PMC5987387_01
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PMC5987387_05
a Chest radiograph showing multiple bilateral nodules in both lung fields. b CT scan of the chest showing numerous tiny nodules with perilymphatic distribution without lymph-node calcification
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Fig1
The patient was diagnosed with pneumoconiosis by routine chest screening with plain films (Fig. 1a). Multiple nodules showed peri-lymphatic distribution without enlarged lymph nodes (Fig. 1b).
Histologic features of a case of polytetrafluoroethylene (PTFE) exposure-induced pulmonary granulomatous lesions (a and b). a The specimen shows mainly small airway- centered granulomatous micronodular lesions (arrow). b Higher magnification of the specimen shows multinucleated giant cells containing amorphous transparent particles (black arrows). c Polarizing microscopic finding of the same multinucleated giant cell found in Fig. b reveals the birefringent particle (white arrows). a to c Hematoxylin-Eosin stain (Magnification: A: x 40, B and C: x 400). d Transmission electron microscopic feature show intracytoplasmic electron lucent amorphous materials (asterisks) in the histiocyte. e and f Scanning electron microscopic feature (e) and comparing element mapping of fluorine (yellow) reveals the presence of fluorine in the pulmonary lesion. g The scanning electron microscopic feature of the lesion revealing fluorine in Fig. f shows multiple round to oval granular material measuring 2-6 mum. (Original magnification, d: x 3500, e and f: x 500, g x 5000). h: Energy-dispersive X-ray spectroscopy (EDS) spectrum of a particle in a round particle (target 1 shown in Fig. g) found in multinucleated giant cell showing a prominent peak for fluorine (F) but with other associated elements such as carbon (C), and oxygen (O)
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Fig2
On histologic examination, the specimen revealed mainly small airway-centered granulomatous micronodular lesions and multinucleated giant cells containing amorphous transparent particles (Fig. 2a and b). Polarizing microscopic findings of the same multinucleated giant cells shown in Fig. 2b reveals the birefringent particle (Fig. 2c). Transmission electron microscopic features highlight the intracytoplasmic electron lucent amorphous materials (asterisks) in the histiocytes (Fig. 2d). Scanning electron microscopic features of the lesion revealing fluorine elements show multiple round to oval granular material measuring 2-6 mum (Fig. 2e and f). The energy-dispersive X-ray spectroscopy (EDX) spectrum of a particle in a round particle found a multinucleated giant cell showing a prominent peak for fluorine (F) but with other associated elements such as carbon (C) and oxygen (O) (Fig. 2g and h).
FT-IR analysis of the lung tissue of the patient shows the presence of PTFE compared with the standard PTFE peak result
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Fig3
This showed the presence of PTFE in the lung tissue (Fig. 3).
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a Thermogravimetric analysis of the patient's personal air sample shows prominent weight loss at 550-660  C. A total of 0.40994 mg of the sample weight was reduced at 550-600  C. b Thermogravimetric analysis of the regional sample shows weight loss near 450  C, and no prominent weight loss was found at 550-600  C. c Thermogravimetric analysis of the PTFE spray solution shows prominent weight loss at 550-600  C
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Fig4
In total, 0.40994 mg of the sample weight was reduced at 550-600  C (Fig. 4a). The regional sample showed no prominent weight loss at 550-600  C (Fig. 4b). All three solutions showed prominent weight loss at 550-600  C, which corresponded with the results of the personal sample analysis (Fig. 4c).