1. No category

CaesarStone® silicosis epidemic:
Atypical pathological presentation
N.Abdel-rahman,A.Amital,D.Shitrit
Y. Raviv , MR. Kramer
SILEX
Visconti - 1870
Кремень ‫ﺻﻮان צור‬
‫ ﺻ ان‬Flint
Silicon dioxide- SiO2
Bernardino Ramazzini (1633-1714) in early 18th century.
“...when the bodies of such workers are dissected, they have
been found to be stuffed with small stones.”
Diseases of Workers (De Morbis Artificum Diatriba, 1713).
CaesarStone® silicosis:
Disease resurgence
g
among
g artificial
stone workers
Mordechai R. Kramer, Paul D. Blanc,, Elizabeth Fireman, Anat Amital Alexander
G b Nader
Guber,
N d Abdel
Abd l Rahman,
R h
David
D id Shitrit
Shit it
Chest 2012: In press
The Israeli Cesar stone
epidemic
9
8
7
6
5
4
3
2
1
1997 1999 2001 2003 2005 2007 2009 2011
0
‫מספר החולים‬
Spanish epidemic
Case #1
• 45 old male
• 16 year occupational exposure to CaesarStone ®
as marble stone worker: Cutting and Polishing .
• Rheumatoid arthritis
• Smoking history - 15 years.
• Persistent cough , fever, weight loss.
Case #1
Case #1
Case #1
Case #1
Case #1
Case #1
Case #1 (cont)
• Open
Ope lung
u gb
biopsy
opsy suspec
suspected
ed
B cell lymphoma
• 6 courses
co rses of R
R-CHOP
CHOP
• Worsening
g dyspnea
y p
,
Hypoxemia
• Biopsy revision
revisionsilicosis PMF
• Referred for
lung transplantation
2* -SILICOTIC NODULE Case #1
4* -SILICOTIC NODULE Case #1
10* -SILICOTIC NODULE Case #1
‫אלקטרומיקרוסקופיה‪SEM-‬‬
‫‪KM‬‬
‫לאחר השתלת ריאה ימנית‬
‫סיליקוזיס –לימפומה‬
‫•‬
‫•‬
‫•‬
‫•‬
‫ללימפאדנופתיה דו צדדית‬
‫‪B symptoms‬‬
‫קליטה ב‪PET‬‬
‫ביופסיה לא חד משמעית‬
‫בנוכחות עבודה ממושכת עם סיליקה‬
‫‪-‬אבן קיסר האבחנה היא סיליקוזיס!!‬
Case # 2
•
•
•
•
•
•
•
45 Male
20 years of exposure to CaesarStone ®
Cutting and Polishing .
Smoking history for 18 years .
Cough
Shortness of breath
X-ray changes
Case # 2
Case # 2
10*TBB
20*TBB
........ ‫ללכן‬
+ PREDNISONE
‫לאחר סטירוידים‬
‫לאחר סטירוידים‬
CASE II - SEM
‫סרקואידוזיס וסיליקוזיס‬
• 1
1,975
975 patients
ti t with
ith sarcoidosis
id i
• 11 patients with an additional histologically
proved silicosis
• 4 further patients with a silicosis found out by X-rays
• 57 other patients of this group -professional
professional exposure
to quartz dust.
• Coincidence of both diseases without regards of causal
and
d pathogenetic
h
i connections.
i
• Hübener E Kühne W Scharkoff T
186-93:(2)166;1986 Zeitschrift für Erkrankungen der
Atmungsorgane
‫סיליקוזיס‬
‫ק‬
‫סרקואידוזיס‪-‬‬
‫ק‬
‫• גרנולומות ‪CASEATING NON‬‬
‫• קשריות ריאתיות‬
‫נשימה‬
‫מה‬
‫עול קוצר נש‬
‫שיעול‬
‫םש‬
‫ספציפיים‬
‫סימפטומים לא ספצ פ‬
‫• ס מפטומ ם‬
‫• בכל חשיפה ממושכת לשיש יש לחשוב קודם כל‬
‫ה מראה‬
‫ההיסטולוגיה‬
‫ס גם אם הה סטולוג‬
‫סיליקוזיס‬
‫על ס ל קוז‬
‫גרנולומות‬
•
•
•
•
•
•
•
•
•
CASE #3
27 Make
M k
Non smoker
10 years exposure to CaesarStone ®
2002 – Cough
2006 - Bronchoscopy for Lymphadenopathy
 not diagnostic
P iti PPD  LATENT TB Isoniazid
Positive
I
i id
(9months) – clinical improvement
Cough  Steroid treatment
Shortness of breath – 200m
Hemoptysis
CASE #3
CASE #3
TREATMENT
CASE #3 - *2
*10
CASE # 3
CASE 3 -*20
*20
BRF
CASE #3
‫אחרי ההשתלה –ריאה שמאל‬
Am J Respir Crit Care Med Vol 166. pp 215–235, 2002
DOI: 10.1164/rccm.2109105
Inorganic Particulates assosiated with Pulmonary alveolar proteinosis:
SEM and X-RAY microanalysis resulates
Applied Pathology
Pathology. 4(3):138-46,
4(3):138 46 1986,
1986 Abraham,
Abraham J L
L. McEuen
McEuen, D D
D.
•
•
•
•
•
•
24 cases of pulmonary alveolar proteinosis (PAP) were studied by light
microscopy (LM) and scanning electron microscopy (SEM) to test the
h
hypothesis
th i th
thatt PAP was related
l t d to
t silica
ili exposure.
Increased numbers of birefringent particles (vs. controls) were found in
78% of PAP cases.
Available environmental history correlated well with particulate analysis
results, e.g., silica in a sandblaster, metal fumes in a welder, and cement
particles in a cement finisher. Particulates with unique composition were
also
l ffound
d iin cases with
ith unavailable
il bl hi
histories,
t i
e.g. metal
t l ffumes suggestive
ti
of welding or soldering exposure, silicates suggestive of fine particle
exposure (greater than 50% of particles less than 1 micron). Only 1 case
(the sandblaster) showed greater than 50% of the particles to be silica. Of
th 5 infants
the
i f t with
ith PAP,
PAP 3 showed
h
d th
the major
j particulate
ti l t tto b
be ttalc,
l
and 1 had evidence of toxic cadmium selenide fume exposure.
These results are consistent with the hypothesis that PAP, at least in
the majority of cases,
cases is associated with exposure to small inorganic
particulates of several types.
‫• קיימת מגפת סיליקוזיס בישראל בעובדי שיש עם‬
‫ת!‬
‫קטלנית‬
‫א קטלנ‬
‫והיא‬
‫סר וה‬
‫קיסר‬
‫אבן ק‬
‫• ההתבטאות הקלינית יכולה להטעות ולהראות‬
‫ואפילו‬
‫ל‬
‫של סרקואידוזיס‪ ,‬פרוטאינוזיס‬
‫תמונה ל‬
‫לימפומה‬
‫• יש לחשוד בסיליקוזיס בכל חולה עם אנמנזה של‬
‫עבודה בשיש מסוג אבן קיסר ‪.‬‬
Pne mono ltramicroscopicsilico olcanoconiosis
Pneumonoultramicroscopicsilicovolcanoconiosis
the longest English word and is the longest word ever to appear in an English
language dictionary
Non omne quod nitet
aurum est
‫ָהב הוּא‬
ָ ‫לֹא כָּל ַהנּוֹצֵץ ז‬