Sarcoid-Like Granulomatous Disease: Pathologic Case Series in World Trade Center Dust Exposed Rescue and Recovery Workers

Abstract

Sarcoid-like granulomatous diseases (SGD) have been previously identified in cohorts of World Trade Center (WTC) dust-exposed individuals. In the present studies, we analyzed lung and/or lymph node biopsies from patients referred to our clinic with suspected WTC dust-induced lung disease to evaluate potential pathophysiologic mechanisms. Histologic sections of lung and/or lymph node samples were analyzed for markers of injury, oxidative stress, inflammation, fibrosis, and epigenetic modifications. Out of seven patients examined, we diagnosed four with SGD and two with pulmonary fibrosis; one was diagnosed later with SGD at another medical facility. Patients with SGD were predominantly white, obese men, who were less than 50 years old and never smoked. Cytochrome b5, cytokeratin 17, heme oxygenase-1, lipocalin-2, inducible nitric oxide synthase, cyclooxygenase 2, tumor necrosis factor α, ADP-ribosylation factor-like GTPase 11, mannose receptor-1, galectin-3, transforming growth factor β, histone-3 and methylated histone-3 were identified in lung and lymph nodes at varying levels in all samples examined. Three of the biopsy samples with granulomas displayed peri-granulomatous fibrosis. These findings are important and suggest the potential of WTC dust-induced fibrotic sarcoid. It is likely that patient demographics and/or genetic factors influence the response to WTC dust injury and that these contribute to different pathological outcomes.

Twenty-Year Reflection on the Impact of World Trade Center Exposure on Pulmonary Outcomes in Fire Department of the City of New York (FDNY) Rescue and Recovery Workers

“…The average annual incidence increased initially from 15/100,000 in the 15 years prior to 9/11 to 85/100,000 in the year after 9/11 and then stabilized at 25/100,000 after 2002. Similar findings were reported in both survivor and non-FDNY rescue/recovery cohorts [60][61][62]. Unlike pre-9/11 sarcoidosis cases within the FDNY cohort, those with newly diagnosed sarcoidosis post-9/11 were more likely to have new asthma symptoms and airway hyperreactivity [59].…”

Environmental Exposure to Respirable Particles and Estimated Risk of Sarcoidosis: A Systematic Review and Meta-Analysis

“…A summary of studies included in the review is shown in Table 2 Out of the nine studies reviewed, six evaluated the exposure among the 9/11 WTC responders or firefighters and their risk of sarcoidosis. Three out of the six studies that focused on WTC cohort were case series (17)(18)(19). Two studies were specific to the chemical composition of particulate exposure that they assessed which was silica dust (4,7).…”

New Occupational Exposures with Respiratory Effects

“…One recent study has reported that former WTC responders also developed pulmonary fibrosis and the adjusted hazard ratio was nearly 5-times higher in those with a very high level of exposure, and nearly 3-times higher in those with a medium level of dust exposure 121 . In addition to fibrotic changes, several former WTC dust-exposed workers were also reported to develop sarcoid-like granulomatous diseases 122 .…”