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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Centrilobular Fibrosis: An Underrecognized Pattern in Systemic Sclerosis

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Author(s):
de Souza, Romy B. C. [1] ; Borges, Claudia T. L. ; Capelozzi, Vera L. [2] ; Parra, Edwin R. [2] ; Jatene, Fabio B. [3] ; Kavakama, Jorge [4] ; Kairalla, Ronaldo A. [5] ; Bonfa, Eloisa
Total Authors: 8
Affiliation:
[1] Univ Sao Paulo, Fac Med, Div Rheumatol, BR-01246000 Sao Paulo - Brazil
[2] Univ Sao Paulo, Div Pathol, BR-01246000 Sao Paulo - Brazil
[3] Univ Sao Paulo, Div Thorac Surg, BR-01246000 Sao Paulo - Brazil
[4] Univ Sao Paulo, Div Radiol, BR-01246000 Sao Paulo - Brazil
[5] Univ Sao Paulo, Div Pneumol, BR-01246000 Sao Paulo - Brazil
Total Affiliations: 5
Document type: Journal article
Source: RESPIRATION; v. 77, n. 4, p. 389-397, 2009.
Web of Science Citations: 38
Abstract

Background: The impressive association of lung involvement and gastroesophageal reflux in scleroderma raises the possibility of a cause-effect relationship. Objectives: To determine clinical, radiological and histopathological features of systemic sclerosis (SSc) patients according the presence or absence of centrilobular fibrosis (CLF). Methods: Twenty-eight SSc patients with lung involvement were submitted to open lung biopsy and the specimens classified for the presence of CLF (bronchocentric distribution of the lesions and intraluminal matter according to the classification of idiopathic interstitial pneumonia). HRCT, pulmonary function tests and esophageal analysis were also performed. Subsequently, cyclophosphamide was introduced for the nonspecific interstitial pneumonia subgroup and antireflux treatment was intensified for isolated CLF patients. Results: Isolated CLF was found in 21% of the biopsies and also found associated to nonspecific interstitial pneumonia in 84% of these patients. The other 3 cases had usual interstitial pneumonia, pulmonary hypertension and respiratory bronchiolitis-associated interstitial lung disease. The histopathological analysis revealed that all 6 patients with isolated CLF had the bronchocentric distribution and intraluminal basophilic content, with foreign bodies detected in one third of them. The central distribution of lung involvement on HRCT was found in 67% of these patients with a consistent patchy distribution (100%). Ground glass (67%) and consolidation (33%) were the predominant patterns found. The constant clinical finding in all isolated CLF cases was dyspnea, esophageal abnormalities and a moderate lung impairment (FVC: 63.83 +/- 16.31%; DLCO: 61.66 +/- 18.84%). Lung function parameters in isolated CLF patients remained stable after 1 year of exclusively intensive antireflux treatment (FVC, p = 0.23; DLCO, p = 0.59). Conclusions: The novel description of CLF pattern in SSc lung disease with peculiar histological, tomographic and clinical features will certainly contribute to a more appropriate therapeutic approach. Copyright (C) 2008 S. Karger AG, Basel (AU)