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Asbestos&Berylliosis
- 1. Asbestosis and Berylliosis Dr.CSBR.Prasad., MD.,
- 2. Asbestos • Asbestos is a family of crystalline hydrated silicates that form fibers • Greek word – unquenchable • Coal is a lot of dust and little fibrosis • Asbestos is little dust and lot of fibrosis CSBRP-Dec-2012
- 3. Asbestos • In nature – exists as thin long fibrils which are fire resistant and can be spun into yarns • Applications: Thermal insulation Electrical insulation CSBRP-Dec-2012
- 4. Workers at risk • Miners Fabrication of Manufacture of • Pipes • Textiles • Tiles • Insulating boards • Roofs • Sewer conduits • Textiles • Water conduits • Brake lining • Clutch casting CSBRP-Dec-2012
- 5. Geometric forms Serpentine Amphibole • Chrysotile • Crocidolite (blue) • Amosite (brown) • Tremolite • Anthophyllite • Actinolyte CSBRP-Dec-2012
- 6. Geometric forms Serpentine Amphiboles • Curly and flexible • Straight,stiff,brittle • Ex.,chrysotile (90%) • Crocidolite • Less pathogenic • More fibrogenic • Soluble • Less soluble • Get impacted in upper • Reach deeper in resp tract. lungs • Removed by • Penetrate epithelial mucocilia cells, interstitium. CSBRP-Dec-2012
- 7. Asbestos –general remarks • Amphiboles are more pathogenic • Amphibole fibers-longer than 8 µm and thinner than 0.5 µm are more injurious than shorter and thicker ones • High dosage – high incidence of disease • Amphibole exposure – Mesothelioma CSBRP-Dec-2012
- 8. Asbestosis - general remarks • Both initiators and promoters • Oncogenic: free radical injury • Adsorbed toxic chemicals • Silicosis is a nodular fibrosing disease • Asbestosis is a diffuse interstitial process • Diffuse fibrosis because: • Asbestos reaches alveoli consistently • Penetrate epithelial cells CSBRP-Dec-2012
- 9. Asbestosis- pathogenesis • Asbestos - MØ – interstitium – lymphatic - pleura • Chemo attraction to PMN, macrophages • Asbestos bodies - coat of glycoprotein, haemosiderin • Induce fibrosis: MDGF, IL-1 • Induce ANA, Rhematoid factor CSBRP-Dec-2012
- 10. Asbestos induced diseases 1. Asbestosis 2. Pleural diseases Pleural effusion Visceral pleural fibrosis Pleural plaques 3. Tumors Bronchogenic carcinoma Malignant mesothelioma CSBRP-Dec-2012
- 11. Asbestosis • Diffuse pulmonary fibrosis • Histologically: Asbestos bodies • Gross: small, firm lungs cartilage like pleura subpleural fibrosis esp. @ bases late stages: cystic change honeycomb CSBRP-Dec-2012
- 12. Asbestos - microscopy 1. Non specific interstitial fibrosis 2. Asbestos bodies 3. Emphysematous changes CSBRP-Dec-2012
- 13. Asbestos bodies Golden brown, fusiform / beaded rods with translucent center Consists of asbestos fibres coated with iron containing protenaceous material Iron derived from phagocyte ferritin Ferruginous bodies: inorganic particulates coated by similar iron protein complexes CSBRP-Dec-2012
- 14. This long, thin object is an asbestos fiber CSBRP-Dec-2012
- 15. CSBRP-Dec-2012 Asbestos body - Typical beading and knobbed ends (arrow)
- 16. Ferruginous body CSBRP-Dec-2012
- 17. Pleural disease Pleural effusion: Serous effusion Visceral pleural fibrosis: Encases the lung Pleural plaques: Fibrocalcific Micro: oHyalinised collagenous tissue oCalcification oNo asbestos bodies CSBRP-Dec-2012
- 18. Figure 15-22 Asbestos exposure evidenced by severe, discrete, characteristic fibrocalcific plaques on the pleural surface of the diaphragm. CSBRP-Dec-2012
- 19. Diffuse visceral Pleural fibrosis CSBRP-Dec-2012
- 20. Fibrous pleural plaque CSBRP-Dec-2012
- 21. Asbestos - Tumors • Brochogenic carcinoma 5x • Malignant mesothelioma 1000x • Carcinoma esophagus • Carcinoma stomach • Carcinoma colon • Carcinoma kidneys • Carcinoma larynx Concomitant cigarette smoking greatly increases the CSBRP-Dec-2012 risk of lung carcinoma but not that of mesothelioma.
- 22. Malignant Mesothelioma • Monophasic / biphasic tumor • Spindle cells / gland formations • Markers: – Calretinin – CK 5/6 – WT1 CSBRP-Dec-2012
- 23. CSBRP-Dec-2012
- 24. CSBRP-Dec-2012
- 25. Asbestosis - Clinical features • Slow insidious, asymptomatic • Dyspnoea • Dry / productive cough • Advanced cases: Caplan syndrome Pul. HTN cor pulmonale various Cancers CSBRP-Dec-2012
- 26. Berylliosis CSBRP-Dec-2012
- 27. Berylliosis • Exposure to dust / fumes of metallic beryullium • Past - Fluorescent tubes / light bulbs • Presently – • Aerospace industries • Electrical / electronic equipments • Two diseases – acute / chronic CSBRP-Dec-2012
- 28. Acute berylliosis • Unusual sensitivity • Heavy exposure over 2 to 4 wks • Alveoli filled with protein rich fluid with formation of hyaline membrane • C/F: sudden dyspnoea, hyperpnoea substernal pain • Complete recovery CSBRP-Dec-2012
- 29. Chronic Berylliosis • Sensitivity for over years 20 yrs or more • CMI hypersensitivity reaction • Metal beryllium acts as a hapten 1-Non caseating granulomas - sarcoid like 2-Birefringent crystals 3-Schaumann / conchoid bodies 4-Asteroid bodies CSBRP-Dec-2012
- 30. Immunologic Lung Disease CSBRP-Dec-2012
- 31. Immunologic lung disease 1. Bronchial asthma 2. Hypersensitivity (allergic) pneumonitis 3. Pulmonary eosinophilia 4. Goodpasture’s disease 5. Pulmonary alveolar proteinosis CSBRP-Dec-2012
- 32. Hypersensitivity pneumonitis • Immunologically mediated interstitial pneumonitis • Inhaled organic antigenic material • Acute / chronic • Type III or Type IV reaction CSBRP-Dec-2012
- 33. Types of hypersensitivity pneumonitis • Farmers lung Thermophilic actinomycetes • Bagassosis Thermophilic actinomycetes • Byssinosis Cotton fiber, flex, hemp Bired dropping, danders • Bird breeders disease • Mushroom workers Mushroom compost dust • Malt workers lung Mouldy barley,malt dust • Maple bark disease Mouldy maple bark (canada) • Silofillers disease Toxic fumes of nitric oxide / nitric dioxide. CSBRP-Dec-2012
- 34. Gross and microscopy • Early stage: alveolar wall infiltrated by plasma cells histiocytes granulomas • Chronic stage: interstitial fibrosis inflammatory infiltrates honey combing of lung. CSBRP-Dec-2012
- 35. Pulmonary eosinophilia • Immunologically mediated • Two features 1.Infiltration of lungs chest radiographs 2.Elevated eosinophil count in blood CSBRP-Dec-2012
- 36. Pulmonary eosinophilia - causes 1. Loeffler’s syndrome 2. Tropical pulmonary eosinophilia 3. Secondary chronic pulmonary eosinophilia 4. Idiopathic chronic eosinophilic pneumonia 5. Hypersensitivity syndrome CSBRP-Dec-2012
- 37. Pathology • Gross: patchy consolidation • Micro: thickening of alveolar membrane EØ, Plasma cells, Lymphocytes small granulomas lumen may show eosinophils CSBRP-Dec-2012
- 38. Goodpasture’s syndrome Necrotising haemorrhagic interstitial pneumonitis + Rapidly progressive glomerulnephritis CSBRP-Dec-2012
- 39. Goodpasture’s syndrome Etiopathogenesis • Immunologic damage • By anti BM antibodies formed against antigens common to BM of alveoli and GBM. • Trigger: not clear, ?virus ?hydrocarbons ?smoking CSBRP-Dec-2012
- 40. Pathology • Red brown areas of consolidation • Acute stage: focal areas of haemorrhage, necrosis in alveolar wall • Chronic cases: organisation - fibrosis CSBRP-Dec-2012
- 41. Pulmonary alveolar proteinosis (PAP) • Chronic disease characterized by distal air spaces filled by granular eosinophilic PAS positive material with abundant lipid in it • Material -- Surfactant • Can occur at any age • Three distinct classes: acquired congenital & secondary PAP CSBRP-Dec-2012
- 42. This is a rare disease known as pulmonary alveolar proteinosis. The alveolar walls are normal histologically but the alveoli become filled with a PAS postive granular exudate containing abundant lipid and lamellar bodies (by electron microscopy). Patients may cough CSBRP-Dec-2012 up copious amounts of gelatinous sputum. The etiology is unknown.
- 43. E N D CSBRP-Dec-2012