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Occupationally related lung fibrosis and lung cancer

Occupationally related lung fibrosis and lung cancer. Dr Allen R Gibbs Department of Histopathology Llandough Hospital Cardiff and Vale NHS Trust. Factors influencing disease development from mineral particle exposures.

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Occupationally related lung fibrosis and lung cancer

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  1. Occupationally related lung fibrosis and lung cancer Dr Allen R Gibbs Department of Histopathology Llandough Hospital Cardiff and Vale NHS Trust

  2. Factors influencing disease development from mineral particle exposures • Physicochemical – size, deposition, dissolution, migration, surface properties. • Particle type • Concentration and duration of exposure • Presence of other minerals • Individual factors

  3. Agents causing lung fibrosis Dust accumulations with little fibrosis : coal, silicates Mixed dust fibrotic lesions : silica plus silicates or iron Circumscribed nodules : silica Diffuse interstitial fibrosis : asbestos, silicates, metals Progressive massive fibrosis : coal, silica, silicates

  4. Agents causing lung fibrosis With granulomas : beryllium Extrinsic allergic alveolitis (hypersensitivity pneumonitis_ : farmer’s lung, isocyanates etc

  5. Coal - Mineralogy • Carbon • Silica • Clays – illite, kaolinite, mica • Trace metals – beryllium, cobalt, arsenic,cadmium, antimony etc • Organic compounds – benzene, napthaline, phenols etc

  6. Coal – factors affecting response • Cumulative exposure • Coal rank • Quartz content and surface properties • Non coal content – illite, kaolin etc • Individual susceptibility

  7. CWP – histological lesions • Primary dust lesions / macules • Secondary dust lesions / nodules - stellate - rounded • Progressive massive fibrosis (PMF) • Emphysema • Interstitial fibrosis • Caplan lesions

  8. Coal worker

  9. Coal worker

  10. Silica • Amorphous • Crystalline - quartz - tridymite - cristobalite - coesite - stishovite

  11. Silicatosis - examples • Talc • Kaolin • Mica • Fuller’s earth (montmorillonite – attapulgite)

  12. Crystalline silica - exposures • Mining, quarrying and tunneling • Stonecutting, engraving and polishing • Manufacture and use of silica containing abrasives. • Foundry work. • Ceramics and refractories. • Sandblasting and grinding.

  13. Rock of Ages Quarry - Vermont

  14. Rock of Ages Quarry - Vermont

  15. Silicosis - epidemiology • Population at risk changing. • Conditions of exposure changing. • Problems with assessment of exposure. • Problems with case definition. • In UK about 20 to 50 per year? (SWORD & HSE)

  16. Silica-Silicate exposures - lesions • Macules • Mixed dust fibrotic nodules • Classical silicotic nodules - ferruginous bodies - giant cells

  17. Silicosis – Gough Wentworth

  18. Slate Worker - PMF

  19. Silicotic lesion – slate worker

  20. Silicosis – Clinical forms

  21. Silicatosis - examples • Talc • Kaolin • Mica • Fuller’s earth (montmorillonite – attapulgite)

  22. China Clay Pneumoconiosis

  23. China Clay Pneumoconiosis

  24. Talc Pneumoconiosis - NY

  25. Mixed dust fibrosis • Refers to the pulmonary response to dusts containing free silica and less fibrogenic dusts,such as iron, kaolin, mica concomitantly. • Typical lesion is the mixed dust fibrotic nodule.

  26. Mixed dust fibrosis - examples • Iron and steel foundries • Haematite mining • Slate industry • China clay/stone industry • Ceramic industry

  27. Slate worker

  28. Slate worker

  29. Mixed dust fibrotic lesion in granite worker

  30. Silica and silicate exposures

  31. Asbestosis • Diffuse bilateral interstitial fibrosis of the lung caused by asbestos inhalation • Microscopic diagnosis : interstitial fibrosis asbestos bodies

  32. Asbestosis • Long latency • Slow progression • Heavy exposure • Long fibres more potent than short • Amphibole fibres more fibrogenic than chrysotile • Constitutional factors - ?

  33. Diagnosis of asbestosis • Fibrosis should be assessed on inflated lungs, preferably on opposite side to tumour if present. • Diagnosis unlikely to be correct if asbestos bodies are scanty by light microscopy and/or if progression from clinical diagnosis of fibrosis to death is relatively rapid. • May need mineral analysis.

  34. Agents inducing lung cancer • Arsenic • Chromium compounds (hexavalent) • Nickel • Uranium • Asbestos • Silica • Radon

  35. Lung cancer – risk factors • Smoking • Dose • Industry • Fibre type and dimensions • Pulmonary fibrosis • Others

  36. Asbestos – smokingHammond et al 1979

  37. Asbestos – smokingMcDonald et al 1980

  38. Amosite mine

  39. Lung cancer risk - Industry

  40. Lung cancer – Industry and fibre type

  41. Verification of exposure • Macroscopic – coal dust macules, silicotic nodules, emphysema, lung fibrosis, tumour, pleural plaques etc. • Microscopic – asbestos bodies, granulomas, silicotic nodules, dust particles. • Mineral analysis – compare to control population.

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