The algorithm of morphological diagnosis of dusty lesions of the lungs in tumors according to resection data

Abstract

Introduction. The growth of environmentally caused respiratory diseases is an urgent problem of respiratory medicine. The Sverdlovsk region is a large diversified industrial center, which determines the high level of dust pathology in the region. At the same time, many questions of nosological verification of dusty lung lesions remain insufficiently studied.The aim of the study is to determine the structure of dust pathology and to develop criteria for morphological diagnosis of dust lesions of the respiratory organs on the material of lung resections in tumors.Materials and methods. The work is based on the study of the pathomorphology of dust lesions of the respiratory organs in 315 cases of resections of the lungs and intra-thoracic lymph nodes in patients with primary lung cancer operated in the Thoracic Surgery Clinic of the Sverdlovsk regional anti-tuberculosis dispensary. Macroscopic and histological examination of the surgical material of the lungs and lymph nodes was carried out; polarizing microscopy was performed in all cases to identify anisotropic structures in dust clusters. In complex cases of expert evaluation, the most effective and reliable method scanning electron microscopy with x-ray spectral microanalysis-was used to study the elemental composition of dust in lung and lymph node tissue.Results. Dust lesions of the respiratory organs were detected in almost all cases and are represented by non-professional dustchanges associated with smoking, household anthracoconiosis and dust lesions of a professional nature (pneumoconiosis). The frequency of dust lesions is determined and the criteria for morphological diagnostics of household and professional dust lesions are formulated. It is shown that in most cases, when examining surgical material for lung cancer, signs of “combined dusting” are detected, including morphological manifestations of pneumoconiosis of professional and household nature. Pneumoconiosis of a professional nature was detected in 34 (10.8%) cases in the presence of the corresponding dust experience in the history. On the resection material found morphological signs of silicosis and anthracosilicosis (5 cases, 1.6%), electric welder pneumoconiosis (13 cases, 4.2%), bauxite pneumoconiosis (8 cases, 2.5%), pneumoconiosis caused by titanium dust (2 cases, 0.6%), pneumoconiosis caused by exposure to mixed dust (6 cases, 1.9%) were found on the resection material. Asbestos-associated lesions were morphologically determined in 3 cases (2.2%). Attention is drawn to the relatively high frequency of bauxite pneumoconiosis, whose morphological criteria for diagnosis, including color features of anisotropy, are presented almost for the first time.Conclusions. The “Algorithm of morphological diagnostics of dust lesions of the respiratory organs in lung tumors” has been developed. It should be emphasized that the morphological of pneumoconiosis requires clinical and radiological comparisons and mandatory confirmation by professional pathologists. Thus, the diagnosis of dust pathology of the lungs according to resections should be the result of joint multidisciplinary work of doctors of various specialties.