Zeren E H, Colby T V, Roggli V L
Department of Pathology, Cukurova University, Balcali, Adana, Turkey.
Chest. 1997 Nov 5;112(5):1436-8. doi: 10.1378/chest.112.5.1436.
A 57-year-old man with a history of exposure to silica for 32 years presented with pleural thickening of the lower lobe of the left lung and a chronic right-sided pleural effusion without any radiographic evidence of parenchymal nodules in either lung. Light microscopic examination of a left visceral pleural biopsy specimen revealed markedly thickened pleura with fibrosis and macrophages containing birefringent silica and silicates. Occasional rounded intrapleural silicotic nodules were present. The underlying lung tissue did not show fibrosis or silicotic nodules. An energy-dispersive x-ray analysis confirmed the presence of silica. In the absence of lung involvement, this case represents a very unusual pathologic reaction caused by silica and silicates and adds to the clinical differential diagnosis of chronic pleuritis and malignant mesothelioma.
一名有32年二氧化硅接触史的57岁男性，出现左肺下叶胸膜增厚和右侧慢性胸腔积液，肺部影像学检查未发现任何实质结节证据。对左脏层胸膜活检标本进行光镜检查，发现胸膜明显增厚，伴有纤维化，巨噬细胞内含有双折射的二氧化硅和硅酸盐。偶尔可见圆形的胸膜硅结节。其下方的肺组织未显示纤维化或硅结节。能量色散X射线分析证实了二氧化硅的存在。在无肺部受累的情况下，该病例代表了由二氧化硅和硅酸盐引起的一种非常罕见的病理反应，并增加了慢性胸膜炎和恶性间皮瘤的临床鉴别诊断。
