6 Patterns > Fibrosis Pattern > Additional Features > w/ Variable Involvement > Pneumoconiosis

Pneumoconiosis

The term pneumoconiosis refers to the lung disease related to the inhalation of dust.  Once inhaled, dust typically results in pulmonary fibrosis.  Different types of dust have a tendency to develop different types of fibrosis.  Although there are a variety of specific types of pneumoconiosis due to inhalation of pure dust (silicosis, coal workers pneumoconiosis, asbestosis, silicosis, talcosis, siderosis, aluminosis, berylliosis, and hard metal pneumoconiosis) the reality is that most pneumoconioses coming across the surgical pathologists desk are related to mixed dust inhalation.  Therefore it is not uncommon to make a diagnosis of mixed dust pneumoconiosis.  Because chronic inhalation is the mechanism of tissue injury, it is not uncommon for these diseases to show an airway centered distribution to the abnormalities.  A uniform finding is the presence of dust as part of the fibroinflammatory process. 

SEE BELOW FOR SAMPLE SIGNOUT

If you are considering a diagnosis of Pneumoconiosis, the biopsy should show the following features:

• Fibrosis distorting the lung architecture, often in an airway centered distribution

• The fibrosis may show a variety of patterns, including a UIP pattern

• Presence of dust/foreign material

Pulmonary fibrosis with airway distribution

Airways disease with dust

Polarization of mixed dust particles

Mixed dust particles

Polarization of mixed dust particles

Biopsies with the following features should NOT be called Pneumoconioses:

• Cellular interstitial inflammation (consider CTD)

• Pleuritis (consider CTD)

• Lymphoid follicles (consider CTD)

• Numerous giant cells, especially if in the interstitium (consider chronic HP)

• Granulomas (consider chronic HP or Sarcoid)

Clinical Presentation

• Range of presentations from acute to chronic

• Most present with SOB and cough

Radiology

• Reticulation and honeycomb

• May be upper lobe or airway centered

Sample Signout

If you are comfortable that the biopsy has all the features of pneumoconioese and lacks the features arguing for an alternative explanation for the pulmonary fibrosis, consider the following approach to signing the case out:

Mixed dust pneumoconioses (see comment)

Comment:  Due to the presence of mixed dust particles, in combination with marked pulmonary fibrosis, a mixed dust pneumoconioese is favored. Correlation with an occupational exposure history is suggested.