Cryptogenic organizing pneumonia pathophysiology: Difference between revisions
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===Pathogenesis=== | ===Pathogenesis=== | ||
Various steps in the pathogenesis of cryptogenic organizing pneumonia are: | Various steps in the pathogenesis of [[cryptogenic organizing pneumonia]] are: | ||
1) '''Injury phase''' - The early phase of cryptogenic organizing pneumonia. | 1) '''Injury phase''' - The early phase of [[cryptogenic organizing pneumonia]]. | ||
*It is characterized by the deposition of plasma proteins in the alveolar lumen. | *It is characterized by the deposition of [[plasma proteins]] in the [[alveolar]] lumen. | ||
*Mechanism of early phase is an imbalance between coagulation and fibrinolytic cascade and activation of coagulation process which leads to fibrin deposition.<ref name="pmid16880372">{{cite journal |vauthors=Cordier JF |title=Cryptogenic organising pneumonia |journal=Eur. Respir. J. |volume=28 |issue=2 |pages=422–46 |date=August 2006 |pmid=16880372 |doi=10.1183/09031936.06.00013505 |url=}}</ref> | *Mechanism of early phase is an imbalance between [[coagulation]] and [[fibrinolytic]] cascade and activation of [[coagulation]] process which leads to [[fibrin]] deposition.<ref name="pmid16880372">{{cite journal |vauthors=Cordier JF |title=Cryptogenic organising pneumonia |journal=Eur. Respir. J. |volume=28 |issue=2 |pages=422–46 |date=August 2006 |pmid=16880372 |doi=10.1183/09031936.06.00013505 |url=}}</ref> | ||
2) '''Proliferating phase''' - The second stage of the cryptogenic organizing pneumonia in which there is a formation of | 2) '''Proliferating phase''' - The second stage of the [[cryptogenic organizing pneumonia]] in which there is a formation of fibro-[[inflammatory]] buds. | ||
* Macrophages and inflammatory cells help in fragmentation of fibrin. | * [[Macrophages]] and [[inflammatory cells]] help in fragmentation of [[fibrin]]. | ||
* Activated fibroblasts differentiate into myofibroblasts which are migrating through gaps of the basal lamina. | * Activated [[fibroblasts]] differentiate into [[myofibroblasts]] which are migrating through gaps of the [[basal lamina]]. | ||
* Inflammatory cells and fibrin are progressively replaced by aggregated fibroblasts/myofibroblasts intermixed with a loose connective matrix tissue rich in collagen (especially collagen I), fibronectin, procollagen type III and proteoglycans. | * [[Inflammatory cells]] and [[fibrin]] are progressively replaced by aggregated [[fibroblasts]]/[[myofibroblasts]] intermixed with a [[Loose connective tissue|loose connective]] matrix tissue rich in [[collagen]] (especially collagen I), [[fibronectin]], [[procollagen]] type III and [[proteoglycans]]. | ||
* Alveolar epithelial cells proliferate, restoring the continuity of the alveolar-capillary membrane and the integrity of the alveolar unit. | * [[Alveolar]] [[epithelial cells]] proliferate, restoring the continuity of the [[Alveolar-capillary barrier|alveolar-capillary]] membrane and the integrity of the [[alveolar]] unit. | ||
3) '''Mature phase''' - The third stage is characterized by the formation of “mature” fibrotic buds. | 3) '''Mature phase''' - The third stage is characterized by the formation of “mature” fibrotic buds. | ||
*In alveolar buds, there are myofibroblasts, organized in concentric rings alternating with layers of collagen bundles. | *In [[alveolar]] buds, there are [[myofibroblasts]], organized in [[concentric]] rings alternating with layers of [[collagen]] bundles. | ||
4)'''Resolution phase''' - The fourth stage, this stage usually resolves if there is the preservation of alveolar basal laminae. | 4)'''Resolution phase''' - The fourth stage, this stage usually resolves if there is the preservation of [[alveolar]] basal laminae. | ||
==Associated Conditions== | ==Associated Conditions== | ||
| Line 31: | Line 31: | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
On microscopic histopathological analysis:<ref name="urlCryptogenic organising pneumonia | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/cryptogenic-organising-pneumonia-1 |title=Cryptogenic organising pneumonia | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref> | On microscopic histopathological analysis:<ref name="urlCryptogenic organising pneumonia | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/cryptogenic-organising-pneumonia-1 |title=Cryptogenic organising pneumonia | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref> | ||
*It is characterized by chronic mild interstitial inflammation without fibrosis. | *It is characterized by chronic mild interstitial [[inflammation]] without [[fibrosis]]. | ||
*There is the formation of buds of granulation tissue which is made of fibrous tissue (Masson bodies), mononuclear cells and foamy macrophages, in the distal airspaces which cause secondary bronchiolar occlusion due to the presence of the inflammatory process. | *There is the formation of buds of [[granulation tissue]] which is made of [[fibrous tissue]] (Masson bodies), [[mononuclear cells]] and foamy [[macrophages]], in the distal airspaces which cause [[secondary]] bronchiolar [[occlusion]] due to the presence of the [[inflammatory process]]. | ||
[[File:Masson body - high mag.jpg|200px|thumb|centre | [[File:Masson body - high mag.jpg|200px|thumb|centre| source:]] | ||
==References== | ==References== | ||
Revision as of 15:49, 6 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2] Serge Korjian M.D.
Overview
Pathophysiology
Pathogenesis
Various steps in the pathogenesis of cryptogenic organizing pneumonia are:
1) Injury phase - The early phase of cryptogenic organizing pneumonia.
- It is characterized by the deposition of plasma proteins in the alveolar lumen.
- Mechanism of early phase is an imbalance between coagulation and fibrinolytic cascade and activation of coagulation process which leads to fibrin deposition.[1]
2) Proliferating phase - The second stage of the cryptogenic organizing pneumonia in which there is a formation of fibro-inflammatory buds.
- Macrophages and inflammatory cells help in fragmentation of fibrin.
- Activated fibroblasts differentiate into myofibroblasts which are migrating through gaps of the basal lamina.
- Inflammatory cells and fibrin are progressively replaced by aggregated fibroblasts/myofibroblasts intermixed with a loose connective matrix tissue rich in collagen (especially collagen I), fibronectin, procollagen type III and proteoglycans.
- Alveolar epithelial cells proliferate, restoring the continuity of the alveolar-capillary membrane and the integrity of the alveolar unit.
3) Mature phase - The third stage is characterized by the formation of “mature” fibrotic buds.
- In alveolar buds, there are myofibroblasts, organized in concentric rings alternating with layers of collagen bundles.
4)Resolution phase - The fourth stage, this stage usually resolves if there is the preservation of alveolar basal laminae.
Associated Conditions
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
On microscopic histopathological analysis:[2]
- It is characterized by chronic mild interstitial inflammation without fibrosis.
- There is the formation of buds of granulation tissue which is made of fibrous tissue (Masson bodies), mononuclear cells and foamy macrophages, in the distal airspaces which cause secondary bronchiolar occlusion due to the presence of the inflammatory process.
References
- ↑ Cordier JF (August 2006). "Cryptogenic organising pneumonia". Eur. Respir. J. 28 (2): 422–46. doi:10.1183/09031936.06.00013505. PMID 16880372.
- ↑ "Cryptogenic organising pneumonia | Radiology Reference Article | Radiopaedia.org".