Silicotuberculosis with oesophagobronchial fistulas and broncholithiasis: a case report.

A 76-year-old woman was admitted to the hospital four times from November 2007 to June 2009. In this complex case, the patient had silicosis complicated by broncholithiasis, oesophagobronchial fistulas, and relapsed tuberculosis. She had worked as a stone crusher for 3 years and was exposed to a large amount of quartz dust. Barium oesophagography, gastroesophageal endoscopy, and biopsy suggested oesophageal-related chronic inflammation and ulceration, which may have caused the repeated oesophagobronchial fistulas. Bronchoscopy revealed a free broncholithiasis in the left mainstem bronchus. The patient was admitted a fourth time because of silicotuberculosis relapse. After 9 months of antituberculosis treatment, the patient recovered and was still clinically well at the time of this writing.

[Silicotuberculosis]. / La silicotuberculose.

OBJECTIVE: Tuberculosis is a serious and common complication of silicosis. The aim of this study is to describe the epidemiological, clinical, radiological and progressive aspects of this pathological entity. PATIENTS AND METHODS: The study concerns 23 cases of silicotuberculosis which were collected at the service of respiratory diseases at CHU Ibn Rochd of Casablanca, Morocco during 12years (2003-2015). RESULTS: All patients were men. They were 7 diggers, 5 rock crushers, 7 miners and 4 masons. The mean duration of silica exposure was 11years. The symptomatology was dominated by dyspnea and persistent bronchial syndrome. Imagery showed tumor-like opacities in all cases, associated with mediastinal calcified lymphadenopathy in 9 cases, with micronodules in 8 cases and an excavated opacity in 2 cases. The diagnosis of tuberculosis was confirmed by isolation of the Koch's bacillus in sputum in 13% of cases in the bronchial aspirate in 52% and culture in sputum post-bronchoscopy in 13%. The bronchial biopsies confirmed the diagnosis in 2 cases. Tuberculosis had complicated silicosis 9years on average after the cessation of exposure to silica in 65% of cases. The antituberculous treatment was started in all patients with good clinical outcome in 22 cases. We had deplored a case of death by acute respiratory failure. CONCLUSION: Silicosis increases the risk of tuberculosis, hence the importance of TB screening in all patients with silicosis.

The pathologist's view of silicosis in 1930 and in 2015. The Johannesburg Conference legacy.

The 1930 International Labour Office Conference on silicosis in Johannesburg was a turning point in the history of silicosis and in the recognition of the associated pathologic patterns. Since 1930, pneumoconioses such as silicosis have become much rarer in developed countries and can now be diagnosed at an early stage based on clinical and radiologic criteria. However, in spite of these advances, pathologists must remember to look for silica in tissues, particularly when clinical and radiologic findings are more uncertain. Furthermore, nowadays pathologists essentially observe silicotic lesions as incidental findings adjacent to lung cancers. In addition to identifying the characteristic lesions, pathologists must also try to identify their causative agent, in the case of crystalline silica firstly by using polarized light examination, followed as appropriate by more sophisticated devices. Finally, pathologists and clinicians must always keep in mind the various implications of exposure to silica compounds in a wide range of diseases.

Establishment of rat model of silicotuberculosis and its pathological characteristic.

OBJECTIVE: To establish different stages of silicosis rat model complicated with tuberculosis infection, and compare the pathological characteristics and analyze the impact of silicosis on tuberculosis infection. METHODS: SD rats were subjected to intratracheal administration of silica with non-exposure method at the 1st, 30th, or 60th day. At the 50th day, the rats were injected with the suspension of H37Rv (a virulent standard strain of Mycobacterium tuberculosis) via tail-vein. After 40 days post-infection, rats were sacrificed, the lung tissues were isolated, and paraffin was embedded and sectioned. The sections were treated using HE staining for structure observation, acid fast stain of Ziehl-Neelsen for bacterial detection, and Warthin-Starry silver staining for displaying the distribution of dust particles. The bacterial load was quantified by colony counting. RESULTS: Primary to tertiary silicosis could be discovered at the 30th, 60th, and 90th day of post-infection. The rats could be infected by injection of M. tuberculosis via tail vein, with tuberculosis load and the degree of lung tissue lesions positively correlated with silicosis. CONCLUSION: The rat model of silicotuberculosis was established successfully, which facilitated understanding the 'cross-talk' of silicosis and tuberculosis during the process they drive each other.

[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

[Erasmus' syndrome with pseudo-tumour masses]. / Un syndrome d'Erasmus avec des masses pseudo-tumorales.

INTRODUCTION: Erasmus' syndrome involves the association of systemic scleroderma (SS) and exposure to silica. Silicosis may precede the SS but the latter may be the presentation, in which case a history of exposure to silica should be sought as part of the diagnosis. CASE REPORT: A 46-year-old man with history of pulmonary tuberculosis presented with dyspnoea and dysphagea. Clinical examination revealed thickening of the facial skin with a pointed nose, erythema and telangiectasia, Raynaud's syndrome and sclerodactyly. A thoracic CT scan revealed bilateral, fibrotic, pseudo-tumoural masses. Antinuclear antibodies, anti-topoisomerase 1 and antihistone were positive. CONCLUSION: The clinical presentation of Erasmus' syndrome associating systemic scleroderma and pulmonary pseudo-tumours may pose a problem of differential diagnosis from lung cancer. This condition requires regular clinical and radiological monitoring, particularly as both scleroderma and silicosis increase the risk of lung cancer.

Analysis of fibrotic depositions in granulomas in chronic silicotuberculosis in mice.

The stimulating effect of silicon dioxide on fibroblast proliferation in granulomas of male CBA mice surpasses that of BCG vaccine mycobacteria. The number of fibroblasts in granulomas after combined treatment with BCG and SiO2 increased by more than 3 times compared to individual treatment with BCG and by 2 times compared to treatment with SiO2 alone. In silicosis and silicotuberculosis, collagen and argyrophilic fibers in granulomas during the period from 4 to 6 months after administration of granulomogenic factors occupied more than 90% granuloma volume, which 3-fold surpassed the corresponding parameter in mice infected with BCG vaccine alone. In silicosis, pronounced fibrosis was determined by relatively high proliferative and synthetic activities of fibroblasts, while in silicotuberculosis it was achieved due to significantly higher proliferative activity against the background of lower synthetic activity.

Experimental cytomorphological studies of the reaction of mononuclear phagocyte system in granulomatosis of mixed (silicotic and tuberculous) etiology.

Silicon dioxide in combination with Mycobacterium tuberculosis in BCG vaccine is characterized by a significantly higher granuloma-inducing activity than BCG or silicon dioxide alone. Cell "dissociation" from granulomas is not characteristic of granulomas induced by silicon dioxide or its combination with BCG (in contrast to BCG-induced granulomas). A steady increase in the counts and size, particularly on days 120-180, mainly at the expense of fibroblast accumulation and subtotal fibrosis, are intrinsic to these granulomas. Monocyte retention in the bone marrow is characteristic starting from day 56 until day 180 after injection of both granulomatous factors alone or in combination, particularly so in BCG granulomatosis.

[Pathomorphology of specific inflammation in silicotuberculosis].

Silicotuberculosis is an independent disease that arising in patients with silicosis from exacerbation of old tuberculous foci in the lung, less frequently in the lymph nodes and other organs. In silicotiberculosis, there are common secondary tuberculosis forms that are located mainly in the lung, which are rarely accompanied by a rapid progression. Characteristic morphological signs of early, nodal and nodular silicosis are observed. Silicotuberculosis is an independent disease that arises in patients from an exacerbation of old tuberculous foci in the lung, less frequently in the lymph nodes and other organs. In silicotuberculosis, there are usually secondary tuberculosis forms that are located mainly in the lung, which are rarely accompanied by a rapid progression. The characteristic morphological signs of early, nodal, and nodular silicosis are observed. Thoracic and abdominal lymph nodes, lymphatic and blood vessels, the bronchi and pulmonary surfactant system were explored. In silicosis, tuberculosis, and silicotuberculosis, silicon levels and spodograms of some visceral organs were studied and trace elements were determined in the lung.

[A case of silicotuberculosis with difficulty in its diagnosis].

A 68-year-old man who had worked as a stone mason for more than 50 years with a heavy smoking history consulted our clinic with symptoms of cough, low grade fever, weightloss, malaise and a single expectoration of hemo-sputum. He had been diagnosed as silicosis by the mass survey 5 years ago based on nodular shadows with egg-shell calcification in hilar lymphnodes on his chest radiography, and has received chest radiographic examination once a year. As the author was not so familiar with the radiographic features of silicotuberculosis, it was difficult to interprete ill-defined contour of silicotic nodules accompanied by patchy opacities formation in right midlung field and silicotic conglomeration accompanied by an ischemic cavity in the left basal segments. A definitive diagnosis could not be established until 10 months later when a second attack of exacerbation of silicotuberculosis occurred showing multiple thin walled fresh tuberculous cavities on the chest radiography with positive smear and culture. Among multiple tuberculous cavities, there was a cirrhotic-walled cavity caused by endogenous reactivation of a quiescent tuberculous lesion on the right apex. This lesion was considered to be the source of dissemination of this case. Finally, it took about two and a half years before establishing the diagnosis in this case because of a series of doctors delays. He was treated successfully with antituberculous drugs for one and a half years including one year rifampicin medication. The clinico-pathological findings of silicotic conglomeration in the left basal segments were discussed based on the findings of transbronchial biopsy from occluded B10 and chest radiographic findings, and it was revealed that silicotic conglomeration might consist of inflammatory granulation combined with granulomatous tubercle, but not a fibrous lesion.

[Bronchoalveolar lavage in the diagnosis of occupational pulmonary diseases in miners]. / Bronkhoal'veoliarnyi lavazh v diahnostytsi profesiinykh lehenevykh zakhvoriuvan' u hirnykiv.

One of objective methods of early and differential diagnosis of occupational pulmonary diseases in miners (pneumoconiosis, silicotuberculosis, dust bronchitis) is bronchoscopy with a cytologic examination of bronchoalveolar lavage fluid (BAF). BAF-examination was carried out in a total of 88 patients with incipient and advanced forms of dust bronchitis, pneumoconiosis and silicotuberculosis. A direct relationship has been revealed between a decline in local cell-bound immunity caused by a dust-inducted affection mononuclear phagocytes and advancing of stages of dust-related diseases.

[Clinical and morphological comparisons in pulmonary tuberculosis in workers from pneumoconiosis-risk industries]. / Kliniko-morfologicheskie sopostavleniia pri tuberkuleze legkikh u rabochikh koniozoopasnykh proizvodstv.

The relationship between the efficiency of treatment and the nature of morphological changes in the lung was studied in 125 patients with pulmonary tuberculosis without X-ray signs of pneumoconiosis who worked at coniosis-risk enterprises (CRR). Despite adequate specific and pathogenetic therapy, tuberculomas formed and decay cavities preserved in the patients, in this connection they had surgical treatment. Three types of morphological changes were identified. Quartz-containing industrial dust was found to exert an adverse potentiating effect on the course of tuberculosis in most CRE patients: increases in the delimiting a specific process of respiratory disorders and postoperative complications. These specific features should be borne in mind in drawing up a treatment protocol for patients working exposed to industrial dust.

Silicoproteinosis of the lung in a 49-year-old man.

We report a rare case of silicosis, histologically corresponding to silicoproteinosis and tuberculosis, in a man working consecutively as a miner, blacksmith and founder. A microscopic study revealed deposits in alveoli, in which immunohistochemistry did not reveal surfactant (SP-A), that was present in the alveolar fluid in alveolar lipoproteinosis.

MRI signal characteristics of progressive massive fibrosis in silicosis.

AIM: To determine the magnetic resonance imaging (MRI) signal characteristics of progressive massive fibrosis (PMF) in silicosis. SUBJECTS AND METHODS: We evaluated prospectively the MR appearances in 17 patients with 34 PMF lesions on the basis of pre-contrast signal intensity (SI) and SI pattern and post-contrast enhancement pattern, using a 0.5-T unit. There were 13 PMF lesions in six patients who had silicosis and 21 PMF lesions in 11 patients who had silicotuberculosis. The SI pattern on T2-weighted image (WI) was classified into four types and the pattern of contrast enhancement on T1-WI was classified into three types. MR appearances of PMF lesions were correlated with the findings of computed tomography (CT). RESULTS: The commonest signal intensity characteristic was isointensity (70%) on T1-WI and hypointensity (68%) on T2-WI when compared with skeletal muscle. For signal pattern on T2-WI, a type with only internal high SI areas (46% in silicosis group, 38% in silicotuberculosis group) was most frequent. All of these areas corresponded to the low density areas at CT, suggestive of necrosis. After intravenous contrast medium enhancement, rim enhancement (54% in silicosis group, 52% in silicotuberculosis group) was most frequent, followed by no enhancement. CONCLUSION: The most common MRI appearance of PMF was isointensity on T1-WI and hypointensity on T2-WI when compared with skeletal muscle, with internal high SI areas on T2-WI and either rim enhancement or no enhancement.

[Pulmonary fibrosis caused by inhalation: silicosis]. / Fibrosis pulmonares por inhalación: silicosis.

Silicosis is an important disease not only for its prevalence and the degree of pulmonary insufficiency it entails but also because it provides a natural model of interstitial fibrotic disease in the lung which is of known origin. This can, in turn, help us understand the pathogenic nature of a great number of pulmonary fibroses whose cause is unknown. The fifty postmortem studies which we describe correspond to miners who had worked in underground mines in the mountainous region near Cartagena (SE Spain) for times ranging from 5 to 36 years. The autopsies showed that they had been exposed to dust containing abundant metallic particles, particularly iron oxide (mixed dust). Although the pathogenic action was related with silica, it was also clearly modified by the composition of the dust associated with it. The basic lesions which are produced in the lung after inhalation of silica (< 5 microns diameter) are coniosis, fibroconiosis and sclerohyalinosis. The sclerohyalino nodules are characterized by abundant collagenization and hyalinization, different types of which can be distinguished according to the disposition of the collagenous fibres. Nodular lesions gradually grow in size even when exposure to dust has ceased. As they grow they get nearer until they join to form conglomerate masses. When the diameter exceeds 3 cm this is called massive fibrosis. Pulmonary tuberculosis was found in 27% of cases. This took the form of lesions, which could be associated to or independent of silicotic lesions. Besides evolutive nodular lesions, a patient suffering from silicosis may show other unspecific lesions which must be correctly evaluated for a more correct clinical-pathological assessment, since, clinically, the respiratory function may be profoundly affected although such silicotic damage may be not very noticeable by radiological examination. Silicosis of the liver and spleen was not infrequent in the autopsies carried out, with basic lesions in all evolutive states being observed, the most evolved in the spleen. This means that silicosis should be considered as a systemic illness.

[Comparative characteristics of intrathoracic lymph node coniotuberculosis of occupational and non-occupational etiology]. / Sravnitel'naia kharakteristika koniotuberkuleza vnutrigrudnykh limfaticheskikh uzlov professional'nogo i bytovogo geneza.

263 patients with coniotuberculosis of the intrathoracic lymph nodes were compared clinically according to whether they were or not at 0ccupational risk of silicosis. Patients exposed to quartz dust had some special morphological picture of affected lymph nodes: periadenitis, dust caseosis and tubercula in the presence anthracosilicosis sclerosis. Silicotuberculous broncho-adenitis in silicosis patients is characterized by solitary lesions of the lymph nodes, bronchi, rare dissemination to the lungs. Coniotuberculous broncho-adenitis in elderly subjects arises in the result of occupation-unrelated accumulation in the lymph nodes of coal and quartz dust and runs chronically. Unless the disease is controlled early and actively, it may generalize and aggravate with perforation in the bronchi, vessels and esophagus. Profuse hemorrhage, caverns, atelectasis are also possible.

[Pathological observations on massive fibrosis of coal-mine pneumoconiosis].

Morphological studies on massive pulmonary fibrosis due to pneumoconiosis in 42 cases were performed. The cases were divided into two types: the coalescence of fibrotic nodules type and the progressive massive fibrosis type. The former includes fusion of simple silica or coal-silica nodules and coalescence of mainly coal-silico-tubercle nodules. When pneumoconiosis is complicated by tuberculosis, the coal-silico-tubercle is the pathological change caused by the combination of dust and inflammation. The resulting conglomerate mass can be classified as progressive massive fibrosis. A comparison of micro-element content between non-massive fibrosis and massive fibrosis was made, and only the silicon content showed a significant difference (P < 0.05). The morphology, pathogenesis and formation of progressive massive fibrosis are discussed.