Impact of vascular abnormalities in neoplastic and non-neoplastic lung disease

Vascular abnormalities of the pulmonary circulation in the setting of destructive lung diseases caused by inflammation or neoplasia has been scantily researched. A need was felt to document the spectrum of pathological alterations in the vasculature and thus permit speculation into both their pathogenesis and possible clinical significance.

Between January 1999 and June 2001, 21 patients (male:female 3:4) who had chest disease exceeding a duration of six months and later underwent lobectomy were included in the study. The histopathological material was analysed for vascular changes such as arterial intimal fibrosis, muscularisation of intima and pericapillary fibrosis. The study included a detailed morphometric analysis.

The lesions included 15 non-neoplastic diseases and six neoplastic diseases. The striking vasculopathic changes observed in the absence of pulmonary hypertension were pulmonary artery medial hypertropy (100%), intimal fibrosis (62%) and muscularisation of the neo-intima (3%). Pericapillary fibrosis was seen in 83% of the neoplastic lesions and 67% of the non-neoplastic lesions.

This study highlights the impact of chronic lung disease on pulmonary vasculature. The role that neoplastic and non-neoplastic lung disease have to play in the evolution of the documented vascular changes have been postulated, and the need to design effective therapeutic strategies to modulate hypoxia, reverse the inflammatory process and stabilise the fibroblastic process is also highlighted.