Document LJz7DERo9jD1o1rZvO487r9rb

NOV-06-2002 WED 04:28 PM SHEPARD HOFFMAN ESQ FAX NO. 2145220420 P. 23 . /'"VI m lononuclear cells honuclear leukogroups of large *ur cut vacuoles, lar pigment. A ded in the tissue utting, it is difsplenitis, asbesestion, e; fibrosis and rework; patchy vor colls are . There arc s area. The ation, portal ymphoid coli an internal is is chronic its of largo ir substance >f asbestosis r ; There PULMONAHY ASBESTOSIS 63 is engorgement of I ho sinuses with serous material and polymorphonuIfr eiear leukocytes. The histologic diagnosis is asbestosis and acute lymphadenitis. In the lung there is comparatively heavy, old interlobular fibrosis, along the bronchi and blood vessels. Broad bands of fibrous tissue, generally old and hyaline, with considerable hyalino laminated nodule formation, are disposed generally in this aroa, including some adjacent alveoli. Bronchioles here aro irregularly and considerably dilated, and there is much deformity of alveoli involved in the fibrosis. In these alveoli aro large numbers of asbestosis bodies, generally large, brown, jointed, clubbed, and long dumb-bell shapes, in groups associated with large mononuclear phagocytes. These bodies are also seen embedded in the fibrosed areas, and in some of tho bronchioles, while large groups occur in lymph spaces near bronchi. There is only minor small mono nuclear or lymphocyte infiltration of tho fibro'sed tissue, with somo mucus and leukocytes in some bronchioles. The pleura is very thick, composed of old fibrous tissue, and while collections of asbestosis bodies appear in alveoli near the pleura, none are seen within the pleural fibrosed thickening. Thoro is an acute ex udation of fibrin upon the pleura, with some hyperemia, edema, and leukocytosis. There is some black granular material in the same gen eral fibrous area. In the intervening lobulos the alveoli are quite doformed by pressure and emphysema, many largo air sacs being seen. Generally these are empty. In tho lower left lobe the fibrosis is very heavy, most of tho alveolar structure being obliterated, and here thore is a marked bronchiectasis, with chronic inflammatory infiltration of the walls of the bronchi, some purulent exudate in these bronchi, and active pyogenic inflammation of the overlying thickened pleura. At the apices there is a remarkable grade of old fibrosis with large numbers of long asbestosis bodies in large giant colls in thick-walled spaces and in fibrosed areas, with hyaline nodule formation, necrosis and calcification, omphysema and bronchiectasis. Sections from the base of tho right lung, thought grossly to be tuber culous, show the caseous cavitation and infiltration thore to be carci nomatous. On a background of heavy fibrosis and bronchiectasis is extensive infiltration by masses and cords of stratified squamous epi thelium, maturing in considerable degree. This is shown to come from a bronchus, where there is squamous metaplasia of opithelial lining. There are considerable necrosis and purulent leukocytosis of the cavity area. Within and about the carcinoma area there is more active fibro sis than in other portions of the lung, and heavy lymphocytic infiltra tion. The histologic diagnosis is asbesto-silicosis, with fibrosis, emphy sema, bronchiectasis, chronic fibrous and acute pleurisy; epidermoid bronchial carcinoma.