Exogenous Pigments

General Pathology
Basic Principles
of Cellular and Organ
Pathology
Exogenous
Pigments
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Exogenous pigments – table of contents


definition
portals of entry



traumatic lesions
gastrointestinal tract
respiratory tract - pneumoconioses
silicosis
asbestosis
miners´disease
 diff. dg. to pneumoconioses
- coniotoxicoses
- conioallergoses
Pigments
Definition:
colored substances
in the organism
or environment
Pigments
Classification:
 endogenous
–

hemoproteins
derived
– autogenous
exogenous
Exogenous Pigments
- colored
substances
entering the organism via



traumatic lesions
gastrointestinal tract
respiratory tract
Exogenous Pigmentation
 traumatic
origin
– tatuatio traumatica, arteficialis

gastrointestinal tract
– intoxication Pb, Ag, Au, Fe (!),
Hg, Pt……
Exogenous Pigmentation
 traumatic
origin
– tatuatio traumatica, arteficialis
mechanic instilation of „inert“ dyes
(china ink)
into the deep dermis
Tatoo
 From
Polynesian tatau.
 In Tahitian - tatu.
 The Polynesian practice became popular among
European sailors, before spreading to Western
societies
 Mummy
of Amunet from Ancient Egypt
 Pre-Christian Germanic, Celtic and other central
and northern European tribes were often heavily
tattooed
Auschwitz survivor
Sam Rosenzweig
displays his
identification tattoo.
The Art ??
Tatoo
Tatuatio arteficialis
USA
2006:
protest?
aesthetic social communication?
Prevalence
Tattoo Removal: New
Laser Options
J. of Drugs in
Dermatology
April 2013 | Volume 12 |
Issue 4 | Feature | 492
Among individuals seeking tattoo
removal, the following features were
more common:
•
•
•
•
Female gender
White or Hispanic
Age 24 to 39 years
Self-described risk takers
• College educated
• Single
• In stable family
relationships
• Moderate to strong
religious beliefs
• Interest in dissociating
from the past
Piercing
Medical Tattoos
 to
ensure instruments are properly
located for repeated application of
radiotherapy
 for the areola in some forms of breast
reconstruction.
 Tattooing has also been used to convey
medical information about the wearer
(e.g. blood group).
 Tattoos are used in skin tones to cover
vitiligo, skin pigmentation disorder.
Tattoo Removal - Think before you ink
Maybe your new boss frowns upon your tattoos
or your sweetheart can't stand the name of your former...
Laser treatment is now the standard method of removal
for unwanted tattoos.
Laser removal is low risk, non-invasive, and has a very
low incidence of scarring (about 5%).
Tatuatio arteficialis - therapy

LASER = Light Amplification by Stimulated
Emission of Radiation
– low performance laser – biostimulation
– high performance laser – destruction of
pigmentation shifts – postinflammatory,
melasma (chloasma), tattoo



SURGERY / CRYOSURGERY
COMBINATION
COVER UP
Tattoo Removal - Think before you ink

IPL – Intense Pulsed Light Therapy does not involve lasers, but the two processes are
similar. Most tattoos can be removed with only 3-4 sessions. The drawback is the expense IPL can cost $10 and more per pulse.

The Process starts with a consultation with a dermatologist. There are around 100 different
tattoo inks in use today, and some can be removed more easily than others.
The Pain of the laser pulse is most often compared to the sensation of having hot grease
spattered on the skin, hair removed by extraction or to being repeatedly snapped with a
rubber band. Anti-inflammatory drugs like ibuprofen are not recommended, as they may
result in bruising.
The Procedure usually lasts 15-30 minutes per session. It involves laser pulses passing
through the epidermis of your skin and into the dermis, where the tattoo ink absorbs the light
energy. Over the following three to six weeks, the skin naturally removes the ink, which has
been fragmented by the laser energy. A low-grade inflammation may occur after each
procedure; this has been compared to mild sunburn, and any discomfort usually passes
within a few days. After the skin has rested and the immune system has done its job (usually
after 4-8 weeks), the patient is ready for another visit to the dermatologist.
Black, blue and red inks are most responsive to lasers and easiest to remove. Tattoos with
green and yellow inks are the most resistant. Old tattoos may be easier to remove than new
ones, as the inks can fade over time.




Each laser removal session can cost from $200-$1500, depending upon your practitioner.
Most insurance companies don’t cover tattoo removal, since it is considered a cosmetic
procedure. Some tattoos can be removed in 6-8 sessions, while others may require 16-18
sessions spanning over two years or more.
Tatuatio
experimentalis
Tatuatio
Tattoo
 inert – persistent
 macrophage degraded
 macrophage transported
secondary lymph node pigmentation
Tattoo Removal - Think before you ink
Temporary tattoo – e.g. with Henna
The paste is applied
and left on the skin
for several hours to
stain. The stain will
gradually fade away
as the skin sheds.
Henna tattoos can
last days to over a
month depending on
application and
aftercare.
Exogenous Pigmentation
gastrointestinal tract
Pb, Ag, Au, Fe (!),
Hg, Pt, Bi…..
 intoxication
 side effect in metals containing
therapies
Bismuth staining of the
tongue
(gastric ulcer treatment)
Lead poisoning
Exogenous Pigmentation
through Airways
PNEUMOCONIOSES
Def.:
conditions or diseases
elicited with dust particles
inhalation (<5)
Pneumoconioses
– coniosis simplex
(anthracosis, siderosis)
– coniofibrosis
(silicosis, asbestosis,
coal workers disease, siderosis)
– coniotoxicosis  conioalergosis
(byssinosis, berylliosis)
organic dusts
Anthracosis
Def.:
pneumoconiosis caused by inert
coal-like dust
(without quartz admixture)
no symptoms = coniosis simplex
100% population prevalence
Anthracosis pleurae
Anthracosis pulmonum et lnn. peribronchialium.
Metastases carcinomatosae lnn. peribronchialium
Anthracosis pulmonum
Anthracosis pulmonum
Anthracosis pulmonum
Sputum - macrophages
Sputum - siderophages / coniophages
Silicosis
Def.:
pneumoconiosis caused by quartz dust
with pronounced fibrosis response
CONIOFIBROSIS
long lasting exposition (20–40 years)
 progression even after exposure
elimination
 part of miners disease
 affinity to other lung diseases
(tbc)

Silicosis
Pathogenesis:
toxic activity of quartz dust to macrophages

production of PDGF1, IGF-1, fibronectin

chemotaxins, IL-8

enzyme activation,

lung injury, inflammation,

FIBROSIS
Silicosis
Stages:
– diffuse reticular fibrosis (often clinically silent)
– silicotic nodules (+ perifocal emphysema)
– massive fibrosis
Silicosis
Silicosis gr. II
Silicosis – silica crystals (polarised light)
Silicosis
Complications:
pulmonary fibrosis
pulmonary hypertension
cor pulmonale
Cause of death
cardiorespiratory insuffitiency
Hypertrophia
excentrica ventriculi
dx. cordis
Coal Workers
Pneumoconiosis - CWP miners´disease


Coal macules- dust laden macrophages
Coal nodules – mild collagen admixture
Advanced

Combined silicosis & anthracosis
complicated often with tbc
Asbestosis
Def.:
pneumoconiosis caused by Asbestos
fibrils with pronounced fibrotising
response
CONIOFIBROSIS
Asbestos
fibrillar mineral with various forms and
fibrogenic capacity

chrysotile (90%), amosite, croccydolite
etc.
Asbestosis
Pathogenesis:
 toxic
influence due to fibrils size and
concentration
 fibrosis
with feruginous bodies
 hyalin pleural plaques
 risk of mesotelioma and lung carcinoma and GIT
malignancies (Carlos Bedrossian-Venice 2006)
 pleural effusions („mesot. in situ“ – Bedrosjan 2004)
 other neoplasias?
Hyalinosis pleurae
Fibrous pleural plaque – marker of possible asbestosis!
Asbestosis
Asbestosis
Asbestosis
Hyalinosis pleurae
Mesothelioma
Mesothelioma
Ca bronchogenes
Hyalinosis et metastases
carcinomatosae pleurae
parietalis
Lotti M, Bergamo L, Murer B.
Occupational toxicology of asbestos-related
malignancies.
Clin Toxicol (Phila). 2010 Jul;48(6):485-96.
Asbestos
is banned in most Western countries but related malignancies are still of clinical
concern because of their long latencies.
The
retrospective assessment of exposure - questionnaires and collection of medical
history.
Fibers
and asbestos bodies are counted in lung tissue, broncho-alveolar lavage, and
sputum.
The
etiology of lung cancer is difficult to define in cases of low-level asbestos exposure
and concurrent smoking habits.
MESOTHELIOMA:
The diagnosis difficult, because of sampling, fixation, and processing,
and uses of immunohistochemical probes.
Assessment
Given
of exposure is crucial
the premise that asbestosis is necessary to causally link lung cancer to asbestos, it
follows that the assessment of both lung fibrosis and asbestos body burden is necessary.
Park EK, Takahashi K, Jiang Y, Movahed M, Kameda T.:
Elimination of asbestos use and asbestos-related
diseases: An unfinished story.
Cancer Sci. 2012 Oct;103(10):1751-5.


Asbestos - a proven human carcinogen.
Asbestos-related diseases (ARDs):
–
–
–
–




lung cancer,
malignant mesothelioma,
asbestosis,
pleural plaques, thickening and effusion.
The WHO and the International Labour Organization have called on
countries to stop using asbestos.
ARDs are increasing and asbestos use is continuing in the world.
Industrializing countries are faced with a myriad of forces prompting
them to continue using asbestos.
Full-scale international cooperation will thus be needed to achieve the
goal of eliminating ARDs.
Mesothelioma
Mesothelioma
carcinoma
Ultrastruct Pathol. 2014 Sep 30:1-6. [Epub ahead of print]
Electron Microscopy Remains the Gold
Standard for the Diagnosis of Epithelial
Malignant Mesothelioma: A Case Study.
Oczypok EA, Oury TD.
Department of Pathology, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA.
According to the most recent World
Health Organization (WHO) estimates, more than 107 000
people die each year from asbestos-related lung cancer,
mesothelioma, and asbestosis resulting from exposure at
work (1). The asbestos epidemic is far from over.
http://www2.epa.gov/asbestos
Pneumoconioses
– coniosis simplex
(anthracosis, mild siderosis)
– coniofibrosis
(silicosis, asbestosis, coal workers
disease, severe siderosis)
--------------------– coniotoxicosis  conioalergosis
(byssinosis, berylliosis,….)
organic „dusts“
Coniotoxicosis  Conioalergosis
- diff. dg. to Coniofibroses
Berylliosis
• acute - toxic pneumonitis
• chronic – non caseating granulomas
Byssinosis – cotton dust
Farmer´s lung – moldy hay, actinomycetes,
Bird fanciers disease - bird feather dust
(dif. dg. chlamydophilla psittaci inf.)
Fibrosis pulmonum intersticialis
Hypertrophia excentrica
ventriculi dx. cordis
COR PULMONALE
decompensatum