Tuberc Respir Dis.  2015 Oct;78(4):445-449. 10.4046/trd.2015.78.4.445.

Pulmonary Foreign Body Granulomatosis in Dental Technician

• Chung SJ
• Koo GW
• Park DW
• Kwak HJ
• Yhi JY
• Moon JY
• Kim SH
• Sohn JW
• Yoon HJ
• Shin DH
• Park SS
• Pyo JY
• Oh YH
• Kim TH

• KMID: 2320725
• DOI: http://doi.org/10.4046/trd.2015.78.4.445

Abstract

Occupational lung diseases are caused by several toxic substances including heavy metals; however, the exact pathologic mechanisms remain unknown. In the workplace, dental technicians are often exposed to heavy metals such as cobalt, nickel, or beryllium and occasionally develop occupational lung diseases. We described a case of occupational lung disease in a patient who was employed as a dental technician for over a decade. A 31-year-old, non-smoking woman presented with productive cough and shortness of breath of several weeks duration. Chest computed tomography revealed a large number of scattered, bilateral small pulmonary nodules throughout the lung field, and multiple mediastinal lymph nodes enlargement. Percutaneous needle biopsy showed multifocal small granulomas with foreign body type giant cells suggestive of heavy metals inhalation. The patient's condition improved on simple avoidance strategy for several months. This case highlighted the importance of proper workplace safety.

Keyword

Lung Disease; Dental Technicians

MeSH Terms

Adult
Beryllium
Biopsy, Needle
Cobalt
Cough
Dental Technicians*
Dyspnea
Female
Foreign Bodies*
Giant Cells, Foreign-Body
Granuloma
Humans
Inhalation
Lung
Lung Diseases
Lymph Nodes
Metals, Heavy
Nickel
Thorax
Beryllium
Cobalt
Metals, Heavy
Nickel

Figure

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  Figure 1 Chest computed tomography (CT) on admission (A) and at 3 months after suitable precaution (B). (A) Chest CT on admission showed multiple small nodules in both lower lung fields. Both hilar and mediastinal lymph nodes enlargement are also seen. (B) After 3 months, multiple small nodules are reduced in size and number. Enlargement of both-hilar and mediastinal lymph nodes are absent.

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  Figure 2 Histologically, the lung biopsy reveals multifocal small and discrete non-caseating epithelioid granulomas containing foreign body-type giant cells. (A) Multifocal granulomas shown in a low power field (H&E stain, ×100). (B) Representative non-caseating epithelioid granulomas containing giant cells engulfing foreign bodies in a high power field (H&E stain, ×400). (C) Typical granuloma containing giant cells engulfing refractile foreign bodies (arrow) (H&E stain, ×400). (D) Typical granulomas containing foreign body-type giant cells engulfing refractile foreign bodies (arrow), which are conspicuous under polarized light microscopy (H&E stain, ×200).

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