68Ga-PSMA-Ligand PET/CT Uptake in Anthracosilicosis.

This interesting image illustrates a case of biopsy-proven pulmonary anthracosilicosis, a mixed dust pneumoconiosis, associated with Ga-PSMA-ligand uptake. Prostate-specific membrane antigen (PSMA) is an emerging imaging biomarker, with clinical application in evaluation of prostate cancer using Ga-PSMA-ligand PET/CT. Contrary to its name, PSMA is expressed in a number of other normal tissues and pathological states. Prostate-specific membrane antigen expression has been linked to tumor angiogenesis in various other epithelial neoplasms, as well as neovasculature associated with tissue regeneration and repair. Awareness of nonneoplastic inflammatory conditions associated with Ga-PSMA-ligand uptake aids in patient assessment and management.

Rapid Growth of Lung Nodules due to Combined Pulmonary Vasculitis, Silicoanthracosis, and Chondrocalcinosis.

Background. Silicoanthracosis is a pneumoconiosis due to occupational inhalation of silica and carbon dusts. Clinically, it can be associated with vasculitis or rheumatoid arthritis. In association with these diseases, silicoanthracosis can present within the lung with multiple pulmonary nodules which, as a differential diagnosis, can mimic metastatic disease or multiple abscesses. Case Presentation. We present the case of a 62-year old former pit worker with pulmonary nodules, chondrocalcinosis due to calcium pyrophosphate deposition (CPPD), and a history of renal cancer. Within a short period of time, pulmonary nodules grew rapidly. Thoracoscopically, the resected lung specimen revealed silicoanthracosis associated with small-to-medium-size vasculitis in the presence of antineutrophil cytoplasmatic autoantibodies (c-ANCA). Conclusion. Pulmonary silicoanthracotic lesions on the base of ANCA-associated vasculitis and CPPD arthritis can rapidly grow. A mutual correlation between silicoanthracosis, ANCA-associated vasculitis, and CPPD seems possible. Apart from this, consideration of metastatic disease should be obligatory in patients with a history of cancer at the same time being immunosuppressed.

[Quantitative characteristics of pathomorphologic changes in bronchi and pulmonary artery branches in miners with preroentgenologic stage of anthrasilicosis].

Morphometric studies covered lung tissue of 10 miners exposed to dusty work conditions over 1 to 30 (13.4 +/- 3.6) years, who were considered apparently healthy according to follow-up examinations and died in technogenic accident. Findings are that dysregeneration, hypertrophic and sclerotic changes in respiratory part of lungs, in bronchi and in pulmonary circuit arteries develop simultaneously--that proves common pathogenetic concept of these changes and systemic character of the pneumoconiosis. The results necessitate improved methods to evaluate health state of workers, refined criteria for nosologic diagnosis of respiratory diseases related to dust.

[Anthracosilicosis: a rare clinical and radiological presentation simulating lung metastases]. / Silicoantracosis: una forma de presentación clinicorradiológica excepcional simulando metástasis pulmonares.

We present the case of an asymptomatic patient with an initial clinical and radiological diagnosis of lung metastases in whom histological study diagnosed anthracosilicosis. A review of the literature shows that this presentation of anthracosilicosis is exceptional; our patient had atypical radiological findings and a very long latency period (over 50 years) after a brief (nearly 6 years) exposure to coal dust.

CT differentiation of anthracofibrosis from endobronchial tuberculosis.

OBJECTIVE: The purpose of this study was to use CT to differentiate anthracofibrosis from endobronchial tuberculosis (TB), both of which are major causes of benign bronchostenosis. MATERIALS AND METHODS: We retrospectively reviewed the clinical and CT findings of 49 patients with anthracofibrosis and 35 patients with endobronchial TB diagnosed on the basis of bronchoscopic, microbiologic, and pathologic findings. Forty-five patients with anthracofibrosis and 32 patients with endobronchial TB had bronchostenosis on CT and were enrolled in the analysis. Nine (20%) of 45 patients with anthracofibrosis had coexistent active TB (two, endobronchial TB; six, pulmonary TB; one, TB pleurisy), and 13 (29%) had pulmonary infections other than TB. Two patients with anthracofibrosis and coexistent endobronchial TB were excluded from the analysis. The CT findings were analyzed with emphasis on the pattern, distribution, and location of bronchostenosis and the number of pulmonary lobes involved. RESULTS: Anthracofibrosis was more common than endobronchial TB among elderly patients (p < 0.05). Statistically significant findings on CT were the pattern of bronchostenosis, presence of main bronchus involvement, and number of pulmonary lobes involved (p < 0.05). Bronchostenosis with anthracofibrosis usually involves multiple lobar or segmental bronchi. The main bronchus, however, tends to be preserved in anthracofibrosis. Most cases of endobronchial TB involve one lobar bronchus and the ipsilateral main bronchus with contiguity in extent. CONCLUSION: Anthracofibrosis can be differentiated from endobronchial TB on CT. Furthermore, CT is helpful in the diagnosis of anthracofibrosis before bronchoscopy is performed.

A case report of anthracosilicotic spindle-cell pseudotumor of mediastinal lymph node: cytologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration.

Pigmented spindle-cell tumors of the lymph nodes have a broad differential diagnosis, including both benign and malignant neoplasms. Here, we report a case of a pigmented spindle-cell lesion in a mediastinal lymph node mimicking a spindle-cell melanoma on fine-needle aspiration cytology. Smears showed atypical polygonal and spindle cells with bland nuclear features and abundant cytoplasmic anthracotic pigment. Immunohistochemistry was negative for melanoma markers, but showed positivity for histiocyte markers. Polarization microscopy revealed minute birefringent intracellular crystals consistent with silica. Electron microscopy was confirmatory and a diagnosis of anthracosilicotic spindle-cell pseudotumor was made. To the best of our knowledge, fine-needle aspiration cytology findings of this lesion have not been reported.

[Correlation of different types of emphysema in high-resolution computed tomography (HR-CT) with the ILO-classification of coal workers pneumoconiosis]. / Zusammenhang zwischen Empyhsemtyp und Schweregrad der Pneumokoniose bei Bergleuten: Korrelation von HR-CT-Befunden und ILO-Klassifikation.

PURPOSE: The complaints of patients suffering from pneumoconiosis and the decrease in cardio-respiratory function tests are related to the major complications, emphysema or bronchitis, resp. to a lesser degree the complaints are directly influenced by the silicotic process itself. Up to now, no large study has analysed the correlation of different types and severity of emphysema with the ILO-classification of pneumoconiosis in miners. MATERIAL AND METHODS: In 104 miners the severity of pneumoconiosis was classified by ILO. By HR-CT the type and severity of emphysema was analysed using a 4-point-scale. The correlation of emphysema with the ILO-classification was tested with Pearson-correlation. RESULTS: The centrolobular emphysema was the dominant type with 59 %, but there was no dependence on the severity of pneumoconiosis. Only the paracicatricial emphysema had a significant correlation (p < 0.05) with the degree of large opacities. On the other hand, the paracicatricial emphysema was only detected in 32 %; under quantitative aspects it was seen to be less common than the centrolobular, the parapleural and the paraseptal emphysema (46 %). There was no significant correlation with the size and distribution of the small opacities and the different types of emphysema. CONCLUSIONS: Only the large opacities had a significant correlation with the appearance of paracicatricial emphysema. The other types of emphysema, especially, the dominant centrolobular type had no obvious association with pneumoconiosis. The multifactoral genesis of emphysema has to be taken into account.

Hepatosplenic antracosilicosis: a rare cause of splenic calcifications.

A case of a 62-year-old man with known longstanding pulmonary antracosilicosis, with associated hepatosplenic antracosilicosis, is presented. A CT scan of the upper abdomen revealed multiple calcifications within the spleen, and to a lesser degree within the subcapsular region of the liver, as well as "egg-shell" calcifications of abdominal lymph nodes, most noticeable at the splenic hilum. Although histopathologically not proven, the similar appearance of the calcified hepatosplenic nodules to the small round calcifications scattered throughout the lungs, as well as the typical "egg-shell" morphology of the calcified abdominal lymph nodes, should raise the suspicion of hepatosplenic antracosilicosis.

["Phtisis atra"--a now seldom disease picture as a special disease course of silicosis]. / "Phtisis atra"--ein heute seltenes Krankheitsbild als besondere Verlaufsform der Silikose.

Progressive massive fibrosis (PMF) of the lung is caused by coalescence of fibrotic nodules. The center of the PMF often displays necrotic areas. If the necrosis gets in contact to the bronchial system cavitation may occur. We report on a 68 year old patient suffering from severe silicosis of the lung and metastatic spread of a histologically proven lung cancer into the brain. The patient who was administered to the hospital under the intention of cerebral radiotherapy showed a colliquative PMF in the right upper lobe with cavitation and expectoration of large amounts of black-stained sputum (melanoptysis).

Anthracotic and anthracosilicotic spindle cell pseudotumors of mediastinal lymph nodes: report of five cases of a reactive lesion that stimulates malignancy.

We report five cases of reactive mediastinal spindle cell proliferations associated with anthracosis and anthracosilicosis that simulated a malignant process both on clinical and morphological grounds. Clinically, the lesions formed radiographically evident masses or were infiltrative. Microscopically, a prominent storiform pattern of intertwining spindle cells was found in four cases. This proliferation extended outside of the lymph node capsule in three cases and surrounded nerves in two. Because of this combination of features, the submitted diagnoses included a malignant neoplasm in four cases. The spindle cells were immunoreactive for histiocytic markers and focally contained fine anthracotic pigment. All cases featured nodular hyaline scars and contained polarizable material suggestive of silica, although a history of industrial exposure was obtained in only two cases. No lesion has enlarged or otherwise progressed during follow-up ranging from 6 to 48 months. The differential diagnosis includes a variety of spindle cell neoplasms, including malignant fibrous histiocytoma, follicular dendritic cell tumor, spindle cell melanoma, and Kaposi's sarcoma.

[Interpretation of early radiological changes in the diagnosis of pneumoconiosis among coal miners]. / Interpretacja wczesnych zmian radiologicznych w diagnostyce pylicy górników kopaln wegla kamiennego.

Apart from certain changes which are typical for pneumoconiosis, the radiological picture of the lungs of sigma coal miners does frequently show some irregular small opacities of s, t and u types. The role and specificity of these changes in the early diagnosis of pneumoconiosis has not been too well defined by now. A 10-year study (conducted at 2 or 3 year intervals) was carried out among 150 miners from 2 mines characterized by different dust loading. Some irregular changes in the miners' lungs were observed. The control group derived from the same mines comprised 115 miners with no radiological changes found in their lungs. The evolution of radiological changes took place in 55.3% of the miners and was more intensive in the heavily dusted mine. Radiological changes were revealed in 38.3% of the controls. It was indicated that pneumoconiosis results much more frequently (38.6%) from the evolution of the irregular changes rather than directly from the proper radiological picture of the lungs (5.3%). In 44.7% of the subjects the changes of s, t and u type did not undergo any evolution, which may be due to their non-specific characteristics. The evolution of irregular opacities is dominating in the patients with bronchitis and emphysema. No significant correlation between smoking and the progress of irregular opacities was found. The observation of the further exposure to the dusts did not produce any clear results. The progress of the changes of s, t and u type was observed more frequently in those still working under ground, but more cases of pneumoconiosis were found in the miners who stopped working. This fact indicates that the further exposure affects the s, t and u type changes and confirms the observations by other authors concerning the manifestation of pneumoconiosis after the break of exposure. The results of the 10-year study prove that the miners with this sort of changes are exposed to a higher risk of pneumoconiosis, although the answer concerning specificity of irregular changes in the radiological picture has not yet been found.

A comparison of pneumoconiosis interpretation between Chinese and American readers and classifications.

As a preliminary step in joint Sino-American pneumoconiosis research efforts, a formal chest X-ray pneumoconiosis reading trial was conducted among Chinese and American radiologists. Twelve Chinese readers from different institutions located in south central China used the 1986 Chinese Roentgenodiagnostic Criteria of Pneumoconioses. Three American radiologists, centified as NIOSH "B" readers, used the International Labour Office Classification of Pneumoconioses. The chest X-ray study set consisted of 150 posterior-anterior films. One-half were Chinese X-rays of silica-exposed workers, and the other half were American films of variously exposed workers but primarily coal miners. All readings were done independently. The results showed that the inter-reader variability among the Chinese was similar to that of the American readers, both being in an acceptable range. In addition, there was general agreement between the Chinese and American interpretations. For small opacity profusion, the Chinese readers tended to read slightly more diseases than their American counterparts, although there was exact agreement as to the major category in two-thirds of the films. Agreement for film quality, and pleural disease was less, but was not different from reported variation among American "B" readers. Overall, the results suggest that despite the use of two different classification systems, a valid correspondence exists between the Chinese and American Interpretations, which is suitable for use in epidemiologic research.

[An comparative analysis of the radiographic appearances and the pathologic findings in anthracosilicosis and anthracosilicosis associated with tuberculosis].

Pulmonary tuberculosis is a serious complication of anthracosilicosis and a promoting factor for death. It is very difficult to distinguish the advanced stage of atypical anthracosilicosis from anthracosilicosis associated with tuberculosis by the chest radiograph when the tubercule bacili is negative in sputum, but it is necessary for physician to treat and administrate. In order to probe into the differential diagnosis of these two diseases author made a comparison analysis between the radiographic appearances and the pathological findings of 21 autopsies cases which were clinically diagnosed as anthracosilicosis associated with tuberculosis. There were 8/21 cases (38.1%) of misdiagnosis before the misdiagnosis there were the lack of series observation on the similarities and differences in radiographic appearances between these two diseases and neglect of sputum examination. The main points of clinical differentiation between them were summed up.

[CT diagnosis of coal workers' pneumoconiosis].

In order to evaluate the usefulness of CT in CWP, 100 coal workers were examined with both chest radiograph and CT scan. Comparison was done, the result indicated that both modalities yielded similar sensitivity to simple CWP. The CT score of simple CWP correlated well with ILO classification and 1986 Chinese criteria for staging of pneumoconiosis, whereas in complicated CWP, the CT scan was significantly superior to chest radiograph. CT scan identified readily large opacities. It could detect large opacities in 40% of simple CWP diagnosed on the basis of chest radiograph. CT scan also identified more cavities and calcifications within large opacities. The CT attenuation values were less reliable. The authors were of the opinion that at present CT attenuation values is not recommended for routine evaluation of CWP.