Search

The frequency of asbestos-related pulmonary fibrosis leading to lung transplant is not well documented. A review of our laboratory information system in the setting of a high bilateral orthotopic lung transplant program (BOLT) at our institution, as well as a PubMed literature search, demonstrates a low frequency of asbestosis-related pulmonary fibrosis resulting in lung transplant, emphasizing that lung transplant due to interstitial fibrosis secondary to severe asbestosis is relatively rare. We present a unique case of a 65-year-old man with a history of interstitial lung disease in a background of asbestos exposure who underwent bilateral lung transplant and was found to have severe asbestosis (grade 4/4). We present radiographic and gross lung findings associated with the disease in addition to histologic findings. We furthermore demonstrate the use of asbestos fiber quantification by light and scanning electron microscopy. Drs Sporn and Roggli consult with plaintiff and defense attorneys in asbestos litigation., J. Carney; T. Sporn; E. Pavlisko; V. Roggli. Department of Pathology, Duke University Medical Center, Durham, North [...]

Malignant mesothelioma is a highly fatal cancer of the visceral and parietal pleura most often caused by asbestos exposure. Studies have shown that a fibrous zeolite mineral found in soil, erionite, is a strong causative agent of malignant mesothelioma as well. Cases of erionite associated pleural mesothelioma have been widely reported in Turkey, but only rarely in North America. Here we report an additional North American case of epithelial malignant pleural mesothelioma in a vehicle repairman who was raised on a farm in the Mexican Volcanic Belt region. A left decortication was performed and lung tissue sections were stained for various markers of mesothelioma and other cancers. Fiber analysis was performed on lung tissue by using analytic scanning electron microscopy (SEM). Histologic examination confirmed malignant pleural mesothelioma. By SEM, there were 53 700 uncoated fibers per gram of wet lung. Energy dispersive spectrometry demonstrated composition of the fibers as erionite. Erionite was also identified in soil samples (by powder x-ray diffraction, electron diffraction, polarized light microscopy, and EM) obtained from the farm in Mexico where the patient was raised. We describe a case of erionite-associated malignant pleural mesothelioma, proven by lung digestion studies and fiber composition analysis. No asbestos fibers in excess of background were found in the patient's lung. Erionite is found in widespread regions of North America, and several cases of mesothelioma have now been identified in association with erionite in central regions of Mexico. Health care professionals should be alert to the possibility of erionite-associated mesothelioma related to environmental exposures. Dr Roggli consults with plaintiff and defense attorneys in asbestos litigation; Dr Oury does medical legal consulting for asbestos-related cases., A. Kraynie (1); E. Oczypok (2); G. Berry (3); M. Gunter (4); V. Roggli (1); T. Oury T. (2) (1) department of Pathology, Duke University School of Medicine, Durham, North [...]

Andrew J Ghio,1 Elizabeth N Pavlisko,2 Victor L Roggli,2 Nevins W Todd,3 Rahul G Sangani4 1Human Studies Facility, US Environmental Protection Agency, Chapel Hill, NC, 27514, USA; 2Department of Pathology, Duke University, Durham, NC, USA; 3Department of Medicine, University of Maryland, Baltimore, MD, 21201, USA; 4Department of Medicine, West Virginia University, Morgantown, WV, USACorrespondence: Andrew J GhioHuman Studies Facility, US Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC, USAEmail ghio.andy@epa.govAbstract: It is proposed that the mechanistic basis for non-neoplastic lung injury with cigarette smoking is a disruption of iron homeostasis in cells after exposure to cigarette smoke particle (CSP). Following the complexation and sequestration of intracellular iron by CSP, the host response (eg, inflammation, mucus production, and fibrosis) attempts to reverse a functional metal deficiency. Clinical manifestations of this response can present as respiratory bronchiolitis, desquamative interstitial pneumonitis, pulmonary Langerhans’ cell histiocytosis, asthma, pulmonary hypertension, chronic bronchitis, and pulmonary fibrosis. If the response is unsuccessful, the functional deficiency of iron progresses to irreversible cell death evident in emphysema and bronchiectasis. The subsequent clinical and pathological presentation is a continuum of lung injuries, which overlap and coexist with one another. Designating these non-neoplastic lung injuries after smoking as distinct disease processes fails to recognize shared relationships to each other and ultimately to CSP, as well as the common mechanistic pathway (ie, disruption of iron homeostasis).Keywords: iron, ferritins, pulmonary disease, chronic obstructive, pulmonary emphysema, chronic bronchitis, hypertension, pulmonary, pulmonary fibrosis

Asbestos exposure is indisputably associated with the development of malignant mesothelioma (MM). However, relatively few studies have correlated the manner of exposure with asbestos fiber content and type. We report findings from 1445 MMs with known exposure histories, including fiber burden analyses performed in 268 cases. A total of 1445 histologically and immunohistochemically confirmed cases of MM were placed in 23 categories, according to the predominant manner of asbestos exposure. Asbestos body counts were determined by light microscopy. Asbestos fiber content and type were assessed using scanning electron microscopy and energy dispersive X-ray analysis. Ninety-four percent of cases fell into 19 of the 23 exposure categories. Six occupational categories, including pipefitter, boilermaker, machinist, electrician, maintenance worker and sheetmetal worker, as well as one para-occupational (household contact) exposure category, were represented. Twelve categories reflected the kind of industry in which exposure occurred. These included insulation, shipbuilding, railroad, oil/chemical, paper mill, US Navy, molten metal, glass/ceramic, power, automotive, asbestos manufacture and construction. Elevated levels of commercial amphibole fibers were identified in all 19 categories. The highest levels were identified among insulation and asbestos manufacturing industries and pipefitters. The median value of non-commercial amphibole fibers exceeded commercial amphibole fibers in four categories (automotive industry, household contacts, building occupants and environmental exposures). Multiple exposure categories were identified in one-quarter of cases. The majority of MMs in the USA fall into a limited number of exposure categories, with overlap of categories in a substantial proportion of cases. For most exposure categories, commercial amphiboles are the predominant fiber type. [ABSTRACT FROM AUTHOR]

Abstract Background Lung injury caused by both inhaled dusts and infectious agents depends on increased availability of iron and metal-catalyzed oxidative stress. Because inhaled particles, such as silica, and certain infections can cause secondary pulmonary alveolar proteinosis (PAP), we tested the hypothesis that idiopathic PAP is associated with an altered iron homeostasis in the human lung. Methods Healthy volunteers (n = 20) and patients with idiopathic PAP (n = 20) underwent bronchoalveolar lavage and measurements were made of total protein, iron, tranferrin, transferrin receptor, lactoferrin, and ferritin. Histochemical staining for iron and ferritin was done in the cell pellets from control subjects and PAP patients, and in lung specimens of patients without cardiopulmonary disease and with PAP. Lavage concentrations of urate, glutathione, and ascorbate were also measured as indices of oxidative stress. Results Lavage concentrations of iron, transferrin, transferrin receptor, lactoferrin, and ferritin were significantly elevated in PAP patients relative to healthy volunteers. The cells of PAP patients had accumulated significant iron and ferritin, as well as considerable amounts of extracellular ferritin. Immunohistochemistry for ferritin in lung tissue revealed comparable amounts of this metal-storage protein in the lower respiratory tract of PAP patients both intracellularly and extracellularly. Lavage concentrations of ascorbate, glutathione, and urate were significantly lower in the lavage fluid of the PAP patients. Conclusion Iron homeostasis is altered in the lungs of patients with idiopathic PAP, as large amounts of catalytically-active iron and low molecular weight anti-oxidant depletion are present. These findings suggest a metal-catalyzed oxidative stress in the maintenance of this disease.