title: Giant cell interstitial pneumonia: unusual lung disorder and an update.
abstract: BACKGROUND
  Giant cell interstitial pneumonia (GIP) was a rare form of pneumoconiosis, associated with exposure to hard metals, which had been reported mostly as isolated case reports. We described eight cases of GIP diagnosed in our hospital during the past seven years, with particular reference to new findings.
  
  
  METHODS
  Eight patients with GIP confirmed by biopsy in the Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University from 2005 to 2011 were retrospectively analyzed. For each patient, the occupy histories and medical records were thoroughly reviewed and clinic data were extracted. Two radiologists, without knowledge of any of the clinical and functional findings, independently reviewed the HRCT scans of all patients. Follow-up data were collected.
  
  
  RESULTS
  Among the eight patients, seven had a history of exposure to hard metal dusts, one denied an exposure history. The most common manifestations were cough and dyspnea. One patient initiated with pneumothorax and another pleural effusion, both of which were uncommon to GIP. The main pathologic appearances were the presence of macrophages and multinucleated giant cells in the alveolar space. The clinical symptoms and radiographic abnormalities were obviously improved after cessation of exposure and receiving corticosteroid treatments, recurrences were observed in two patients when they resumed work. In spite of exposure cessation and corticosteroid treatment, one patient developed pulmonary fibrosis at seven years follow-up.
  
  
  CONCLUSIONS
  Awareness of the patients' occupational history often provided clues to the diagnosis of GIP. Histopathologic examinations were necessary to establish the right diagnosis. Exposure cessation was of benefit to most patients; however, pulmonary fibrosis was possible in spite of exposure cessation and corticosteroid treatment. Better ways should be found out to improve the outcome and quality of life.
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Jinghong
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Huang
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Min
authors.initials: M
authors.lastname: Cao
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Liyun
authors.initials: L
authors.lastname: Miao
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Yonglong
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Pathology, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China.
authors.forename: Fanqing
authors.initials: F
authors.lastname: Meng
authors.affiliation: Department of Respiratory Medicine, Nanjing Drum Tower Hospital affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China. Email: caihourong2013@163.com.
authors.forename: Hourong
authors.initials: H
authors.lastname: Cai
mesh_terms: D000328:Adult; D000497:Alloys / Q000633:toxicity; D003035:Cobalt / Q000633:toxicity; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D014414:Tungsten / Q000633:toxicity; D055815:Young Adult
chemical_list: D000497:Alloys; C080121:hard metal; D003035:Cobalt; D014414:Tungsten