Surfactant apoprotein in nonmalignant pulmonary disorders

Formalin-fixed, paraffin-embedded lungs exhibiting a variety of nonmalignant disorders were studied by immunoperoxidase staining using antibodies specific for surfactant apoprotein, IgG, IgM, IgA, albumin, fibrinogen, and lysozyme. Normal Type II pneumocytes showed staining for surfactant apoprotein in the perinuclear region only. The extent and intensity of staining for apoprotein was markedly increased in reactive Type II pneumocytes. This increase appeared to be a nonspecific reaction to lung injury. The intra-alveolar material in pulmonary alveolar proteinosis stained intensely for surfactant apoprotein, indicating that the accumulated proteinaceous material contained pulmonary surfactant. Type II pneumocytes in pulmonary alveolar proteinosis exhibited hyperplasia as well as hypertrophy. The few macrophages in lung affected by pulmonary alveolar proteinosis stained intensely for lysozyme. The excessive intraalveolar accumulation of proteinaceous material in pulmonary alveolar proteinosis may be the result of both an over-production as well as a deficient removal of pulmonary surfactant.