Lipoid pneumonia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]
Overview
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Pathophysiology
Exogenous lipoid pneumonia
- It is understood that exogenus lipoid pneumonia is the result of chronic body reaction to fatty substance in the alveoli[1].
- Lipid reaches alveoli by aspiration or inhalation.
- Some mineral oils can cause lung injuries such as gasoline[2].
- Mineral oils can enter the tracheobronchial tree without causing cough reflex which will bother mucociliary transport system chronically.
- Injected lipids mechanism of further producing lipid pneumonia is more complicated:
- It is suggested that the lung is the first capillary bed encountered during circulation, bearing the majority of damage.
- as the lipid goes inside the alveoli, it is trapped and hard to expectorate, this condition may be worsen by associated neurological and gastrointestinal disorders affecting swallowing or cough.
- Lipids in alveoli form emulsion and then consumed by macrophages via phagocytosis.
- Since the alveolar macrophages cannot metabolize consumed fatty substance, oil is repeatedly released into alveoli after death of these macrophages.
- The oil released, illicits a giant-cell granulomatosis reaction.
- In fresh lesions, lipid-laden macrophages are seen.
- In advanced lesions larger vacuoles and inflamatory infiltrates are seen in alveolar and bronchial walls and septa.
- In oldest lesions fibrosis and parenchymal destruction around large lipid-containing vacuoles is seen.
- Staining can help demonestrating whether vacuoles are filled with lipid or not:
- Oil red O
- Sudan black
Endogenous lipoid pneumonia
- The pathogenesis of endogenous lipoid pneumonia is still not well understood however there are plenty of suggested mechanisms:[3][4][5].
- Most proven mechanisms are :
- Retained epithelial secretion
- Cell breakdown
- Leakage from vessels
- Prolonged hypoxia
- Local oxygen and carbon dioxide tension.
- Endogenous lipoid pneumonia can be caused by transbronchial dissemination of cancer cell breakdown products[6].
- Poorly differentiated adenocarcinoma cells secreting mucin is the most common neoplastic reason.
- Another mechanism suggested is anoxic tissue injury stimulating various enzymes such as phospholipase and mono-oxygenases[7][8][9].
- These enzymes activation in turn cause modification of LDL cholesterol, enhancing lipid uptake by alveolar macrophages similar to atherogenesis.
- Most proven mechanisms are :
- Infection changes to endogenous lipid pneumonia is generally localized in airways because the souronding lung is already consolidated, limiting the spread of bacteria[10].
Genetics
There is no genetic predisposition reported with lipoid pneumonia.
Associated Conditions
- Vaping is associated with exogenous lipid pneumonia.[7][4]
- Fire eating is associated with exogenous lipid pneumonia.
- Using oily laxative is associated with exogenous lipid pneumonia.
- Pulmonary adenocarcinoma is associated with endogenous lipid pneumonia.
- Long lasting pulmonary granulomatosis diseases is associated with endogenous lipid pneumonia.
Gross Pathology
Microscopic Pathology
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
References
- ↑ Guerguerian, Anne-Marie; Lacroix, Jacques (2000). "Pulmonary injury after intravenous hydrocarbon injection". Paediatrics & Child Health. 5 (8): 471–472. doi:10.1093/pch/5.8.471. ISSN 1205-7088.
- ↑ Domej, Wolfgang; Mitterhammer, Heike; Stauber, Rudolf; Kaufmann, Peter; Smolle, Karl Heinz (2007). "Successful outcome after intravenous gasoline injection". Journal of Medical Toxicology. 3 (4): 173–177. doi:10.1007/BF03160935. ISSN 1556-9039.
- ↑ Burke, M; Fraser, R (1988). "Obstructive pneumonitis: a pathologic and pathogenetic reappraisal". Radiology. 166 (3): 699–704. doi:10.1148/radiology.166.3.3340764. ISSN 0033-8419.
- ↑ 4.0 4.1 "www.thoracic.org" (PDF).
- ↑ Cohen, Allen B.; Cline, Martin J. (1972). "In VitroStudies of the Foamy Macrophage of Postobstructive Endogenous Lipoid Pneumonia in Man1–3". American Review of Respiratory Disease. 106 (1): 69–78. doi:10.1164/arrd.1972.106.1.69. ISSN 0003-0805.
- ↑ Tamura, A.; Hebisawa, A.; Fukushima, K.; Yotsumoto, H.; Mori, M. (1998). "Lipoid Pneumonia in Lung Cancer: Radiographic and Pathological Features". Japanese Journal of Clinical Oncology. 28 (8): 492–496. doi:10.1093/jjco/28.8.492. ISSN 0368-2811.
- ↑ 7.0 7.1 Taki, Takao; Nakazima, Tomoko; Emi, Yohko; Konishi, Yohichi; Hayashi, Akira; Matsumoto, Makoto (1986). "Accumulation of surfactant phospholipids in lipid pneumonia induced with methylnaphthalene". Lipids. 21 (9): 548–552. doi:10.1007/BF02534050. ISSN 0024-4201.
- ↑ Evans AJ, Sawyez CG, Wolfe BM, Connelly PW, Maguire GF, Huff MW (1993). "Evidence that cholesteryl ester and triglyceride accumulation in J774 macrophages induced by very low density lipoprotein subfractions occurs by different mechanisms". J Lipid Res. 34 (5): 703–17. PMID 8509711.
- ↑ Tölle, Angelika; Kolleck, Ingrid; Schlame, Michael; Wauer, Roland; Stevens, Paul A.; Rüstow, Bernd (1997). "Effect of hyperoxia on the composition of the alveolar surfactant and the turnover of surfactant phospholipids, cholesterol, plasmalogens and vitamin E". Biochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism. 1346 (2): 198–204. doi:10.1016/S0005-2760(97)00036-2. ISSN 0005-2760.
- ↑ Burke, M; Fraser, R (1988). "Obstructive pneumonitis: a pathologic and pathogenetic reappraisal". Radiology. 166 (3): 699–704. doi:10.1148/radiology.166.3.3340764. ISSN 0033-8419.