title: An observational study of giant cell interstitial pneumonia and lung fibrosis in hard metal lung disease.
abstract: BACKGROUND
  Hard metal lung disease has various pathological patterns including giant cell interstitial pneumonia (GIP) and usual interstitial pneumonia (UIP). Although the UIP pattern is considered the prominent feature in advanced disease, it is unknown whether GIP finally progresses to the UIP pattern.
  
  
  OBJECTIVE
  To clarify clinical, pathological and elemental differences between the GIP and UIP patterns in hard metal lung disease.
  
  
  METHODS
  A cross-sectional study of patients from 17 institutes participating in the 10th annual meeting of the Tokyo Research Group for Diffuse Parenchymal Lung Diseases, 2009. Nineteen patients (seven female) diagnosed with hard metal lung disease by the presence of tungsten in lung specimens were studied.
  
  
  RESULTS
  Fourteen cases were pathologically diagnosed as GIP or centrilobular inflammation/fibrosing. The other five cases were the UIP pattern or upper lobe fibrosis. Elemental analyses of lung specimens of GIP showed tungsten throughout the centrilobular fibrotic areas. In the UIP pattern, tungsten was detected in the periarteriolar area with subpleural fibrosis, but no association with centrilobular fibrosis or inflammatory cell infiltration. The GIP group was younger (43.1 vs 58.6 years), with shorter exposure duration (73 vs 285 months; p<0.01), lower serum KL-6 (398 vs 710 U/mL) and higher lymphocyte percentage in bronchoalveolar lavage fluid (31.5% vs 3.22%; p<0.05) than the fibrosis group.
  
  
  CONCLUSIONS
  The UIP pattern or upper lobe fibrosis is remarkably different from GIP in distribution of hard metal elements, associated interstitial inflammation and fibrosis, and clinical features. In hard metal lung disease, the UIP pattern or upper lobe fibrosis may not be an advanced form of GIP.
authors.affiliation: Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Moriyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Terada
authors.forename: Toshinori
authors.initials: T
authors.lastname: Takada
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suzuki
authors.forename: Ichiei
authors.initials: I
authors.lastname: Narita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kawabata
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Hebisawa
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Arakawa
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys / Q000009:adverse effects*; D003035:Cobalt / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D015726:Giant Cells; D006801:Humans; D008168:Lung / Q000166:cytology / Q000187:drug effects* / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011009:Pneumoconiosis / Q000473:pathology; D011014:Pneumonia / Q000139:chemically induced / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000139:chemically induced / Q000473:pathology*; D014041:Tokyo; D014414:Tungsten / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000497:Alloys; C080121:hard metal; D003035:Cobalt; D014414:Tungsten
keywords: OCCUPATIONAL & INDUSTRIAL MEDICINE