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What Does The Lung Pathology Report Indicate?

Posted on Mon, 22 Aug 2016

Question: I have a lung pathology report that states "there is a rare small aggregate of macrophages. Aleolar macrophages are scattered singly and in a few small clusters; some macrophages contain iron." Diagnosis is Intersitial pulmonary fibrosis. With 3 years exposure to asbestos while in the navy, could it be assumed that these macrophages with iron are asbestos related?

Answered by Dr. Dr.Arnab (4 hours later)

Brief Answer:
extremely unlikely as per your description..

Detailed Answer:
Hello xxxxxxxxxx, welcome to HCM,

I've gone through your query and the detailed Pathology report and understand your concern..

Let me clarify something to you in the first place, 3 years is an extremely less time span of exposure to cause asbestos related pulmonary fibrosis, but i'm not saying it's totally impossible, as it can be an aggravating factor to the development of your IPF..

However, the lung pathology report is considered conclusive in this regards, which didn't show any of those characteristics features like asbestos bodies etc.

Iron laden macrophages are a generalized finding in all most all varieties of IPF, thus, is not conclusive.. Moreover, i believe you must've done lot of researches on your own, so you must be knowing by now that asbestos related changes take much longer duration to actually cause any significant effect in lungs(5-10 yrs at least)..

I've also seen, that you'd past history of CABG , so any underlying long standing hypertension can be considered one of the contributory factor for IPF in your case.. there's also a history of Bronchiectasis which is another risk factor for those presence of iron laden macrophages..I'd like to see your Echocardiography reports at the same time because there may be a possibility of an element of pulmonary arterial hypertension, do check it out yourself..

Feel free to discuss further, i'd be glad to clarify any further queries of yours..

Take Care
Kind Regards
Have a Nice Day

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr.Arnab (2 hours later)

The asbestos exposure was daily in a small space for 2 1/2 years, 50 years ago. Is it possible the macrophages have in-cased the asbestos fibers? It took 10 years to diagnose IPF and then only through the pathology report. Nothing was showing up on x-ray or on exam.
For 10 years looking for reason for fatigue in legs when walking, ruled out PAD and other causes. Not short of breath, just fatigue.
For the 2 1/2 years since diagnose they has not been much change.
The lungs have put more stress on the heart functions, than the heart on the lungs in all diagnoses so far.

Could asbestos fibers be hidden in the macrophages in this small sample that have built up over the last 50 years? Slow progression of actual IPF. No other known risk factors.

Answered by Dr. Dr.Arnab (4 hours later)

Brief Answer:
i can understand what your going through..

Detailed Answer:
Hello xxxxxxxxxxxxxxxxxx, Welcome back,
Thanks for following up,

I can very much understand what your going through for such a long duration but the fact remains constant..

No it's not a possibility..

Had there been any elements of fiber remnants, it would've been detected in the microscopy, no matter how small the sample is, that's why it's considered gold standard of diagnosis till date..however, you can always get a second opinion from another pathologist by reviewing the sample's slide(i hope it must be there with you)..

Yes, IPF is really a slowly progressed disease but that is not likely..

I remain at your disposal for any further assistance..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee