Coal Mine Dust Desquamative Chronic Interstitial Pneumonia: A Precursor of
Dust-Related Diffuse Fibrosis and of Emphysema
#MMPMID28689212
Jelic TM
; Estalilla OC
; Sawyer-Kaplan PR
; Plata MJ
; Powers JT
; Emmett M
; Kuenstner JT
Int J Occup Environ Med
2017[Jul]; 8
(3
): 153-165
PMID28689212
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BACKGROUND: Diseases associated with coal mine dust continue to affect coal
miners. Elucidation of initial pathological changes as a precursor of coal
dust-related diffuse fibrosis and emphysema, may have a role in treatment and
prevention. OBJECTIVE: To identify the precursor of dust-related diffuse fibrosis
and emphysema. METHODS: Birefringent silica/silicate particles were counted by
standard microscope under polarized light in the alveolar macrophages and fibrous
tissue in 25 consecutive autopsy cases of complicated coal worker's
pneumoconiosis and in 21 patients with tobacco-related respiratory bronchiolitis.
RESULTS: Coal miners had 331 birefringent particles/high power field while
smokers had 4 (p<0.001). Every coal miner had intra-alveolar macrophages with
silica/silicate particles and interstitial fibrosis ranging from minimal to
extreme. All coal miners, including those who never smoked, had emphysema.
Fibrotic septa of centrilobular emphysema contained numerous silica/silicate
particles while only a few were present in adjacent normal lung tissue. In coal
miners who smoked, tobacco-associated interstitial fibrosis was replaced by
fibrosis caused by silica/silicate particles. CONCLUSION: The presence of
silica/silicate particles and anthracotic pigment-laden macrophages inside the
alveoli with various degrees of interstitial fibrosis indicated a new disease:
coal mine dust desquamative chronic interstitial pneumonia, a precursor of both
dust-related diffuse fibrosis and emphysema. In studied coal miners, fibrosis
caused by smoking is insignificant in comparison with fibrosis caused by
silica/silicate particles. Counting birefringent particles in the macrophages
from bronchioalveolar lavage may help detect coal mine dust desquamative chronic
interstitial pneumonia, and may initiate early therapy and preventive measures.
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