1. Jaroslava Dušková Inst. Pathol.,1st Med. Faculty, Charles Univ. Prague General Pathology Basic Principles of Cellular and Organ Pathology Exogenous Pigments

2. Exogenous pigments – table of contents u definition u portals of entry  traumatic lesions  gastrointestinal tract  respiratory tract - pneumoconioses  silicosis  asbestosis  miners´disease  diff. dg. to pneumoconioses - coniotoxicoses - conioallergoses

3. Pigments Definition: colored substances in the organism or environment

4. Pigments Classification: u endogenous – hemoproteins derived – autogenous u exogenous

5. Exogenous Pigments - colored substances entering the organism via  traumatic lesions  gastrointestinal tract  respiratory tract

6. Exogenous Pigmentation v traumatic origin – tatuatio traumatica, arteficialis v gastrointestinal tract – intoxication Pb, Ag, Au, Fe (!), Hg, Pt……

7. Exogenous Pigmentation v traumatic origin – tatuatio traumatica, arteficialis mechanic instilation of inert dyes (china ink) into the deep dermis

8. Tatoo u From Polynesian tatau. u In Tahitian - tatu. u The Polynesian practice became popular among European sailors, before spreading to Western societies u Mummy of Amunet from Ancient Egypt u Pre-Christian Germanic, Celtic and other central and northern European tribes were often heavily tattooed

9. Prevalence u In June 2006 the Journal of the American Academy of Dermatology published a survey made in 2004. v 36% of Americans ages 18–29, v 24% of those 30-40 v 15% of those 41-51 had a tattoo u In September 2006 the Pew Research Center v 36% of Americans ages 18–25, v 40% of those 26-40 v 10% of those 41-64 had a tattoo u In January 2008 by Harris Interactive v 14% of all adults in the United States have a tattoo v 2003, 16% v 9% of those ages 18–24, v 32% of those 25-29 v 25% of those 30-39 v 12% of those 40-49 have tattoos v 8% of those 50-64. u Men are just slightly more likely to have a tattoo than women (15% versus 13%)

10. Medical Tattoos u to ensure instruments are properly located for repeated application of radiotherapy u for the areola in some forms of breast reconstruction. u Tattooing has also been used to convey medical information about the wearer (e.g. blood group). u Tattoos are used in skin tones to cover vitiligo, skin pigmentation disorder.

11. 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%).

12. Tatuatio arteficialis - therapy u LASER = Light Amplification by Stimulated Emission of Radiation –low performance laser – biostimulation –high performance laser – destruction of pigmentation shifts – postinflammatory, melasma (chloasma), tatoo u SURGERY / CRYOSURGERY u COMBINATION u COVER UP

13. Tattoo Removal - Think before you ink u 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. u 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. u 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. u 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. u 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. u 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.

14. Tatoo v inert – persistent v macrophage degraded v macrophage transported secondary lymph node pigmentation

15. 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.

16. Exogenous Pigmentation vgastrointestinal tract Pb, Ag, Au, Fe (!), Hg, Pt, Bi….. v intoxication v side effect in metals containing therapies

17. Exogenous Pigmentation through Airways PNEUMOCONIOSES Def.: conditions or diseases elicited with dust particles inhalation (<5  )

18. Pneumoconioses – coniosis simplex (anthracosis, siderosis) – coniofibrosis (silicosis, asbestosis, coal workers disease, siderosis) – coniotoxicosis  conioalergosis (byssinosis, berylliosis) organic dusts

19. Anthracosis Def.: pneumoconiosis caused by inert coal-like dust (without quartz admixture) no symptoms = coniosis simplex 100% population prevalence

20. Silicosis Def.: pneumoconiosis caused by quartz dust with pronounced fibrosis response CONIOFIBROSIS v long lasting exposition (20–40 years) v progression even after exposure elimination v part of miners disease v affinity to other lung diseases(tbc)

21. Silicosis Pathogenesis: toxic activity of quartz dust to macrophages u production of PDGF1, IGF-1, fibronectin u chemotaxins, IL-8 u enzyme activation, u lung injury, inflammation, u FIBROSIS

22. Silicosis Stages: –diffuse reticular fibrosis (often clinically silent) – silicotic nodules (+ perifocal emphysema) – massive fibrosis

23. Silicosis Complications: pulmonary fibrosis pulmonary hypertension cor pulmonale Cause of death cardiorespiratory insuffitiency

24. Coal Workers Pneumoconiosis - CWP - miners´disease u Coal macules- dust laden macrophages u Coal nodules – mild collagen admixture Advanced u Combined silicosis & anthracosis complicated often with tbc

25. Asbestosis Def.: pneumoconiosis caused by Asbestos fibrils with pronounced fibrotising response CONIOFIBROSIS Asbestos fibrillar mineral with various forms and fibrogenic capacity v chrysotile (90%), amosite, croccydolite etc.

26. Asbestosis Pathogenesis: u toxic influence due to fibrils size and concentration u fibrosis with feruginous bodies u hyalin pleural plaques u risk of mesotelioma and lung carcinoma and GIT malignancies (Carlos Bedrossian-Venice 2006) u pleural effusions („mesot. in situ“ – Bedrosjan 2004) u other neoplasias?

27. lin Toxicol (Phila). 2010 Jul;48(6):485-96. Occupational toxicology of asbestos-related malignancies. Lotti M, Bergamo L, Murer B.  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 of exposure is crucial  Given 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. Lotti M, Bergamo L, Murer B. Occupational toxicology of asbestos-related malignancies. Clin Toxicol (Phila). 2010 Jul;48(6):485-96.

28. 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. u Asbestos - a proven human carcinogen. u Asbestos-related diseases (ARDs): –lung cancer, –malignant mesothelioma, –asbestosis, –pleural plaques, thickening and effusion. u The WHO and the International Labour Organization have called on countries to stop using asbestos. u ARDs are increasing and asbestos use is continuing in the world. u Industrializing countries are faced with a myriad of forces prompting them to continue using asbestos. u Full-scale international cooperation will thus be needed to achieve the goal of eliminating ARDs.

29. Pneumoconioses – coniosis simplex (anthracosis, mild siderosis) – coniofibrosis (silicosis, asbestosis, coal workers disease, severe siderosis) --------------------- – coniotoxicosis  conioalergosis (byssinosis, berylliosis,….) organic „dusts“