Breakdown of lung framework and an increase in pores of Kohn as initial events of emphysema and a cause of reduction in diffusing capacity

Akira Yoshikawa,1 Shuntaro Sato,2,3 Tomonori Tanaka,1 Mikiko Hashisako,1,4 Yukio Kashima,5,6 Tomoshi Tsuchiya,7 Naoya Yamasaki,7 Takeshi Nagayasu,7 Hiroshi Yamamoto,2 Junya Fukuoka1,6 1Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Department of Pathology, 2Clinical Research Center, Nagasaki University Hospital, Nagasaki, 3Division of Biostatistics, Kurume University School of Medicine, Fukuoka, 4Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 5Department of Pathology, Hyogo Prefectural Awaji Medical Center, Sumoto, 6Department of Pathology, 7Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Purpose: Pulmonary emphysema is the pathological prototype of chronic obstructive pulmonary disease and is also associated with other lung diseases. We considered that observation with different approaches may provide new insights for the pathogenesis of emphysema. Patients and methods: We reviewed tissue blocks of the lungs of 25 cases with/without emphysema and applied a three-dimensional observation method to the blocks. Based on the three-dimensional characteristics of the alveolar structure, we considered one face of the alveolar polyhedron as a structural unit of alveoli and called it a framework unit (FU). We categorized FUs based on their morphological characteristics and counted their number to evaluate the destructive changes in alveoli. We also evaluated the number and the area of pores of Kohn in FUs. We performed linear regression analysis to estimate the effect of these data on pulmonary function tests. Results: In multivariable regression analysis, a decrease in the number of FUs without an alveolar wall led to a significant decrease in the diffusing capacity of the lung for carbon monoxide (DLCO) and DLCO per unit alveolar volume, and an increase in the area of pores of Kohn had a significant effect on an increase in residual capacity. Conclusion: A breakdown in the lung framework and an increase in pores of Kohn are associated with a decrease in DLCO and DLCO per unit alveolar volume with/without emphysema. Keywords: lung, pathology, COPD, pulmonary function, pathogenesi