuki

Higa³

et al. 2014

Intern. Med.

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Objective The purpose of this study was to perform clinicopathological evaluations of patients with pure influenza A virus pneumonia. Methods We performed clinicopathological analyses of four cases of pure influenza A virus pneumonia. Patients Among the four cases, three were caused by the pandemic (H1N1) 2009 virus. Three patients were analyzed during autopsy, and one underwent transbronchial lung biopsy. Results We suggest that the interval between influenza virus A pneumonia onset and our analysis affected the pathological findings. Diffuse alveolar damage was observed during the acute phase. After ten days, organizing pneumonia and marked proliferation of premature type II alveolar epithelium were observed. Clinically, intra-alveolar hemorrhage was observed in two patients. Pathologically, hyaline membrane formation and intra-alveolar hemorrhage were observed in all cases. Conclusion Severe epithelial damage was determined as the main mechanism of respiratory failure caused by influenza A virus pneumonia.

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“…11 In order to validate the importance of HM and explore the quantitative relationship between this factor and parenchymal changes in diffuse alveolar damage, as well as to characterize the immunostaining features of HM, we studied HM in lungs of patients with different manifestations of DAD [pulmonary and extrapulmonary (ARDS) and idiopathic acute interstitial pneumonia (AIP)].…”

Section: Introductionmentioning

confidence: 99%

Nonhomogeneous Immunostaining of Hyaline Membranes in Different Manifestations of Diffuse Alveolar Damage

Serra

Parra

Eher

et al. 2006

Clinics

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Peres e Serra A, Parra ER, Eher E, Capelozzi VL. Nonhomogeneous Immunostaining of hyaline membranes in different manifestations of diffuse alveolar damage. CLINICS. 2006;61(6):497-502. PURPOSE:To determine the nature of hyaline membranes in different manifestations of diffuse alveolar damage, [pulmonary and extrapulmonary acute respiratory distress syndrome], and idiopathic [acute interstitial pneumonia]. MATERIALS AND METHODS: Pulmonary specimens were obtained from 17 patients with acute respiratory distress syndrome and 9 patients with acute interstitial pneumonia. They were separated into 3 different groups: (a) pulmonary diffuse alveolar damage (pDAD) (n = 8), consisting only of pneumonia cases; (b) extrapulmonary diffuse alveolar damage (expDAI) (n = 9), consisting of sepsis and septic shock cases; and (c) idiopathic diffuse alveolar damage (iDAD) (n = 9), consisting of idiopathic cases (acute interstitial pneumonia). Hyaline membranes, the hallmark of the diffuse alveolar damage histological pattern, were examined using various kinds of antibodies. The antibodies used were against surfactant apoprotein-A (SP-A), cytokeratin 7 (CK7), cytokeratin 8 (CK8), alpha smooth muscle actin (α-SMA), cytokeratin AE1/AE3 (AE1/AE3), and factor VIII-related antigen (factor VIII). RESULTS: Pulmonary diffuse alveolar damage showed the largest quantity of hyaline membranes (12.65% ± 3.24%), while extrapulmonary diffuse alveolar damage (9.52% ± 3.64%) and idiopathic diffuse alveolar damage (7.34% ± 2.11%) showed intermediate and lower amounts, respectively, with the difference being statistically significant between pulmonary and idiopathic diffuse alveolar damage (P < 0.05). No significant difference was found for hyaline membranes Sp-A immunostaining among pulmonary (15.36% ± 3.12%), extrapulmonary (16.12% ± 4.58%), and idiopathic (13.74 ± 4.20%) diffuse alveolar damage groups. Regarding factor VIII, we found that idiopathic diffuse alveolar damage presented larger amounts of immunostained hyaline membranes (14.12% ± 6.25%) than extrapulmonary diffuse alveolar damage (3.93% ± 2.86%), with this difference being statistically significant (P < 0.001). Equally significant was the difference for progressive decrease of cytokeratin AE1/AE3 immunostaining in hyaline membranes present in the extrapulmonary diffuse alveolar damage (5.42% ± 2.80%) and idiopathic diffuse alveolar damage (0.47% ± 0.81%) groups (P < 0.001). None of the groups stained for cytokeratin CK-7, CK-8, vimentin, or α anti-smooth muscle actin. CONCLUSIONS: This study showed that only the epithelial/endothelial components (SP-A, factor VIII, and AE1/AE3) of the alveolar/capillary barrier are present in hyaline membranes formation in the 3 groups of patients with diffuse alveolar damage. The significant difference in the expression of factor VIII-related antigen and cytokeratin AE1/AE3 in the expDA versus iDAD groups as well as the significant difference in the amount of hyaline membranes present in the pDAD versus iDAD groups are suggestive of a local and specifi...

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Immunohistochemical characterisation of pulmonary hyaline membrane in various types of interstitial pneumonia

Cited by 11 publications

References 14 publications

Early Stages of Hyaline Membrane Formation Detected in Alveolar Mouths in Diffuse Alveolar-Damage-Associated Diseases

Early Stages of Hyaline Membrane Formation Detected in Alveolar Mouths in Diffuse Alveolar-Damage-Associated Diseases

Clinicopathological Findings of Four Cases of Pure Influenza Virus A Pneumonia

Nonhomogeneous Immunostaining of Hyaline Membranes in Different Manifestations of Diffuse Alveolar Damage

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