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Korean J Parasitol > Volume 17(1):1979 > Article

Original Article
Korean J Parasitol. 1979 Jun;17(1):19-44. English.
Published online Mar 20, 1994.  http://dx.doi.org/10.3347/kjp.1979.17.1.19
Copyright © 1979 by The Korean Society for Parasitology
A histopathologic study of the lungs infected with Paragonimus westermani in the dog
Ok-Ran Lee
Department of Parasitology, Catholic Medical College & Catholic Institute of Parasitic Diseases, Korea.
Abstract

Pulmonary paragonimiasis is one of the most important endemic parasitic disease in Korea. Although it is well known that Paragonimus westermani invades into the lung tissue eventually resulting respiratory failure, the pathogenesis of inducing lung lesions is not fully elucidated. It is still debatable on the nature of morphological component of 'cyst' which is known to be the most consistent change in lung paragonimiasis.

For the purpose of clarification of morphological changes associated with pulmonary paragonimiasis, an experimental study was carried out by giving metacercariae of P. westermani to 10 dogs. These dogs were sacrificed 2 months and 6 months after infection respectively, and light microscopic and electron microscopic observations were made. Following conclusions were obtained.

1. Paragonimus lung lesions could basically be classified into two categories, i.e., direct mechanical effects by the worms and eggs, and the changes secondary to the worm infection. The relative importance of these two appeared almost same.

2. Adult worms of P. westermani reside inside the lumina of the dilated bronchi in great majority of the cases. Only exceptions were secondary abscess formation and subsequent scar where no epithelial lining was detected around the worms. In 6 months group almost all P. westermani worms were found inside the bronchial lumina.

3. Obliterative endobronchiolitis was another prominent feature among changes that were not directly associated with worms or eggs. This finding was more prominent in the distal segments of the bronchial trees that harbor the Paragonimus worms.

4. P. westermani eggs were found as isolated and aggregated fashions, provoking characteristic granulomatous inflammation. Some of the egg granulomas were seen in the areas apart from the locations where the worms were physically located.

5. Ultrastructural observations of the cyst wall showed fair numbers of plasma cells and mast cells. Some of the cystlining epithelial cells showed increased deposit of glycogen granules, suggestive of early metabolic alteration of the respiratory epithelium.

Figures


Fig. 1
Dog lung specimen (after fixation). Two months after infection. All three lobes are equally involved, showing multiple nodular excrescenes on the pleural surface.


Fig. 2
Dog lung specimen after cut section through the mainstem bronchus of the lung. At worm is seen in a bronchial lumen(center). At least three "cysts" containing impacted worms are seen, along with yellow gray specks scattered throughout the lung parenchyme.


Fig. 3
Low power photomicrograph of the lung shown in Fig 2. Sector A represents a portion of a dilated bronchus containing a pair of Paragonimus worm. Sector B represents adenomatous proliferation of bronchial mucosa and peribronchial inflammation.


Fig. 4
Low power picture of the lung in 2 months after infection. Widespread replacement of alveolar structure by various inflammatory exudate is seen. Two areas of worm-associated lesion(F) and granulomas associated with eggs (D) and areas of nonspecific inflammation with fibrosis (E) are shown.


Figs. 5-8
Fig. 5. & 7.Paragonimus worms are surrounded by acute inflammatory exudate and partly destroyed epithelial lining. Two month group.

Fig. 6. In the same "cyst" of Fig 7 there are areas of definite epithelial covering shown in the middle of the picture. ×40.

Fig. 8. Six month group. Lining epithelia of the "cyst" are proliferative and show squamous metaplasia. ×40.



Figs. 9-12
Fig. 9. Two month group. Amongst pools of neutrophils scattered eggs are seen near Paragonimus worm left. ×100.

Fig. 10. & 11. Six month group. Showing flattened squamous epithelium (Fig 10) and squamous cell nests (Fig 11) around the worms. Focal subepithelial fibrosis is also seen. ×100.

Fig. 12. Higher magnification of Fig 11 showing intercellular bridges among polygonal squamous cells. ×360.



Figs. 13-16
Fig. 13. Six month group. Around a vessel many eggs with surrounding fibrosis and cellular infiltration is seen. ×40.

Fig. 14. Two month group. Several eggs found in relatively less involved area. Some of the eggs are found free in the alveolar sac, without provoking any signficant reaction. ×100.

Fig. 15. Six month group. Higher magnification of eggs and surrounding cell reaction. Many histiocytes and epithelioid cells surrounding degenerated eggs.

Fig. 16. Dense collections of Paragonimus eggs, found near the tract around the dilated bronchus containing worm. Two month group.



Figs. 17-20
Fig. 17. A bronchiole showing Iuminal obliteration by epithelial overgrowth and inflammatory exudate. Peribronchiolar inflammation is also prominent. Two month group. ×40.

Fig. 18. Two month group. Proliferating epithelial cells show abundant clear cytoplasm. Many plasma cells are seen at the bottom. ×360.

Fig. 19. Two month group. Bronchiolitis is seen together with a marked peribronchiolitis. Heavy inflammatory cell is transmural. ×100.

Fig. 20. Two month group. Characteristic obliterative endovronchiolitis, showing luminal obliteration by proliferative epithelial cells having vesicular nuclei and abundant clear cytoplasm. These cells are mixed with inflammatory cells mimicking proliferated histiocytes. ×360.



Figs. 21-24
Fig. 21. Two month group. A larger bronchial lumen is partly obliterated by proliferating mucosal folds ×100.

Fig. 22. Two month group. A small bronchioles with remnant of smooth muscle wall, showing inflammation, luminal obliteration and egg granulomas around. ×100.

Fig. 23. Two month group. Adenomatous hyperplasia shown often in the bronchi located adjacent to the worm-harboring "Cyst". ×360.

Fig. 24. Two month group. Exudative pleuritis and subpleural inflammation are shown. ×100.



Figs. 25-28
Fig. 25. Two month group. Dense fibrosis with poor demarcation is seen. This lesion is probably made by migrating worm. Also note a portion of tract seen on the top. ×40.

Fig. 26. Two month group. A focus of subpleural fibrous scar. ×100.

Fig. 27. Six month group. Mesothelial proliferation and stratification are seen above the egg granulomas. ×360.

Fig. 28. Six month group. An area showing vascular thickening. This changes was very focal and rare. ×100.



Fig. 29
Two month group. Electron micrograph of "cyst", dilated bronchial wall. Upper aspect faces the lumen. Epithelial nature of the innermost cell layer is shown by the presence of microvilli at the top. Mast cells are often shown mixed with these epithelial cells. A few plasma cells are also present. ×2000 ×2.2.


Fig. 30
Two month group. Electron micrograph showing a large number of plasma cells and outside layer of collagen fibrosis. ×2000 ×2.5.


Fig. 31 & 32
Six month group. Electron micrograph of non-ciliated epithelial cells and outside layer of collagen fibrosis. ×2000. ×2.2. 6666×2.2.


Figs. 33 & 34
Six month group. Electron micrographs showing Paragonimus egg shell (ES) and surrounding cellular component. Macrophages, degenerated neutrophils and fibroblasts are seen near the egg shell. ×2666×2.2.

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