Localized Inflammatory Pulmonary Disease in Subjects Occupationally Exposed to Asbestos (6)

The main pathologic changes in cases 1, 2, and 3, and to a lesser degree in case 4, of intraluminal fibrosis and inflammation involving the distal air spaces, ie, alveoli, alveolar ducts, and terminal and respiratory bronchioles, show a pathologic change that is considered to be a response to injury that occurs in a variety of disorders,’ and is therefore not a specific disease. This entity has been referred to as “cryptogenic organizing pneumonitis,’ “organizing pneumonia like process,” and most frequently BOOP. That asbestos can potentially produce a localized BOOP-like pulmonary lesion in humans was first suggested in 1961 in a New England Journal CPC. In that case, a 61-year-old man developed a localized consolidation in the left upper lobe that histologically showed organizing pneumonitis in which there were numerous asbestos bodies.

In that case, a secondary infection was suggested, but never proved. In 1981, Saldana reported on four men whose chest radiographs showed localized infiltrates in the absence of difluse changes. Histologically, these masses exhibited the following: (1) extensive “bronchiolitis obliterans” with the presence of asbestos bodies within the organizing masses of exudate occluding bronchi; (2) obstructive pneumonia of “cholesterol” type, large numbers of histiocytes, and confluent giant cell granulomas; (3) a lymphocytic angiitis and a dense lymphoplasmacytic cellular infiltrate; and (4) organization with fibrosis. He referred to these changes as localized asbestos pneumonia, since he could find no other cause of these changes.