Asbestosis

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Asbestosis
Diagnosis in short

Asbestosis. H&E stain.

LM interstitial fibrosis (similar to usual interstitial pneumonia), ferruginous bodies (segmented twirling baton with long slender fibre within it)
LM DDx usual interstitial pneumonia
Stains Iron stain +ve (ferruginous bodies)
Site lung - see diffuse lung diseases

Associated Dx pleural plaques, pleural effusion (may be benign), malignant mesothelioma
Clinical history exposure to asbestos
Prevalence uncommon
Radiology interstitial pattern, lower lobe predominant
Prognosis poor

Asbestosis is a diffuse lung disease due to asbestos exposure. It is a type of hypersensitivity pneumonitis.[1]

General

Definition:

  • Interstitial lung disease due to asbestos exposure.[2]
    • Important to diagnose... asbestosis = compensation.

Conditions associated with asbestos exposure (mnemonic PALM):[2]

Possible association with asbestos exposure:

Diagnosis:

  • Rests on morphology with special techniques (e.g. polarization)[4] and includes tunneling electron microscopy (TEM),[5] as done at special centres.
    • Tissue is typically digested prior to fibre counting.[6]

Microscopic

Features:[6]

  1. Interstitial fibrosis - similar to usual interstitial pneumonia (UIP).
  2. Ferruginous bodies - key feature.
    • Segmented twirling baton with long slender fibre within.
    • Black crystal-like appearance - may be confused with dirt on H&E.

Images

Stains

See also

References

  1. Zacharisen MC, Fink JN (November 2011). "Hypersensitivity pneumonitis and related conditions in the work environment". Immunol Allergy Clin North Am 31 (4): 769–86, vii. doi:10.1016/j.iac.2011.07.004. PMID 21978856.
  2. 2.0 2.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 375. ISBN 978-1416054542.
  3. Reid, A.; Heyworth, J.; de Klerk, N.; Musk, AW. (Nov 2009). "Asbestos exposure and gestational trophoblastic disease: a hypothesis.". Cancer Epidemiol Biomarkers Prev 18 (11): 2895-8. doi:10.1158/1055-9965.EPI-09-0731. PMID 19900938.
  4. Galateau-Salle, F. (Dec 1999). "[Anatomopathological tools for screening and medical surveillance of people exposed to asbestos].". Rev Mal Respir 16 (6 Pt 2): 1244-56. PMID 10897845.
  5. Neumann, V.; Löseke, S.; Tannapfel, A. (2011). "Mesothelioma and analysis of tissue fiber content.". Recent Results Cancer Res 189: 79-95. doi:10.1007/978-3-642-10862-4_6. PMID 21479897.
  6. 6.0 6.1 Roggli, VL.; Gibbs, AR.; Attanoos, R.; Churg, A.; Popper, H.; Cagle, P.; Corrin, B.; Franks, TJ. et al. (Mar 2010). "Pathology of asbestosis- An update of the diagnostic criteria: Report of the asbestosis committee of the college of american pathologists and pulmonary pathology society.". Arch Pathol Lab Med 134 (3): 462-80. doi:10.1043/1543-2165-134.3.462. PMID 20196674.