Morphogenesis and pathogenesis of chronic lung diseases. X. An anatomoclinical and pathogenetic study of 48...

Forty-eight cases of operated pseudotumoral chronic pneumonites were anatomoclinically and histogenetically studied. Two groups of cases can be established. The first one (21 cases), in which the histogenetic mechanism is related to previous bronchopulmonary infections, suppurations, and immune processes of the immediate type, is characterized by numerous granulocytic foci, granulomatous structure, Arthus type vasculites and fibrous evolution. The unefficient therapy could be one of the determining factors of this evolution, by maintenance of active germs and released antigens. The second group (27 cases) is characterized by hypertrophic bronchites reflecting the prolonged penetration of airborne antigens, by a step by step involvement of peribronchial and parenchymatous structures. A multiphasic development is comparatively demonstrated in the different cases, and dominated by various proportions of plasmocytes and fibroblasts interfering with a restorative granulomatous process involving the intra- and interlobular areas and evolving to a fibrogranulomatous state. Obstructive pneumonitic phenomena and reactive endoalveolitis obliterans interfere, too. Correlations between the dynamics of this picture and the experimental data assert an immune mechanism with repeated immediate and delayed hypersensitivity reactions and auto-aggressive phenomena, determined by released antigens and inductors of cell proliferation and differentiation, as the main processes conducing to the building up of the pseudotumoral chronic pneumonites.