1
|
Davaajav K, Dagva D, Dashtseren I, Takahashi Y, Nakayama T. Elevated Levels of the Cancer Marker Neuron-Specific Enolase in a Patient With Coexisting Silicosis and Sarcoidosis. Cureus 2024; 16:e61130. [PMID: 38919222 PMCID: PMC11198998 DOI: 10.7759/cureus.61130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
In a periodical medical checkup, a 39-year-old Mongolian underground miner was diagnosed with silicosis based on chest radiography, computed tomography (CT), and work history. Chest radiography showed diffuse bilateral rounded nodules in both lung fields, with upper lobe dominance and large opacities in the right upper zone. Chest CT presented conglomerated massive changes in the right upper lobe and the coalescence of small nodules in the left upper lung. In the blood test, serum levels of the lung cancer marker neuron-specific enolase (NSE) were elevated (24.58 ng/mL). Carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA 21-1) levels were within the reference range. Subsequent to the suspicion of a tumour in the right upper lobe, a right upper lobectomy was performed. The histopathological examination of the lung specimen revealed the coalescence of numerous silica nodules, accompanied by indications of associated sarcoidosis. The histological features suggested the presence of two concurrent pathological processes: silicosis and sarcoidosis. This case demonstrated the combination of three clinical conditions diagnosed in one patient, including complicated silicosis associated with sarcoidosis and elevated serum NSE levels. This case report may serve as a foundation for future investigations exploring the potential of NSE as a marker for silicosis.
Collapse
Affiliation(s)
| | - Dolgormaa Dagva
- Forensic Medicine, National Forensic Agency of Mongolia, Ulaanbaatar, MNG
| | - Ichinnorov Dashtseren
- Pulmonology and Allergology, Mongolian National University of Medical Sciences, School of Medicine, Ulaanbaatar, MNG
| | | | - Takeo Nakayama
- Health Informatics, Kyoto University, Graduate School of Medicine, Kyoto, JPN
| |
Collapse
|
2
|
Hubska J, Shahnazaryan U, Rosłon M, Szczepankiewicz B, Nikiforow K, Pisarek M, Barnaś M, Ambroziak U. Sarcoid-like Lung Disease as a Reaction to Silica from Exposure to Bentonite Cat Litter Complicated by End-Stage Renal Failure-A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912921. [PMID: 36232221 PMCID: PMC9566682 DOI: 10.3390/ijerph191912921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 06/01/2023]
Abstract
A 44-year-old woman was admitted to hospital with end-stage renal failure, productive cough, and decreased exercise tolerance. She had owned nine cats, which resulted in long-term exposure (18 years) to silica-containing bentonite cat litter. High-resolution computed tomography of the chest showed micronodular lesions in the lungs, and mild mediastinal lymphadenopathy. A lung biopsy revealed multinucleated giant cells, some of which had birefringent material and Schaumann bodies. X-ray photoelectron spectroscopy revealed the presence of silicon in the lung biopsy specimen, as well as in the patient's cat litter. The pulmonary condition was suggestive of sarcoid-like lung disease, rather than silicosis, sarcoidosis, or hypersensitivity pneumonitis, according to the clinicopathological findings. Renal failure appeared to be a result of chronic hypercalcemia due to extrarenal calcitriol overproduction in activated alveolar macrophages. Ultimately, the patient was diagnosed with sarcoid-like lung disease complicated by end-stage renal failure from exposure to bentonite cat litter. Therapy with steroids, in addition to elimination of the bentonite cat litter exposure, resulted in a significant improvement in the health condition. At a follow-up visit after 4 months, an almost complete resolution of the lung lesions and a significant improvement in renal function were observed.
Collapse
Affiliation(s)
- Joanna Hubska
- Student Scientific Club “Endocrinus” Affiliated to Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland
| | - Urszula Shahnazaryan
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland
| | - Marek Rosłon
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland
| | | | - Kostiantyn Nikiforow
- Institute of Physical Chemistry Polish Academy of Sciences, Kasprzaka 44/52 Str., 01-224 Warsaw, Poland
| | - Marcin Pisarek
- Institute of Physical Chemistry Polish Academy of Sciences, Kasprzaka 44/52 Str., 01-224 Warsaw, Poland
| | - Małgorzata Barnaś
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland
| | - Urszula Ambroziak
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland
| |
Collapse
|
3
|
Mochizuka Y, Kono M, Katsumata M, Hirama R, Watanuki M, Oshima Y, Takeda K, Tsutsumi A, Miwa H, Miki Y, Hashimoto D, Enomoto N, Nakamura Y, Suda T, Nakamura H. Sarcoid-like Granulomatous Lung Disease with Subacute Progression in Silicosis. Intern Med 2022; 61:395-400. [PMID: 34334564 PMCID: PMC8866780 DOI: 10.2169/internalmedicine.7533-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 67-year-old man was admitted to our hospital with cough and fatigue. He had had long-term exposure to silica due to cement processing. Chest computed tomography showed bilateral centrilobular nodules, and hilar and mediastinal lymphadenopathy with calcification, suggesting chronic silicosis. Within a few months, these nodules enlarged, and bilateral patchy consolidations appeared. A lung biopsy revealed sarcoid-like granulomas with birefringent particles under polarized light without malignancy or infection. He was diagnosed with silicosis-associated sarcoid-like granulomatous lung disease, rather than sarcoidosis, according to the clinicopathological findings. His pulmonary manifestations improved after the discontinuation of silica exposure and combination therapy of corticosteroid and azathioprine.
Collapse
Affiliation(s)
- Yasutaka Mochizuka
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Masato Kono
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Mineo Katsumata
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Ryutaro Hirama
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Masayuki Watanuki
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yuiko Oshima
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Kenichiro Takeda
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Akari Tsutsumi
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Hideki Miwa
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Yoshihiro Miki
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Dai Hashimoto
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hidenori Nakamura
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Japan
| |
Collapse
|
4
|
Bernardinello N, Petrarulo S, Balestro E, Cocconcelli E, Veltkamp M, Spagnolo P. Pulmonary Sarcoidosis: Diagnosis and Differential Diagnosis. Diagnostics (Basel) 2021; 11:diagnostics11091558. [PMID: 34573900 PMCID: PMC8472810 DOI: 10.3390/diagnostics11091558] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a multisystem disorder of unknown origin and poorly understood pathogenesis that predominantly affects lungs and intrathoracic lymph nodes and is characterized by the presence of noncaseating granulomatous inflammation in involved organs. The disease is highly heterogeneous and can mimic a plethora of other disorders, making diagnosis a challenge even for experienced physicians. The evolution and severity of sarcoidosis are highly variable: many patients are asymptomatic and their disease course is generally benign with spontaneous resolution. However, up to one-third of patients develop chronic or progressive disease mainly due to pulmonary or cardiovascular complications that require long-term therapy. The diagnosis of sarcoidosis requires histopathological evidence of noncaseating granulomatous inflammation in one or more organs coupled with compatible clinical and radiological features and the exclusion of other causes of granulomatous inflammation; however, in the presence of typical disease manifestations such as Löfgren’s syndrome, Heerfordt’s syndrome, lupus pernio and asymptomatic bilateral and symmetrical hilar lymphadenopathy, the diagnosis can be established with high level of certainty on clinical grounds alone. This review critically examines the diagnostic approach to sarcoidosis and emphasizes the importance of a careful exclusion of alternative diagnoses.
Collapse
Affiliation(s)
- Nicol Bernardinello
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (N.B.); (S.P.); (E.B.); (E.C.)
| | - Simone Petrarulo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (N.B.); (S.P.); (E.B.); (E.C.)
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (N.B.); (S.P.); (E.B.); (E.C.)
| | - Elisabetta Cocconcelli
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (N.B.); (S.P.); (E.B.); (E.C.)
| | - Marcel Veltkamp
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, 3430 EM Nieuwegein, The Netherlands;
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (N.B.); (S.P.); (E.B.); (E.C.)
- Correspondence: ; Tel.: +39-049-8211272; Fax: +39-049-8213110
| |
Collapse
|
5
|
Zarogoulidis P, Hatzibougias D, Tsakiridis K, Matthaios D, Hohenforst-Schmidt W, Huang H, Bai C, Tryfon S, Saroglou M, Zaric B, Boujkovinas I, Karapantzou C. Lymphadenopathy and granulomas: benignancy of malignancy and differential diagnosis with endobronchial ultrasound-transbronchial needle biopsy 19G needle fine-needle aspiration biopsy. Lung Cancer Manag 2021; 10:LMT49. [PMID: 34408790 PMCID: PMC8369527 DOI: 10.2217/lmt-2021-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 01/17/2023] Open
Abstract
Endobronchial ultrasound (EBUS) is a very useful tool for the diagnosis of lymphadenopathy of the mediastinum. Nowadays, EBUS can substitute video-assisted thoracic surgery when a 19G needle is used. Several studies have provided data for efficient diagnosis not only for lung cancer, but for also sarcoidosis, tuberculosis and lymphoma. We present five cases of EBUS-transbronchial needle biopsy 19G needle used for the diagnosis of mediastinum lymphadenopathy. We present not only the pathological diagnosis, but also the steps for the differential clinical and pathological differential diagnosis for sarcoidosis, tuberculosis, cancer metastasis, respiratory infection and lymphoma.
Collapse
Affiliation(s)
- Paul Zarogoulidis
- 3 University Surgery Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Pulmonary Department, 'Bioclinic' Private Clinic, Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- Thoracic Surgery Department, 'Interbalkan' European Medical Center, Thessaloniki, Greece
| | | | - Wolfgang Hohenforst-Schmidt
- Department of Cardiology/Pulmonology/Intensive Care/Nephrology, Sana Clinic Group Franken, 'Hof' Clinics, University of Erlangen, Hof, Germany
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Stavros Tryfon
- Pulmonary Department (NHS), 'G Papanikolaou' General Hospital, Thessaloniki, Greece
| | - Maria Saroglou
- Pulmonary Department (NHS), 'G Papanikolaou' General Hospital, Thessaloniki, Greece
| | - Bojan Zaric
- Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | | | - Chrisanthi Karapantzou
- Ear, Nose & Throat (ENT) Department, Ludwig-Maximilians University of Munich, Munich, Germany
| |
Collapse
|
6
|
Hoy RF, Hansen J, Glass DC, Dimitriadis C, Hore-Lacy F, Sim MR. Serum angiotensin converting enzyme elevation in association with artificial stone silicosis. Respir Med 2021; 177:106289. [PMID: 33421941 DOI: 10.1016/j.rmed.2020.106289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Silicosis is a rapidly emerging major health concern for workers in the artificial stone benchtop industry. The association between serum angiotensin converting enzyme (sACE) levels and artificial stone silicosis is unknown. METHODS We investigated 179 male workers (median age 40 years, interquartile range (IQR) 33-48 years) from the stone benchtop industry in Victoria, Australia. All had worked in an environment where dry processing of artificial stone had occurred and were registered with the Victorian Silica-associated Disease Registry between June 2019 and August 2020. Workers had undergone protocolised assessments including respiratory function testing, high resolution CT chest and blood tests panel, including sACE. FINDINGS Sixty workers with artificial stone silicosis were identified and they had a higher median sACE level (64.1 U/L, IQR 51.5, 87.5), compared to 119 without silicosis (35.0 U/L, IQR 25.0, 47.0). Compared to those with a normal assessment, regression modelling noted significantly higher average differences in sACE levels for workers with lymphadenopathy alone (12.1 U/L, 95% confidence interval (CI): 1.3, 22.9), simple silicosis (28.7 U/L, 95% CI: 21.3, 36.0) and complicated silicosis (36.0 U/L, 95% CI 25.2, 46.9). There was a small negative association with gas transfer, but no associations with exposure duration or spirometry. CONCLUSION sACE levels were noted to be higher in artificial stone workers with silicosis compared to those without disease and was highest in those with complicated silicosis. Longitudinal follow up is required to evaluate sACE as a prognostic biomarker for workers with this rapidly emerging occupational lung disease.
Collapse
Affiliation(s)
- R F Hoy
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia.
| | - J Hansen
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia
| | - D C Glass
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia
| | - C Dimitriadis
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia
| | - F Hore-Lacy
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia
| | - M R Sim
- Monash Centre for Occupational & Environmental Health (MonCOEH) School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Monash University, Victoria, Australia
| |
Collapse
|