Pleuroparenchymal Fibroelastosis With Long History of Asbestos and Silicon Exposure

Our plain-English summary of Pleuroparenchymal Fibroelastosis With Long History of Asbestos and Silicon Exposure, by L. Xu, N. Rassaei, C. Caruso (International Journal of Surgical Pathology, 2018).

The study

• Authors: L. Xu, N. Rassaei, C. Caruso
• Journal: International Journal of Surgical Pathology
• Published: 2018;26(2):190-193
• Type of article: Case report
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleuroparenchymal fibroelastosis (PPFE) is an uncommon interstitial lung disease. PPFE is characterized by fibroelastosis involving the pleura and subjacent parenchyma with a predominantly upper lobe distribution. While different possible environmental and familial etiologies have been postulated in the literature, the etiology of this disease remains essentially unclear and most cases are considered as idiopathic. In this report, we describe a rare case of PPFE with multiple lung lobe involvements and prolonged asbestos and silica exposure. Our goal is to investigate the exposure of asbestos and silica and try to identify their possible association with PPFE.

In plain English

This was a case report about one patient with pleuroparenchymal fibroelastosis (PPFE), a rare lung disease in which scarring rich in elastic fibers affects the pleura (the lung lining) and the lung tissue just beneath it. The patient was a 71-year-old African American man with several years of chronic cough and worsening breathlessness on exertion. He had long-time silica exposure from sanding work and 50 years of asbestos exposure as a drywaller. The report did not say which type of asbestos. He had an 18 pack-year smoking history and had quit 20 years earlier. Tissue removed from his right upper, middle and lower lobes showed the same PPFE changes in all three. The microscope showed needle-shaped particles suggestive of silicates and scattered ferruginous bodies, described as suggestive of asbestos bodies. Sixteen months later he was clinically stable, but his FEV1 had fallen from 2.09 L (73%) to 1.80 L (61%). The authors called this, to their knowledge, the first reported PPFE case with prolonged exposure to both silica and asbestos. They wrote that both might have played important roles in his clinical course.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (a single patient)
• Who was studied: One 71-year-old African American man with chronic cough and progressive breathlessness on exertion over several years. He had an 18 pack-year smoking history and had quit smoking 20 years earlier. The report did not state where or when he was treated.
• Exposure: Long-time silica exposure from sanding work and 50 years of asbestos exposure as a drywaller. The asbestos fiber type was not stated.
• Main results:
  • Wedge excisions of the right upper, middle and lower lobes all showed similar changes, including fibroelastosis of the visceral pleura (the lining covering the lung).
  • On gross examination the pleura was thickened, up to 0.2 cm, with focal, scattered small calcifications.
  • Under polarized light, scattered needle-shaped particles suggestive of silicates were seen in the lung tissue.
  • Scattered ferruginous bodies were found in the lung tissue. A figure caption described them as suggestive of asbestos bodies.
  • Lung function testing showed a diffusion capacity for carbon monoxide (DLCO) of 33% of the predicted value.
  • At follow-up 16 months later, the patient was clinically stable overall, but his FEV1 had dropped from 2.09 L (73%) to 1.80 L (61%).
• The authors' conclusion: The authors concluded that, to their knowledge, this was the first reported case of PPFE with prolonged exposure to both silica and asbestos. They wrote that both silica and asbestos (worded as 'asbestosis' in the article) might have played important roles in the patient's clinical course.

Topics

Medical terms in this study, explained in our Lexicon: Interstitial Lung Disease, Pleura, Parenchyma, Etiology, Idiopathic.

Related studies

• Idiopathic pleuroparenchymal fibroelastosis: an unrecognized or misdiagnosed entity? — C.D. Becker, J. Gil, et al. (2008)
• A CARE-compliant case report: Lung transplantation for a Chinese young man with idiopathic pleuroparenchymal fibroelastosis — H. Huang, R. Feng, et al. (2017)
• Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis — A. Sekine, E. Hagiwara, et al. (2021)
• Asbestosis: demonstration of distinctive interstitial fibroelastosis: a pilot study — M.R. Wick, T.J. Kendall, et al. (2009)
• Respiratory symptoms and functional status in workers exposed to silica, asbestos, and coal mine dusts — X.R. Wang, D.C. Christiani (2000)
• Silicon: the health benefits of a metalloid — K.R. Martin (2013)

Browse more research in International Journal of Surgical Pathology, or return to medical research.