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Interstitial Vascularity in Fibrosing Alveolitis

Departments of Pathology and Thoracic Medicine, Interstitial Lung Disease Unit, Royal Brompton Hospital; National Heart and Lung Institute, Imperial College of Science, Technology, and Medicine; Department of Histochemistry, Royal Postgraduate Medical School, Hammersmith Hospital; Division of Academic Rheumatology, Royal Free Hospital, London; Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, United Kingdom; and Division of Respiratory Diseases, University of Siena, Siena, Italy

Correspondence and requests for reprints should be addressed to Dr. Elisabetta A. Renzoni, Interstitial Lung Disease Unit, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College of Science Technology and Medicine, Emmanuel Kaye Building, 1B Manresa Road, London SW3 6LR, UK. E-mail: e.renzoni{at}ic.ac.uk

The aim of this study was to evaluate interstitial vascularity in cryptogenic fibrosing alveolitis (CFA) and in fibrosing alveolitis associated with systemic sclerosis (FASSc). Open lung biopsies from eight patients with CFA, nine patients with FASSc, and normal lung from 12 patients undergoing surgery for lung cancer were studied. Markers for endothelial cells (CD34) and cell proliferation (proliferating cell nuclear antigen) were localized by sequential immunohistochemistry and quantified using computer-assisted analysis. Vascular distribution was evaluated at increasing distances (up to 160 µm) from the airspaces. Vessel density was markedly reduced in both FASSc (3.9%) and in CFA (4.5%) compared with control samples (20.4%, p < 0.0001). The percentage of tissue occupied by vessels decreased with increasing distance from alveoli in control samples but not in CFA or FASSc samples. Endothelial cell proliferation indices were increased in FASSc but not in CFA, compared with control samples (p = 0.006). In conclusion, there is net vascular ablation and redistribution of blood vessels in areas of interstitial thickening in both CFA and FASSc, which may contribute to gas exchange impairment.

Key Words: pulmonary fibrosis • scleroderma • pathologic neovascularization • endothelial proliferation

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