EOSINOPHILIC GRANULOMA OF THE LUNG AND THE EXTRINSIC PULMONARY GRANULOMATOSES

Although involvement of the lungs was reported by Holm et al.' only 4 yr after Lichtenstein and Jaffe's original paper on the subject,* the first cases in which the disease'process was apparently limited to the lungs were only reported 7 yr later by Farinacci et a1.3 in 1951. The cause of eosinophilic granuloma is unknown, but many suggestions as to its origin have been put forward based on the personal experience of the authors. Although none of the pathogenic hypotheses have been confirmed, hypersensitivity is the most commonly accepted explanation for the condition. Auld4 and Thompson and Langer' suggest that an inhaled irritant might be implicated. In support of this idea Girard and Bouzakoura6 recently presented the case of a patient with eosinophilic granuloma of the lungs and, simultaneously, hypersensitivity to wood dust and horse serum. The disease cleared up spontaneously on cessation of exposure. The authors conclude that the purely pulmonary form of eosinophilic granuloma may be a particular form of hypersensitivity pneumonitis. The presence of pigment within the macrophages and histiocytes has been described by many authors,59798 but not particularly investigated. Recent electron microscopy studies have shown tubular or "rod-like'' structures within the cytoplasm of the histiocytes, attributed to viruses' o r metabolic products such as cholesterol and lecithin.''." The finding of cement particles within the pulmonary lesions of one of our latest cases of eosinophilic granuloma of the lungs as well as the wide experience of our pathologist, Prof. C . Pimentel, in the histology of the different responses of the lung to inhaled particles and their identification within the pathological material led us to review the 7 cases existing in the files of the Department of Chest Diseases.