Beryllium disease: The relation of pulmonary pathology to clinical course and prognosis based on a study of 130 cases from the U.S. Beryllium Case Registry

Abstract

A group of 130 cases examined by biopsy or autopsy from the U.S. Beryllium Registry was reviewed and the histological findings in the lung correlated with the clinical course and prognosis. The appearance of the six acute cases studied was nonspecific, and it was impossible to correlate specific histological features with clinical course or intensity of exposure. The remaining 124 chronic cases were divisible into two moderately overlapping histological groups based on the degree of interstitial cellular infiltration. The largest group, representing 80 per cent of the total could be divided into two subgroups based on the absence or presence of a distinct granulomatous reaction. Although the mean course of illness in both subgroups was about eight years from the time of onset, 85 per cent of the first were already dead at the time of study, whereas only 60 per cent of the second had died. In contrast, the second group, representing 20 per cent of the total, showed minimal interstitial cellular infiltration and prominent granuloma formation resembling and often indistinguishable from sarcoidosis. In this group, the mean course to date was over 11 years and all but one patient was still alive. These findings suggest a distinct relation between the intensity of interstitial cellular infiltration and prognosis and may provide additional insight into the clinical behavior of patients presenting with a histological picture resembling sarcoidosis. No relationship could be found between the histological pattern and the effect of steroids, the character of the industrial exposure, or the length of the latent period prior to the onset of clinical symptoms.