Hard metal lung disease: a clinical, histological, ultrastructural and X-ray microanalytical study.

Four employees occupied in hard metal grinding work at the same machine shop developed interstitial lung disease after 2-7 years of working. Open lung biopsies from two of them showed giant cell interstitial pneumonia with bronchiolitis. The multinucleate giant cells were shown by electron microscopy to include both pneumocytes and macrophages. The giant pneumocytes were severely damaged, the endoplasmic reticulum being swollen and the few lamellar bodies being small, and some mitoses were visible in the pneumocytes. No mitoses were found in the giant macrophages. Pulmonary dust particles were studied in situ by scanning transmission electron microscopy and energy-dispersive spectrometry. Cobalt was no longer found in most of the pulmonary hard metal particles, but it was regularly detected in grinding dust particles in air samples studied by scanning electron microscopy and energy-dispersive spectrometry.

Quantitative x ray microanalysis of pulmonary mineral particles in a patient with pneumoconiosis and two primary lung tumours.

The right upper lung lobe of a 74 year old man was resected for a central tumour. Two primary cancers were found; a central small cell carcinoma and a peripheral squamous cell carcinoma. In addition, the peripheral lung tissue showed generalised peribronchiolar fibrosis extending from the non-respiratory bronchioles to the level of the alveolar ducts. Abundant asbestos bodies and large amounts of black dust were seen around the bronchioles. Pulmonary mineral particles were studied by quantitative energy dispersive x ray microanalysis (EDS) using scanning transmission electron microscopy (STEM). The x ray spectra for mineral particles were measured in thin sections, and the characteristic peak intensities of the elements were converted to weight fractions (in oxides). The results enabled the minerals present to be identified and their presence confirmed by calculating the mineral formula. These originated from nine natural minerals, anthophyllite and chrysotile asbestos, talc, and quartz, feldspars, and muscovite, which are components of sand, and also from two artificial mullites used in fire clay. The exposure history of the patient explained the most likely origins of the minerals detected. The patient had been a mason for 23 years, repairing and demolishing stoves and fireplaces and using asbestos for insulation work.