Pneumoconiosis

Pathological anatomy. Silicosis. In mucosal and submucosal layer throat, upper respiratory tract in the early stages of the disease are observed from lymphoid infiltrates, plasma cells and hyperplasia of mucous glands, and further atrophic and sclerotic changes. In light meets nodular and diffuse sclerosis (interstitial, interstitial) form of silicosis. For nodular, developing more often by prolonged exposure through inhalation of dust with a high content of free SiO2, characteristic SelectionKey nodules, which are located closely and often merge with each other (Fig. 1)forming a sometimes large sites (granulomas form of silicosis). For diffuse sclerosis form of pneumoconiosis arising from prolonged exposure through inhalation of dust with a low content of free SiO2, a characteristic common interstitial sclerosis. To a mixed form of silicosis include where in disseminated interstitial sclerosis detected a moderate amount of knots. At showdown pleura sharply thickened, the light dense, weight increased, in the ashes of the burned lungs silicon dioxide is 29-45-60% (at the rate of 4-10%). There are knots typical and atypical. The first are either concentric galinadiamond beams connective tissue (Fig. 2) or from the beams going whirling. Atypical nodules usually irregular in shape and do not have the above structure. In knots detect clusters of quartz dust, located freely or in macrophages and dust cells. Later in knots and nodes occur necrotic changes due to severe changes in the nervous apparatus of the lungs and blood vessels of knots from the toxic effects of quartz dust. In necrotic areas are often delayed lime, and sometimes on the rise SelectionKey caverns.

Fig. 1. Large SelectionKey site, which occupies almost the entire upper portion of the lung (granulomas form). Major sites and miliary nodules in the rest of the parenchyma.
Fig. 2. Typical SelectionKey knots with closeconnections location collagen bundles of connective tissue. In the centre of knots faint gleams of vessels.

In the bronchi - obstructive bronchiolitis and bronchitis. The walls of the bronchi thickened, gaps narrowed due to compression of the surrounding sklerozirovanie cloth or increased dense lymph nodes (deforming bronchitis, bronchiolitis).
Emphysema (see) has been consistently, especially on the edges of the lungs.
In the lungs find a large number of particles of quartz dust, well identified in spidogram (cuts, burned at temperature of 650 degrees) and using an electronic microscope (Fig. 3).

Fig. 3. Particles of silica dust (electrode microscopy; X 20 000).

Lymph node bifurcation, basal, mediastinum increased, dense, with selectionstyle knots. Sclerosis capsules and surrounding tissue, necrosis of the lymph nodes, sometimes accompanied by fusion with their neighboring organs, causing complications - purulent mediastinum, pericarditis, abscess and lung gangrene, empyema, bleeding when arrosee vessels. In extended lymph vessels of the lungs characterized by stasis of dust cells (SelectionKey lymphangitis).
Heart increased in weight, mainly as a result of hypertrophy of the right half.
When granulomas form of silicosis meets typical chronic pulmonary heart (see). In the spleen, liver, bone marrow, kidney occasionally there are SelectionKey knots.
In 16-80% of cases of lung silicosis is complicated by the accession of tuberculosis (silicotuberculosis).
Asbestosis. On the fingers of hands and feet, the palms and soles, rarely in the Shin find asbestos warts that occur from getting into the skin of small cortical crystals asbestos causing hyperkeratosis, acanthosis and the emergence of a giant cells foreign phone
In the chest cavity found various prevalence pleural adhesions. Pleura thickened. Light diffuse sealed (asbestose easy). Unlike silicosis, when asbestosis do not find outlined fibrous nodules and units. In the long occurs catarrhal or purulent bronchitis, multiple broncho - and bronchioectasis, and consequently some parts of the lungs are fine, "honeycomb" character. Microscopically in the lungs detect severe interstitial sclerosis and many of asbestos dust. Asbestos bullock found in the lungs in different quantity (Fig. 4). In bifurcation, hilar lymph nodes lot of asbestos dust and diffuse sclerosis.
Heart increased due to hypertrophy of the right half. Occasionally typical pulmonary heart.

Fig. 4. Asbestosis. Asbestos bodies in sections of the lungs.

According to the materials of the autopsy, when asbestosis often primary lung cancer (16%), localized mainly in the lower lobes.
Talks. In the light - common interstitial sclerosis, bronchitis caused by deposition talkaway dust. Meet single, multiple sclerosis nodules that contain a lot of dust, not like selectionnee. Constantly found moderate emphysema. Described the so-called telksnio (pseudoallescheria) Taurus. In bifurcation, hilar lymph nodes lot of dust and multiple sclerosis without the formation of nodules. It is not uncommon to Telekomunikasi.
When the immoderate use of talc for dusting operating gloves in patients exposed transactions may occur the so-called surgical talks. Particles talc, getting even a small amount on the wound surface, serous membranes, causing an inflammatory process, formation and knots - granulomas, macro - and microscopic resembling TB tubercles. In them are caseous necrosis, but find a needle crystals and records of talc.
Silicates from mica dust is slowly progressing, clinically benign flowing pneumoconiosis. The lungs are mica dust, and mica Taurus", similar to asbestos. In the lymph nodes - the deposition of dust, sclerosis.
The pathogenesis of silicosis and silikatov not entirely clear. The idea of exclusively mechanical quartz dust in the development of pulmonary fibrosis gave place to views about the leading role of the chemical and physical processes in the interaction of dust particles with tissues. By toxic-chemical theory (the theory of the solubility) crystalline SiO2 slowly dissolves in tissue fluids, with the formation of colloidal solution silicic acid (H2SiO3), which causes fibrosis. Physico-chemical theories explain the mechanism of action of particles of quartz arising under production conditions violation of the structure of the crystal lattice, which creates conditions for active chemical reaction between a particle of silica fabrics. The theory on the role of polymerized silicic acid suggests that slow dissolution of particles of quartz is formed silicic acid high polymerization degree, possess toxic properties, causing intensive development of connective tissue, and this acid, like mucopolysaccharides, takes part in building collagen fibers. According to immunological theory, the development of sclerosis when silicosis caused by the interaction of particles SiO2 protein tissue on the principle of antigen + antibody. Antigens are proteins (lipoproteins), formed under influence of SiO2 on tissues and cells (macrophages) and their decay causing in the reticuloendothelial system, the formation of antibodies. Arising from the interaction of antigen and antibody protein precipitate appears on the newly formed reticulin fibers emerging silikatnogo bundle.


Antracot. In severe entrecote light black. The development of sclerosis depends on the character of coal and from the composition of the rocks which lie coal seams. Some authors believe that sclerosis lung when entrecote due to the action of SiO2, contained in coal seams. Others believe that the coal dust has sclerosing effect, though much weaker than quartz. Dust is located in dust cells and outside of them. Areas of connective tissue with dust cells (antarkticheskie foci) is not like SelectionKey nodules, at the confluence they form large antarkticheskie nodes. In the diffuse antarkticheskii the pneumosclerosis occurs slate, or antarkticheskie, induration lungs. To complications in entrecote include chronic bronchitis, bronchial pneumonia, emphysema, sclerotic changes in the walls of blood vessels.
Due to disorders of blood circulation and from the direct impact of coal ached lung tissue blackened dead tissue with the formation of cavities. These forms, accompanied by hemoptysis, called black consumption. In sharp entrecote lymph nodes observed fusion them with the walls of the trachea or bronchus and breakthrough coal masses into the lumen with their aspiration into the lungs and the development of pneumonia, abscesses.
Sideros as a special form of pneumoconiosis by some authors questioned and even denied, as described cases of Salerosa they see as diseases caused by iron dust mixed with SiO2. Some authors consider sideros as a mixed pneumoconiosis - siderations caused by quartz and iron dust, which is sometimes attached tuberculosis. There are red and black sideros. The first is caused by dust containing iron oxides. Light increased in volume, yellowish-brownish-red. The second arises from the dust with iron oxide or carbonate and phosphate compounds. Light black, remind light when Antracite. Microscopically find a weak interstitial sclerosis, miliary nodules, unlike selectionnee. In the lymph nodes lot of dust and significant sclerosis.
Aluminas ("aluminum light"). In the lungs find common interstitial sclerosis and various sizes sclerotic areas. Marked bronchiectasis change, small - and rupnieciba emphysema. Lymph nodes (bifurcation and root) moderately increased, dense, gray and black sclerotic (fibrous). Heart increased.
Berillios. In the acute form discover pneumonia (exudate away alveolar epithelium, lymphoma cells, few polinucleari and erythrocytes). In the later phases are disseminated granuloma, consisting of fibroblasts, lymphoid and plasma cells. In chronic berillios occurs chronic beryllium Wegener, characterized by interstitial sclerosis and development miliary granulomas (miliary berillios); when it is merged appear grayish-white knots with diameter from 2 mm up to 0.5-1.5 cm in places obliterative bronchiolitis. In the early stages of granulomas composed of histiocytes, epithelioid, lymphoid, plasma and giant cell type Langhans or foreign bodies, and then they hardening. In granulomas meet characteristic of the disease basophilic education - conchoidal (recoverable) cells (Fig. 5)with diameter from 20 to 100 MK, sometimes located in the giant multi-core cells. Lymph nodes (bifurcations, basal, neck) whitish-grey, yellowish, these granulomas. Granulomas are found in the liver, spleen (originating hematogenous route) and in the subcutaneous tissue (when getting particles beryllium through broken skin); they resemble TB bumps, sometimes With caseous necrosis.