Abstract Extensive atypical proliferation of alveolar lining cells was found at autopsy on a child dying in respiratory distress while receiving cyclophosphamide and vincristine. Lungs were heavy and uniformly consolidated. Microscopic study revealed highly atypical cells filling alveolar spaces and lining alveoli and some bronchioles. These changes are compatible with those previously described in adults treated with busulfan, which like cyclophosphamide is an alkylating agent. The pathologic features are also similar to autopsy findings in patients treated with artificial respirators and intensive oxygen therapy. In this case respirators were not used, and the only exposure to increased oxygen was in an oxygen tent for two days before death. It is likely that proliferation of alveolar and bronchiolar lining cells is a relatively nonspecific response seen in a variety of conditions. References 1. Heard BE, Cooke RA: Busulphan lung . Thorax 23:187-193,1968.Crossref 2. Nash G, Blennerhassett JB, Pontoppidan H: Pulmonary lesions associated with oxygen therapy and artificial ventilation . New Eng J Med 276:368-374, 1967.Crossref 3. Rossmann P, Vortel V: Pulmonary metastases imitating alveolar cell carcinoma . J Path Bact 81:313-321,1961.Crossref 4. Robbins SL: Pathology , ed 3. Philadelphia, WB Saunders Co, 1967, p 756. 5. Rappoport MB: A case of malignant adenomatosis of the lungs in a six-year-old child . Grudn Khir 4:101-102, 1962. 6. Min K-W, Györkey F: Interstitial pulmonary fibrosis, atypical epithelial changes and bronchiolar cell carcinoma following busulfan therapy . Cancer 22:1027-1032,1968.Crossref 7. Frank L: Varicella pneumonitis: Report of a case with autopsy findings . Arch Path 50:450-456, 1950. 8. Scheinman JI, Stamler FW: Cyclophosphamide and fatal varicella . J Pediat 74:117-119, 1969.Crossref 9. Liebow AA, Steer A, Billingsley JG: Desquamative interstitial pneumonia . Amer J Med 36:369-404,1965.Crossref 10. Schneider RM, Nevius DB, Brown HZ: Desquamative interstitial pneumonia in a 4-year-old child . New Eng J Med 277:1056-1058, 1967.Crossref 11. Berkheiser SW: Epithelial proliferation of the lung associated with cortisone administration: A pathological and experimental study . Cancer 16:1354-1364, 1963.Crossref 12. Bennett DE, Million RR, Ackerman LV: Bilateral radiation pneumonitis, a complication of the radiotherapy of bronchogenic carcinoma . Cancer 23:1001-1018, 1969.Crossref 13. Northway WH Jr, Rosan RC, Porter DY: Pulmonary disease following respiratory therapy of Hyaline-membrane disease: Bronchopulmonary dysplasia . New Eng J Med 276:357-368, 1967.Crossref 14. Weston JT, Guin GH: Epithelial atypias with chemotherapy in 100 acute childhood leukemias . Cancer 8:179-186,1955.Crossref 15. Gureli N, Denham SW, Root SW: Cytologic dysplasia related to busulfan (Myleran) therapy: Report of a case . Obstet Gynec 21:466-470,1963. 16. Oliner H, Schwartz R, Rubio F, et al: Interstitial pulmonary fibrosis following busulfan therapy . Amer J Med 31:134-139, 1961.Crossref 17. Philips FS, Sternberg SS, Cronin AP, et al: Cyclophosphamide and urinary bladder toxicity . Cancer Res 21:1577-1589, 1961. 18. Koller PC: Comparative effects of alkylating agents on cellular morphology . Ann NY Acad Sci 68:783-801,1958.Crossref 19. Johnson IS, Armstrong JG, Gorman M, et al: The vinca alkaloids: A new class of oncolytic agents . Cancer Res 23:1390-1427, 1963.
American Journal of Diseases of Children – American Medical Association
Published: Oct 1, 1970