PMC4901174_01
Chest radiologic findings in Case 1. (A) Chest X-ray showed faint nodular shadows in the bilateral lung fields. (B) Chest high-resolution computed tomography shows diffuse fine nodular opacities that were distributed mainly in the upper and middle lung zones with mediastinal lymph node enlargement.
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Chest X-ray showed faint infiltrative shadows in the bilateral outside lung fields (Fig. 1A). Chest high-resolution CT (HRCT) revealed micronodules, most prominent in the upper and middle lung zones with mediastinal lymph node enlargement (Fig. 1B).
Histological findings from surgical lung biopsy specimen from the left S1+2 region in Case 1 (A,B). Epithelioid cell granuloma (arrow) in the pulmonary interstitium and hyalinous elastolytic fibrosis predominantly in the bronchiolovascular sheath (hematoxylin and eosin stain, 20 x and 40 x).
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A video-assisted lung biopsy was performed and histological findings of tissue obtained from the left S1+2 region are shown in Fig. 2.
Electron probe microanalyzer images of a lung specimen from Case 1. (A) Gray scale image (left) of the granulomatous lesion obtained from the circled region in the lung specimen stained with hematoxylin and eosin (right). A square, 10 x 10 mum, indicated by the yellow arrowhead numbered 1, was quantitatively analyzed, with results shown in Table 1 Site 1. (B) Qualitative color image of aluminum distribution is superimposed on the lung tissue image with amino nitrogen colored green. Because the distribution of amino nitrogen corresponds to the pathologic image, detected elements colored red are easily localized in the lung specimen. (C) Gray scale image (left) of the subpleural lesion with black particle deposition obtained from the circled region in the lung specimen stained with hematoxylin and eosin (right). A square, 10 x 10 mum, indicated by the yellow arrowhead numbered 2, was quantitatively analyzed, with results shown in Table 1 Site 2.
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EPMA (EPMA 8705; Shimadzu Ltd., Kyoto, Japan)-WDS analysis and pathological examinations. EPMA images of a lung specimen are shown in Fig. 3, and results by quantitative analysis are shown in Table 1. In particular, aluminum was widely distributed in the granulomatous lesion (Fig. 3B).
PMC4901174_02
Chest radiologic findings in Case 2. (A) Chest X-ray showed diffuse nodular shadows (B). Chest high-resolution computed tomography shows diffuse nodular opacities with interlobular septal thickening.
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Diffuse nodular shadows were found on chest X-ray (Fig. 4A), and chest HRCT showed diffuse nodular opacities with interlobular septal thickening (Fig. 4B).
Histological findings in surgical lung biopsy from the right S3 region in Case 2. (A,B) granulomatous lesion mainly composed of multinucleated giant cells in adventitia of pulmonary muscular artery (hematoxylin and eosin stain, 10 x and 40 x); (C) argyrophilic fiber formation around multinucleated giant cells (silver stain, 40 x).
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Results of histology of tissue obtained from the right S3 region are shown in Fig 5.
Electron probe microanalyzer images of a lung specimen from Case 2. A) Gray scale image (left) of the granulomatous lesion obtained from the squared region in the lung specimen stained with hematoxylin and eosin (right). A square, 10 x 10 mum, indicated by the yellow arrowhead numbered 3, was quantitatively analyzed, with results shown in Table 1 Site 3. (B) Qualitative colored image of aluminum distribution (colored red) is superimposed on the lung tissue image with amino nitrogen colored green. (C) Gray scale image (left) of the fibrosing lesion around the bronchiole obtained from the squared region in the lung specimen stained with hematoxylin and eosin (right). A square, 10 x 10 mum, indicated by the yellow arrowhead numbered 4, was quantitatively analyzed, with results shown in Table 1 Site 4.
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Elemental analysis was performed for the granuloma (Fig. 6A) and the centrilobular fibrosing lesion (Fig. 6C). Especially wide distribution of aluminum was observed in the granuloma (Fig. 6B).