Pneumoconiosis is characterized by chronic lung inflammation and fibrosis, and inflammation can promote pulmonary fibrosis, which in turn leads to pneumoconiosis. When a large shadow with a long diameter of not less than 2 cm and a short diameter of not less than 1 cm appears in the lung, it can be classified as stage Ⅲ pneumoconiosis. This paper reports a case of stage Ⅲ pneumoconiosis with a large shadow in the upper right lung accompanied by burr-like changes misdiagnosed as lung cancer by CT examination.When the large shadow lesions in patients with pneumoconiosis and lung cancer are difficult to distinguish on CT, an additional MRI examination, particularly T(2)W imaging sequence is useful sequence for identifying the two.
Humans ; Pneumoconiosis/pathology* ; Lung/pathology* ; Lung Neoplasms/pathology* ; Pulmonary Fibrosis/pathology* ; Diagnostic Errors

Objective: To investigate the clinicopathological characteristics of occupational lung diseases, to reduce the missed diagnoses and misdiagnoses of the diseases and to help standardize the diagnosis and treatment of these patients. Methods: A total of 4 813 lung biopsy specimens (including 1 935 consultation cases) collected at the Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, China from January 1st, 2017 to December 31th, 2019 were retrospectively analyzed. Among them, 126 cases of occupational lung diseases were confirmed with clinical-radiological-pathological diagnosis. Special staining, PCR and scanning electron microscopy were also used to rule out the major differential diagnoses. Results: The 126 patients with occupational lung diseases included 102 males and 24 females. All of them had a history of exposure to occupational risk factor(s). Morphologically, 68.3% (86/126) of the cases mainly showed pulmonary fibrotic nodules, dust plaque formation or carbon end deposition in pulmonary parenchyma. 16.7% (21/126) of the cases mainly showed welding smoke particle deposition in the alveolar cavity and lung interstitium while 15.1% (19/126) of the cases showed granulomas with fibrous tissue hyperplasia, alveolar protein deposition or giant cell interstitial pneumonia. The qualitative and semi-quantitative analyses of residual dust components in the lung under scanning electron microscope were helpful for the diagnosis of welder's pneumoconiosis and hard metal lung disease. Conclusions: The morphological characteristics of lung biopsy tissue are important reference basis for the clinicopathological diagnosis and differential diagnosis of occupational lung diseases. Recognizing the characteristic morphology and proper use of auxiliary examination are the key to an accurate diagnosis of occupational lung diseases on biopsy specimens.
Male ; Female ; Humans ; Retrospective Studies ; Pneumoconiosis/pathology* ; Lung/pathology* ; Dust ; Pneumonia, Viral/pathology* ; Biopsy

Occupational pneumoconiosis is one of the main occupational diseases in China. Progressive massive fibrosis in pneumoconiosis should be distinguished from lung cancer for their similar imaging features which is often identified by (18)F-FDG PET-CT in clinic. Here we reported two cases of pneumoconiosis. Both of them were suspected of carrying malignant tumors by preoperative PET-CT exam, however, nodules in these two patients were all proved to be benign by intraoperative pathology which suggested that there is false-positive possibility in the distinguishment of pneumoconiosis nodules by (18)F-FDG PET-CT.
Fibrosis ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms/pathology* ; Pneumoconiosis/pathology* ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography/methods*

OBJECTIVETo study the character of welder's pneumoconiosis on CT, pathology, and lung function.

METHODSTo contrast 185 welder's pneumoconiosis and 115 silicosis on CT, pathology, and clinical characters which were diagnosed between Jan 2008 and Dec 2013. Chest X-ray and lung function of 39 welder's pneumoconiosis patients were followed up after diagnosed 4~6 years later.

RESULTSAverage age and working years of welder's pneumoconiosis were 36.7 and 11.5, less than silicosis patients 58.8 and 22.1, respectively (P<0.05). Of all 185 welder's pneumoconiosis 98.4% were of stage I and no stage III, while in silicosis group stage I, stage II and stage III were 56.5%, 22.6% and 20.9%, respectively. The ratio differences between the two groups were statistically significant,P<0.05. 82.7% of welder's pneumoconiosis patients were observed pathologically moderate or above dust deposition in lung tissue while interstitial fibrosis level was just mild (97.6% patients) or no fibrosis (2.4% patients). By contrast, 60.0% silicosis patients pathologically showed moderate or above dust deposition while 77.8% were of moderate or above fibrosis. CT findings in welder' s pneumoconiosis were diffuse branching linear structure (38.9%), low density consistent size centrilobular micronodules (19.5%), or both (30.8%). Poorly-defined ground-glass attenuation centrilobular micronodules or widely ground glass shadow were observed in 6.4% welder's pneumoconiosis patents. 30.8% patients failed to reach the original stage when 39 welder's pneumoconiosis followed up chest radiograph.

CONCLUSIONChanges in welder's lung caused by welding fume were not only siderosis, but also interstitial fibrosis.

Adult ; Dust ; Fibrosis ; Follow-Up Studies ; Glass ; Humans ; Lung ; pathology ; Middle Aged ; Pneumoconiosis ; physiopathology ; Radiography, Thoracic ; Siderosis ; physiopathology ; Silicosis ; diagnosis ; physiopathology ; Welding

Lung ; pathology ; Pneumoconiosis ; microbiology ; Pseudomonas Infections ; microbiology ; Pseudomonas aeruginosa

OBJECTIVETo evaluate the differences in the autophagy activity of alveolar macrophages between patients with different stages of coal workers' pneumoconiosis (CWP).

METHODSA total of 116 coal workers were investigated in the field. Their lung lavage fluid was collected and purified to obtain alveolar macrophages. The morphological characteristics of autophagy were observed by transmission electron microscopy. The expression of autophagy marker (LC3) and autophagy regulators (Beclin1, mTOR, and p-mTOR) was measured by Western blot. The autophagy activity of alveolar macrophages was compared between dust-exposed subjects and patients with stage I, II, and III CWP.

RESULTSThe autophagy activity of alveolar macrophages differed between patients with different stages of CWP, according to transmission electron microscopy. Patients with stage II CWP had significantly higher protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage ICWP (P < 0.05); patients with stage III CWP had significantly lower protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage II CWP (P < 0.05), but had significantly higher protein expression of LC3 II/I and Beclin1 than those with stage I CWP (P < 0.05); patients with stage II CWP had a significantly higher protein expression of Beclin1 than the dust-exposed subjects (P < 0.05). Patients with stage II CWP had significantly lower expression of mTOR and p-mTOR in pulmonary macrophages than the dust-exposed subjects and those with stage I CWP (P < 0.05), while patients with stage III CWP had significantly higher expression of mTOR and p-mTOR than those with stage II CWP (P < 0.05).

CONCLUSIONThe autophagy activity of alveolar macrophages varies between patients with different stages of CWP.

Anthracosis ; pathology ; Apoptosis Regulatory Proteins ; metabolism ; Autophagy ; Beclin-1 ; Biomarkers ; Bronchoalveolar Lavage Fluid ; Coal ; Coal Mining ; Dust ; Humans ; Macrophages, Alveolar ; pathology ; Membrane Proteins ; metabolism ; Microtubule-Associated Proteins ; metabolism ; Occupational Exposure ; Pneumoconiosis ; pathology

OBJECTIVETo analyze the clinical features and investigate the clinical diagnostic methods of hard metal lung disease (HMLD), then provide reference for the diagnostic criteria of occupational HMLD.

METHODSRetrieved the open published case reports associated with HMLD from January, 2000 to June, 2014. Regarding the ages, sex, types and years of work, clinical features and laboratory results for analyzing.

RESULTSCollected 21 clinical cases of HMLD belonged to 6 internal reports and 15 oversea reports. Among them 15 male and 6 female, ages were from 22 to 58, length of service between 1 year and 43 years. Clinical presentations included cough (20 cases), dyspnea on progressive (10 cases), and pulmonary function testing showed a restrictive abnormality. The imaging features presented as bilateral areas of ground-glass attenuation, diffuse small nodules, extensive reticular opacities and traction bronchiectasis. The finding of giant cell interstitial pneumonia (GIP) was almost pathognomonic for hard metal pneumoconiosis. The main pathological findings contained a different levels of lymphocyte, acidophilic cell infiltration, hyperplasia of fibrous tissue and numerous large multinucleated histiocytes which ingested inflammatory cells were admixed with macrophages. 16 cases of the 21 reports showed GIP.

CONCLUSIONSClinical presentations include cough and dyspnea on progressive, and pulmonary function testing show a restrictive abnormality. The imaging features present as bilateral areas of ground-glass attenuation, areas of consolidation, diffuse small nodules, extensive reticular opacities and traction bronchiectasis. The prime pathological findings contain interstitial pneumonia with intra-alveolar macrophages and a large amount of multinucleated histiocytes.

Adult ; Alloys ; Cobalt ; Female ; Humans ; Lung ; physiopathology ; Lung Diseases, Interstitial ; pathology ; Macrophages, Alveolar ; Male ; Middle Aged ; Occupational Diseases ; pathology ; Pneumoconiosis ; pathology ; Tungsten ; Young Adult

OBJECTIVETo study the radiographycal changes and prognosis of welders' pneumoconiosis patients diagnosed within the last few years.

METHODSOccupational hygienics data (including years on welding work, welding materials exposed to and work environment), symptoms, lung function test results and follow-up data of 136 welders' pneumoconiosis patients were collected retrospectively. The follow-up lasted up till June 30, 2014, with follow-up interval being one year. Chest radiographs were read/reviewed together by 3 senior experts experienced in pneumoconiosis diagnosing and shape and size of small opacity, overall profusion, affected lung zones and pneumoconiosis stages were all logged.

RESULTSOf all 136 pneumoconiosis cases, five were of stage II and 131 were stage I, and they had been engaged in welding work for 9.2±6.34 years. All patients were present with slight symptoms including coughing, chest distress and dyspnea, while their lung function remained normal. Small round opacities were found on chest radiographs of 88.9% of the 136 cases. Years of follow-up on 131 cases of stage I Welder's pneumoconiosis showed that irregular small opacities remained fundamentally unchanged, while small round opacities tended to gradually lessen instead of coalescence. Two years after primary diagnosing, the total affected lung zones of follow-up objects were noticed to start lessening, and reduced by 0.02 per patient among the 48 follow-up subjects. Of the 48 cases followed up up to six years after primary diagnosing, the affected lung zone number was reduced by 0.54 per patient while 4 cases (8%) went down to below stage I. As of the 36 patients followed up 10 years after after primary diagnosis, the number of affected lung areas decreased by 1.14, and 22% (8 cases) appeared less than stage I on chest radiograph.

CONCLUSIONIt seemed that the so-called welders' pneumoconiosis featuring small round opacities tended to get improved over time, which suggested the diagnosis of siderosis.

Cohort Studies ; Humans ; Lung ; Occupational Exposure ; adverse effects ; Pneumoconiosis ; diagnostic imaging ; pathology ; Radiography, Thoracic ; Retrospective Studies ; Siderosis ; diagnostic imaging ; pathology ; Thoracic Cavity ; Welding

OBJECTIVETo study the pathological features of progressive massive fibrosis (PMF) in the lung tissues of patients with coal workers' pneumoconiosis (CWP).

METHODSA retrospective analysis was made on the autopsies from 8 patients with CWP, which were observed under a microscope by HE staining, given their occupational history.

RESULTSThe age of 8 cases ranged 47-71 years (mean, 59.9 years), and their dust exposure time was 18-32 years (mean, 25.1 years). All the 8 cases were complicated by chronic bronchitis as well as emphysema, 7 cases by pulmonary heart disease, and 4 cases by pulmonary tuberculosis. In this group of patients, PMF was mainly distributed in the hilum and the upper lobe of the lung, including 7 cases of nodular fusion type and 1 case of PMF type. The collagen fibers around PMF extended radially and destroyed its surrounding tissue.

CONCLUSIONNodular fusion type is the main form of PMF in the lung tissues of CWP patients. It has a progressive and destructive process, which is the manifestation of advanced CWP.

Aged ; Anthracosis ; pathology ; Coal Mining ; Dust ; Humans ; Lung ; pathology ; Male ; Middle Aged ; Pneumoconiosis ; pathology ; Retrospective Studies

OBJECTIVETo evaluate the clinical value of (18)F-FDG PET/CT in the differentiation between benign lesions and lung cancer for large shadows in patients with pneumoconiosis.

METHODSA retrospective study was conducted in 21 patients with a confirmed diagnosis of pneumoconiosis who had a total of 37 large shadows in the lung fields as shown by whole-body (18)F-FDG PET/CT imaging, and (18)F-FDG uptake was evaluated using the maximum standardized uptake value (SUVmax). Twelve lesions were examined by CT-guided aspiration biopsy, and one case underwent fiberoptic bronchoscopy, as well as tests based on bronchoalveolar lavage fluid and sputum; the other cases were followed up for more than 2 years. The differences between pneumoconiosis nodules with high (18)F-FDG uptake and lung cancer were evaluated by t test.

RESULTSSeventeen lung masses or nodules with high (18)F-FDG uptake were detected in 13 patients; among the 13 patients, 5 lesions of 5 cases were confirmed as non?small cell lung cancer (1 case of squamous cell carcinoma, 3 cases of adenocarcinoma, and 1 case of recurrent squamous cell carcinoma after operation), and 7 lesions of 7 cases were progressive massive fibrosis as shown by CT-guided aspiration biopsy; one case had no tumor cells detected by fiberoptic bronchoscopy, and 2.5-year follow-up revealed no changes in the lesions. The other 8 patients showed no increased (18)F-FDG uptake in their 20 lung nodules, which were confirmed as benign lesions by follow-up. The diameter range of lung cancer was 1.6∼6.8 cm, and the SUVmax range was 4.8∼14.0; the diameter range of pneumoconiosis nodules with high (18)F-FDG uptake was 1.5∼4.6 cm, and the SUVmax range was 2.6∼12.4. There were no significant differences in diameter and SUVmax between the lung cancer and pneumoconiosis nodules with high (18)F-FDG uptake (P > 0.05 for both). (18)F-FDG PET/CT had a specificity of 62.5% (20/32), an accuracy of 67.6% (25/37), a false-positive rate of 37.5% (12/32), and a negative predictive value of 100% (20/20) for the diagnosis of lung cancer. The lung cancer detection rate was 23.8% (5/21).

CONCLUSIONIn (18)F-FDG PET/CT imaging for patients with pneumoconiosis, the lung lesions without (18)F-FDG uptake or symmetrical lesions with high (18)F-FDG uptake are considered as benign pneumoconiosis nodules; however, (18)F-FDG PET/CT might have a limited role in evaluating the solitary lung lesions in patients with pneumoconiosis and needs further study.

Adenocarcinoma ; diagnostic imaging ; pathology ; Adult ; Aged ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung ; pathology ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Pneumoconiosis ; diagnostic imaging ; pathology ; Positron-Emission Tomography ; Retrospective Studies ; Tomography, X-Ray Computed