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MORPHOLOGICAL ANALYSIS OF ALVEOLAR MACROPHAGE IN PATIENTS WITH SARCOIDOSIS: LET'S REFLECT THE CELL ON A BRONCHOALVEOLAR FLUID SPECIMEN‐PART 2.

Background and Aims: It has been known that the cell count and fraction of bronchoalveolar lavage fluid: BALF specimen is useful to diagnose as interstitial lung disease including sarcoidosis. We have a hypothesis that alveolar macrophage: AM on BALF in sarcoidosis has the characteristic cell form because sarcoidosis is disease constitute granuloma due to epithelial cells. Aim of this study is to determine the characteristic cell form of AM in sarcoidosis. Methods: Fifteen cases of sarcoidosis were enrolled in this study. We analyzed the cell area, nuclear area, and NC ratio of AM on BALF specimen by digital microscope. Primary endpoint was a comparison of those findings in between sarcoidosis and healthy volunteer (n = 5). Also, we compared with those in pulmonary alveolar proteinosis: PAP (n = 10). Secondary endpoints were to investigate the following findings of AM on BALF in sarcoidosis: deviation of nuclear, chromatin hyperplasy of nuclear, phagosome, and ruffling. Results: Median cell area and nuclear area of AM in sarcoidosis was 335 and 90 μm, respectively. These findings were significant larger than those of healthy volunteer (90 and 26 μm, respectively). They were as same as those of PAP (315 and 53 μm, respectively). Although NC ratio of AM in sarcoidosis was as same as those of healthy volunteer, they were larger than those of PAP. Also, the following findings: chromatin hyperplasy of nuclear, phagosome, and ruffling were associated with the growth of cell size. Conclusion: AM form in sarcoidosis was clearly difference from healthy volunteer. As compared with healthy volunteer, both cell area and nuclear area of AM increased in sarcoidosis. It suggested the above findings were caused by the increase of bubble appearance in nuclear and cytoplasm. Also, it is interesting the large AM tends to have the ruffling of cell surface. This result might be important finding to evaluate the activity in sarcoidosis in the future.