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Coal workers’ pneumoconiosis / progressive massive fibrosis

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 26 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


● Incidence declining due to dust reduction measures

Simple coal workers’ pneumoconiosis (CWP)


● Patients have coal macules (1-2 mm collections of carbon-laden macrophages) and coal nodules (coal macules and fibrosis) scattered throughout lung, more in upper lobe and upper lower lobe, near respiratory bronchioles
● Usually minimal symptoms but 10% develop progressive massive fibrosis

Micro images

Coal worker's pneumoconiosis

Progressive massive fibrosis


● Also called complicated coal workers’ pneumoconiosis
● Intensely blackened scars > 2 cm, multiple and containing dense collagen and pigment
● Center of lesion may be necrotic due to ischemia
● Associated with pulmonary hypertension and cor pulmonale
● May progress even if dust exposure ceases
● Due to any pneumoconiosis, although most common in CWP and silicosis
● Associated with increased incidence of clinical tuberculosis, chronic bronchitis and emphysema and independent of smoking
● In isolation, not appear to increase the risk of lung cancer

Caplan syndrome


● Rheumatoid arthritis and pneumoconiosis cause rapidly developing nodular pulmonary lesions showing central necrosis surrounded by collagen, fibroblasts and macrophages (similar to rheumatoid nodules)
● Associated with exposure to coal, asbestosis and silica dust

End of Lung-nontumor > Pneumoconiosis > Coal workers’ pneumoconiosis / progressive massive fibrosis

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