The pathologic changes observed in case 4 were unusual, with focal organization of the intra-alveolar inflammatory infiltrate and easily identifiable asbestos bodies in the tissue. Because of the numerous eosinophils and macrophages within the alveoli, the diagnosis of chronic eosinophilic pneumonia was considered, although chronic eosinophilic pneumonia is usually not described as a localized disease. Also, eosinophils are reported to be a common inflammatory cell in pleural eflusions caused by asbestos and are a frequent cell type in bronchoalveolar lavage fluid specimens from persons with asbestosis.
Case 5 was unusual, and was the only instance in which we had the opportunity to examine a localized nodular lesion obtained surgically via wedge biopsy (1980), and nine years later (1989), a similar localized lesion in the same location at postmortem examination. The mass observed radiographically in the right upper lobe showed a desquamative interstitial pneumonitis type pattern with accumulation of alveolar macrophages within distorted alveolar spaces. Asbestos attracts and activates alveolar macrophages, and Cor-rin and Price reported a case of desquamative interstitial pneumonitis in which asbestos bodies were identified in association with intra-alveolar macrophages. The patient described had smoked ten cigarettes per day until one year before the onset of his illness, a history of potential significance, since desquamative interstitial pneumonitis occurs predominantly in cigarette smokers. More recently, Freed et al reported a case of desquamative interstitial pneumonitis in a man with a 32-year history of working in the drywall construction trade, and a three pack-per-day history of cigarette smoking.