Lung - nontumor

Topic Completed: 1 September 2011

Revised: 30 January 2019, last major update September 2011

Copyright: (c) 2003-2017,, Inc.

PubMed search: asbestosis [title] pneumoconiosis pulmonary

Elliot Weisenberg, M.D.
Page views in 2018: 2,699
Page views in 2019 to date: 2,585
Cite this page: Weisenberg E. Asbestosis. website. Accessed October 15th, 2019.
Definition / general
  • Similar to other pneumoconiosis
  • Initial injury is at bifurcations of small airways and ducts; macrophages ingest fibers, release chemotactic factors and fibrogenic mediators, causing interstitial fibrosis similar to other fibrosing lung diseases such as UIP
  • Begins around respiratory bronchioles and alveolar ducts, extends distally; eventually causes honeycomb lungs
  • Begins in lower lobes and subpleurally (in contrast to coal workers' pneumoconiosisP and silicosis), progresses to middle and upper lobes
  • Visceral pleura becomes fibrotic, may bind lung to chest wall; may have associated Caplan syndrome
  • Symptoms: usually begin after 10 years of exposure, initially shortness of breath with exertion and later at rest; may progress to heart failure
  • Pleural plaques: well circumscribed plaques of dense collagen, often with calcium; on parietal pleura and dome of diaphragm; do not contain asbestos bodies, but rare if no asbestos history; may induce pleural effusions, usually no symptoms
  • Asbestos fiber detection: H&E, Prussian blue, incineration and EM
Gross images

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Pleural plaque

Microscopic (histologic) description
  • Early: interstitial pneumonia with desquamative features, hyperplastic alveolar cells with intracytoplasmic Mallory's hyaline tissue
  • Later: diffuse interstitial fibrosis with honeycombing (silicosis is nodular), asbestos bodies (golden brown, fusiform or beaded rods with translucent center; asbestos fibers coated with iron-containing proteinaceous material); iron from phagocyte ferritin
  • Asbestos fibers may have oxalate crystal deposition (Hum Pathol 2003;34:737)
  • Ferruginous bodies: inorganic particulates coated with phagocyte ferritin
Microscopic (histologic) images

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Asbestos fiber

Ferruginous body

Pleural plaque

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