Mineral dusts as etiologic agents in pulmonary fibrosis: the diagnostic role of analytical scanning electron microscopy.

This report demonstrates the value of analytical scanning electron microscopy (SEM) in the evaluation of patients with fibrosing pulmonary disease. We describe the findings in six illustrative cases in which prebiopsy or premortem clinical and epidemiologic information did not suggest an etiologic association with exposure to fibrogenic dusts. Exogenous materials were inconstantly recognized by polarized light microscopy, but examination by SEM resulted in localization of significant inorganic deposits in the biopsy and autopsy tissues studied. Talc, mica, graphite, and mixed inorganic dusts were found in these six cases. Characterization of this material by SEM morphology and x-ray energy spectrometry provided the basis for re-appraisal of the exposure history and its potential pathogenetic importance. The technics described utilize routinely processed, paraffin-embedded tissue, and are readily applicable to problems encountered in the hospital setting.