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Alveolar Metaplasia: Its Relationship to Pulmonary Fibrosis in Industry and the Development of Lung Cancer

British Journal of Cancer
Nature Publishing Group
Publication Date
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30 ALVEOLAR METAPLASIA: ITS RELATIONSHIP TO PULMONARY FIBROSIS IN INDUSTRY AND THE DEVELOPMENT OF LUNG CANCER W. JONES WILLIAMS From the Welsh National School of Medicine, Cardiff Received for publication November 27, 1956 MANY factors are probably responsible for the rising incidence of lung cancer and one may be the increasing exposure of the population to industrial dusts and fumes. Peripheral lung scars have been suggested as a site of origin (Womack and Graham, 1941; Prior, 1953; Raeburn and Spencer, 1953; Spencer and Raeburn, 1954, 1956; King, 1954). Areas of lung fibrosis often contain dust pigment and may be associated with epithelial metaplasia of adjacent air spaces. Few studies, however, have been made of epithelial changes in relation to fibrosis in lungs of industrial workers. If the dust is carcinogenic then one might expect an increased frequency of metaplasia or atypical epithelial changes possibly related to the development of carcinoma, occurring at these sites. This paper reports an analysis of epithelial changes in distal air spaces related to areas of fibrosis in lungs from workers with and without carcinoma in industries with varying incidence of lung cancer. The fibrosis may be local or general, local as in a tuberculous scar, general as in asbestosis. "Alveolar metaplasia" will be used to denote change in the epithelium of distal respiratory air spaces to distinguish it from bronchial metaplasia which usually refers to non-respiratory bronchi. Many of the distal air spaces are alveoli, but in the absence of serial sections in every case, exact identification is impossible. The spaces therefore include alveoli, alveolar ducts and respiratory bronchioles. The relationship of alveolar metaplasia to age, occupation, presence or absence of carcinoma, chronic venous congestion, oedema and pyogenic infection will be ascertained. Sex differences were not investigated as the majority of cases were men. This investigation is not concerned with metaplasia proximal to respiratory

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