Anthracotic Pigment Research Articles

Bronchial anthracofibrosis: treatment using airway stents [Case study

Bronchial anthracofibrosis is a rare disease characterised by chronic bronchial inflammation, with bronchoscopic findings showing dark anthracotic pigmentation on the bronchial mucosa in conjunction with bronchial narrowing or obliteration which causes stenosis of the airways. We describe our experience in two patients with severe bronchial anthracofibrosis and discuss a novel treatment of the stenotic bronchi using endobronchial stents.

Clinical Implication of Microscopic Anthracotic Pigment in Mediastinal Staging of Non-Small Cell Lung Cancer by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Microscopic anthracotic pigment (MAP) is frequently observed in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) specimen in non-small cell lung cancer, but its clinical interpretation is not well-known. The aim of this study was to evaluate the clinical implication of MAP in mediastinal staging of non-small cell lung cancer. From May 2010 to July 2011, consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited. Of the total 133 patients, 102 (76.7%) were male patients. Median age was 68 yr. Total 279 mediastinal lymph nodes were sampled by EBUS-TBNA; station 4R (100, 35.8%) and station 7 (86, 30.8%) were the most common sites. Malignant lymph nodes were 100 (35.8%). MAP was observed in 61 (21.7%) lymph nodes, and among them only 3 were malignant lymph nodes (P < 0.001). The lymph nodes with MAP were smaller (9.0 vs 10.8 mm, P = 0.001) and showed low standard uptake values on FDG-PET (4.4 vs 4.7, P = 0.256). In multivariate analysis, MAP was negatively associated with malignant lymph node (adjusted OR, 0.12; 95% CI, 0.03-0.42; P < 0.001). In potentially operable non-small cell lung cancer patients, MAP in endobronchial ultrasound-guided transbronchial needle aspiration specimens is strongly associated with benign mediastinal and hilar lymph nodes.

False-Positive FDG-PET and Bronchial Anthracofibrosis

73-year-old woman presented to our departmentwith a cough for 2 months. She was a housewife and had no history of smoking or tuberculosis, but she did have a history of significant exposure to biomass because she burned firewood. Chest radiograph and chest computed tomography showed a 2.5-cm–sized lung nodule at the left upper lung and percutaneous needle biopsy was performed. Pathologic findings suggested a pulmonary adenocarcinoma. 2-[18F] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomog raphy (PET) scan showed an enlarged 1.3-cm–sized 4R LN (right lower paratracheal lymph node) with 4.9 standardized uptake value (Fig. 1A). endobronchial ultrasound-guided transbronchial needle aspiration was performed at 4R LN for a mediastinal staging. Bronchial anthracofibrosis was observed during bronchoscopy, (Fig. 1B) and pigmentation of the aspirated material was observed macroscopically during endobronchial ultrasound-guided transbronchial needle aspiration. Left upper lobectomy was performed, and 4R LN was confirmed as a reactive LN with anthracosis on the resected lung specimen. Bronchial anthracofibrosis (BAF) is a bronchoscopically visible anthracotic pigmentation associated with the narrowing or obliteration of the bronchi. BAF was previously thought to be associated with active or old tuberculosis infection, but it is now believed to be associated with chronic biomass-fuel smoke exposure. 1 Mediastinal lymphadenopathy with calcification is common in BAF. 1 False-positive PET with FDG as a tracer uptake in anthracosis often mimics metastatic lymphadenopathy seen in lung cancer. 2 In conclusion, if BAF is found on bronchoscopy, PET scans tend to be a false-positive because of anthracosis.

Bronchial anthracofibrosis: a potential false-positive finding on F-18 FDG PET

Bronchial anthracofibrosis characterized by bronchostenosis associated with anthracotic pigmentation in bronchoscopic finding without a relevant history of pneumoconiosis or smoking has been recently described as a clinical entity. Radiologic finding of bronchial obstructive lesion and mediastinal lymph nodes in bronchial anthracofibrosis can be mimicking cancer. However, the metabolic characteristics of bronchial anthracofibrosis have hardly been reported. Here, we report a case of bronchial anthracofibrosis which showing hypermetabolism on F-18 FDG PET.

Talcum induced pneumoconiosis following inhalation of adulterated marijuana, a case report

BackgroundTalcosis, a granulomatous inflammation of the lungs caused by inhalation of talcum dust, is a rare form of pneumoconiosis. Besides inhalative occupational exposure, intravenous abuse of adulterated drugs is a major cause for this condition. Minerals such as talcum (magnesium silicate) and sand (predominant silicon dioxide) are used to increase both volume and weight of illicit substances. In intravenous heroin-abuse, talcosis is a well-known complication. Here we describe a case of talcosis caused by inhalative abuse of adulterated marijuana.Clinical historyA 29-year old man presented with persistent fever, dyspnea and cervical emphysema. He admitted consumption of 'cut' marijuana for several years, preferentially by water pipe smoking.Morphologic findingsLung-biopsies showed chronic interstitial lung disease, anthracotic pigments and birefringent material. Energy dispersive x-ray spectroscopy revealed silicon-containing particles (1-2 μm) and fine aluminum particles (< 1 μm), magnesium and several other elements forming a spectrum compatible with the stated water pipe smoking of talcum-adulterated marijuana.ConclusionsThe exacerbated chronic interstitial lung disease in a 29-year old patient could be attributed to his prolonged abuse of talcum-adulterated marjuana by histopathology and x-ray spectroscopy. Since cannabis consumption is widely spread among young adults, it seems to be justified to raise attention to this form of interstitial pulmonary disease.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnomx.eu/vs/krause/html/start.html.

Histopathological Lung Changes in Children due to Biomass Fuel

Three billion people use biomass fuel worldwide, and up to 2million deaths are attributed to its exposure each year (1). In Peru, over 9 million people use biomass fuel, and in developing countries, biomass fuel exposure is the fourth highest risk factor for disease (2). In this letter, we describe the histopathological findings in the lungs of four children who died nearly four decades ago from accidental causes and resided in homes in which biomass fuel was used. At that time in Peru, children less than 5 years old spent on average 4–5 hours a day inside the kitchen with their mothers. At the time of death, these children underwent a detailed necroscopy in our institute (4,340 m above sea level). Lung tissue sections from the preserved paraffin blocks generated during those necroscopies were stained with hematoxylin and eosin and examined by a pathologist unaware of the clinical data associated with these children. The pathologist scored lung sections from the four children according to the criteria described in Table 1. Macrophages with anthracotic pigment were found in the alveoli and in the septum of all four children (Table 1 and Figure 1). In three of the four children, we found changes compatible with bronchitis (1). We found no evidence for caliciform cell metaplasia or a positive Reid’s index (.0.4) in any of the children. Mild emphysema was noted in a girl of 1 year and 2 months. In adults, exposure to biomass fuel has been associated with the changes we observed in children as well as septal enlargement, fibrosis, bronchitis, glandular hyperplasia, and goblet cell metaplasia (3–6). We suggest that the changes we observed in these children represent the earliest changes associated with biomass fuel–induced lung disease.

Anthracofibrosis or Anthracostenosis

Anthracofibrosis is a bronchial stenosis due to local mucosal fibrosis that also presents anthracotic pigment in the mucosa. The cause has not been well clarified, although there is a frequent association with tuberculosis and the exposure to smoke from biofuel or biomass combustion. It is an entity that has not been reported in Spain, although the influx of people from rural areas of developing countries or rural areas of our own country should make us contemplate this entity in the differential diagnosis of our patients.We present 3 cases detected in Spain (2 of them natives) diagnosed by bronchoscopy and bronchial biopsy, which are techniques necessary to confirm the diagnosis. There is no specific treatment, except for tuberculostatic treatment in cases with coexisting tuberculosis.

Abstract A22: Clinical implication of microscopic anthracotic pigment in mediastinal staging of non-small cell lung cancer by endobronchial ultrasound-guided transbronchial needle aspiration

Abstract Introduction: Microscopic anthracotic pigment is frequently observed in EBUS-TBNA specimen from non-small cell lung cancer, but the clinical interpretation is not known. The aim of this study was to evaluate the clinical implication of microscopic anthracotic pigment in mediastinal staging of non-small cell lung cancer by EBUS-TBNA. Methods: From May 2010 to July 2011, Consecutive potentially operable non-small cell lung cancer patients who underwent EBUS-TBNA for mediastinal staging were recruited in this retrospective study. Results: Total 133 patients, male were 102 (76.7%). Median age was 68. Squamous cell carcinoma (59, 44.4%) and adenocarcinoma (57, 42.9%) were most common. Clinical stages after EBUS-TBNA were as followed; IA (18.8%), IB (17.3%), IIA (6.0%), IIB (9.0%), IIIA (36.8%), IIIB (12.0%). Total 281 mediastinal lymph nodes were sampled by EBUS-TBNA, station 4R (100, 35.8%) and station 7 (86, 30.8%) were most common sites. Malignant lymph nodes were 100 (35.8%). Microscopic anthracotic pigment was observed in 61 (21.7%) lymph nodes, and among them malignant lymph nodes were only 3 (P&amp;lt;0.001). The lymph nodes with microscopic anthracotic pigment were small (9.0 vs. 10.8 mm, P = 0.001) and low SUV on FDG-PET (5.4 vs. 6.7, P = 0.120). In multivariable analysis, microscopic anthracotic pigment was statistically significant associated with benign lymph node (adjusted OR, 14.3; 95% CI, 3.6–57.3; P&amp;lt;0.001). Conclusion: In potentially operable non-small cell lung cancer patients, microscopic anthracotic pigment in endobronchial ultrasound-guided transbronchial needle aspiration specimen was strongly associated with benign mediastinal lymph node.

Anthracofibrosis Involving Lung Parenchyma

To describe computed tomographic (CT) findings of anthracofibrosis involving lung parenchyma. Retrospectively reviewed CT findings of 34 patients with anthracofibrosis involving lung parenchyma, showing deposition of anthracotic pigmentation with focal fibrotic lesions on histologic examination. Types included nodules (41.2%), masses (55.9%), and fibrotic consolidation (2.9%). The mean size was 26.8 mm. The most common location was right upper lobe (n = 10). Satellite nodules were identified in 5 patients, calcification was identified in 11 patients, necrotic low attenuation was identified in 9 patients, and marginal spicule was identified in 26 patients (76.5%). The CT images showed airway manifestation of anthracofibrosis in 13 patients, nodal manifestation in 11 patients, and inactive tuberculosis in 14 patients. Initial radiologic diagnosis included tuberculosis (n = 10), lung cancer (n = 9), organized pneumonia (n = 7), nonspecific pulmonary nodule (n = 7), and anthracofibrosis (n = 1). Anthracofibrosis involving lung parenchyma appears as a nodule, mass, or fibrotic consolidation, surrounded by long spicule. It may be the spectrum of bronchial anthracofibrosis involving small airway of lung parenchyma.

Diesel Exhaust Particulates Exacerbate Asthma-Like Inflammation by Increasing CXC Chemokines

Particulate matter heavily pollutes the urban atmosphere, and several studies show a link between increased ambient particulate air pollution and exacerbation of pre-existing pulmonary diseases, including asthma. We investigated how diesel exhaust particulates (DEPs) aggravate asthma-like pulmonary inflammation in a mouse model of asthma induced by a house dust extract (HDE) containing cockroach allergens and endotoxin. BALB/c mice were exposed to three pulmonary challenges via hypopharyngeal administration of an HDE collected from the home of an asthmatic child. One hour before each pulmonary challenge, mice were exposed to DEP or PBS. Pulmonary inflammation was assessed by histological features, oxidative stress, respiratory physiological features, inflammatory cell recruitment, and local CXC chemokine production. To prove the role of CXC chemokines in the augmented inflammation, CXC chemokine-specific antibodies were delivered to the lungs before DEP exposure. DEP exacerbated HDE-induced airway inflammation, with increased airway mucus production, oxidative stress, inflammatory cell infiltration, bronchoalveolar lavage concentrations of CXC chemokines, and airway hyperreactivity. Neutralization of airway keratinocyte-derived chemokine and macrophage inflammatory protein-2 significantly improves the respiratory function in addition to decreasing the infiltration of neutrophils and eosinophils. Blocking the chemokines also decreased airway mucus production. These results demonstrate that DEP exacerbates airway inflammation induced by allergen through increased pulmonary expression of the CXC chemokines (keratinocyte-derived chemokine and macrophage inflammatory protein-2).

Antracofibrosis o antracoestenosis

Anthracofibrosis is a bronchial stenosis due to local mucosal fibrosis that also presents anthracotic pigment in the mucosa. The cause has not been well clarified, although there is a frequent association with tuberculosis and the exposure to smoke from biofuel or biomass combustion. It is an entity that has not been reported in Spain, although the influx of people from rural areas of developing countries or rural areas of our own country should make us contemplate this entity in the differential diagnosis of our patients.We present 3 cases detected in Spain (2 of them natives) diagnosed by bronchoscopy and bronchial biopsy, which are techniques necessary to confirm the diagnosis. There is no specific treatment, except for tuberculostatic treatment in cases with coexisting tuberculosis.

Abstract 407: Detection of phospho-Stat3-mediated immunosuppressive microenvironment in benign lymph nodes of patients with early stage non-small cell lung cancer

Abstract Objectives: Surgical resection offers the most promising chance for cure in patients who present with early-stage disease, although the majority will experience recurrence due to microscopic disease at the time of surgery. In this study, we sought to identify markers of metastatic potential within benign regional lymph nodes of patients with completely resected non-small cell lung cancer (NSCLC) with a focus on VEGFR-1, myeloid cells and pStat3. Methods: Paraffin-embedded benign pulmonary lymph node specimens from 46 lung cancer patients with stage I-III resected disease were stained for CD68 (AbD Serotec, Raleigh, NC), CD163 (AbD Serotec, Raleigh, NC), VEGFR-1 (Santa Cruz, Santa Cruz, CA), phospho-Stat3 (Cell Signaling, Danvers, MA), MMP-9 (Cell Signaling, Danvers, MA) and VEGF-A (Abcam, Cambridge, MA) by immunohistochemistry or immunofluorescence. Anthracosis in the lymph nodes was evaluated using HE-stained sections. The sections were analyzed with Image Pro Plus or evaluated by two independent observers who were not aware of the patient information (double-blinded). Results: In benign lymph nodes from resected lung cancer patients, CD68 was highly expressed, while VEGFR-1 demonstrated low expression. Furthermore, these cells were associated with anthracotic deposition. Upon additional evaluation, we found that the infiltrating cells with anthracotic pigment display CD68+ CD163+, suggestive of an M2 macrophage phenotype, which are immunosuppressive and cancer promoting. These M2 macrophages expressed MMP-9 and VEGF-A, and in at least 40% of the patient lymph node tissue, pStat3 was elevated in these anthracotic macrophages. The infiltration of CD68+ macrophages was closely correlated with the intensity of anthracosis (P&amp;lt;0.0001, One-way ANOVA). In some lymph nodes, the infiltration of M2 macrophages was dramatically increased. We also observed positive correlations between overall pStat3 level with M2 macrophage infiltration and anthracosis intensity (P&amp;lt;0.05 and P&amp;lt;0.01, respectively, One-way ANOVA). In addition, pStat3 levels in anthracotic cells increased with the intensity of anthracosis in the lymph nodes. Conclusion: Our results indicate the presence of M2 macrophages and anthracosis in benign lymph nodes of patients with stage I-III NSCLC. The infiltration of M2 macrophages in benign pulmonary lymph nodes might serve as a predictive factor for micrometastasis and patient prognosis. Correlations between M2 macrophage in lymph nodes with smoking status, patient stage and survival will also be evaluated. Supported by NIH R01 CA115815 (hy) and NIH K12 CA001727 (klr; skp). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 407. doi:10.1158/1538-7445.AM2011-407

Undergraduate student‐led cadaveric dissection: an interdisciplinary approach to connecting pathological findings to health conditions

A cadaveric anatomical dissection was completed by five Westminster College undergraduate students with the objective to analyze anatomical abnormalities in order to compile a complete report of pathological findings. Abnormalities were identified through observation, histological preparation, and examination of aberrant tissues that may indicate possible health conditions at time of death. Preliminary pathological findings include enlargement of the thyroid gland (length=6.8 cm, width=4.6 cm), abnormal growth on the exterior surface of the superior vena cava (length=3.1 cm, width=1.6 cm), bronchopulmonary lymph nodes with anthracotic pigmentation, a papillary process present on the liver, numerous dense polyps on the descending colon, sigmoid colon and rectum, and uterine irregularities. Further histological analysis of the listed abnormalities was performed to identify the severity of disease(s) at the time of death. In addition to dissection, students documented personal experiences through journaling and participated in educational seminars to enhance their understanding and appreciation for human anatomy.Grant Funding Source: Westminster College

Abnormal FDG-PET Findings in Particulate-Induced Lung Disease

Editor – In a recent issue of Clinical Medicine & Research, Onitilo et al1 report clinical, pathological and imaging findings in the case of a woman, aged 71 years, with life-long exposure to soot from an indoor wood cook stove. The findings of interest included hilar and mediastinal lymph node enlargement that was intensely hypermetabolic on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and histopathological findings of anthracotic pigment accumulation in lymphoid tissue that led to a diagnosis of anthracotic pneumoconiosis. The authors state it is difficult to understand the cause of increased FDG uptake on PET since the patient did not have malignancy or active inflammatory disease. While specific mechanisms of increased FDG uptake in domestically acquired particulate lung disease have not been elucidated, increased FDG uptake in other pneumoconioses has been well established in previous reports. In a series of 6 patients with coal worker’s pneumoconiosis who had a total of 19 nodules greater than 1 cm in diameter, 18 of the nodules were hypermetabolic and none was malignant, consistent with a coal dust induced response.2 Other authors have reported positive findings on PET imaging in the setting of silica induced lung disease,3 including positive uptake in mediastinal lymph nodes consistent with silica induced inflammation.4 These reports support the conclusion by Onitilo et al1 that their patient’s history of life-long exposure to indoor wood smoke caused enlargement of mediastinal and hilar lymph nodes and accounts for the associated increase in metabolic activity that was detected on FDG-PET imaging.

Anthracosis and Large Mediastinal Mass in a Patient with Healed Pulmonary Tuberculosis

A Mexican woman, aged 71 years, with life-long exposure to soot from a wood cook stove in a closed environment, who was treated for tuberculosis 4-years prior, presented with prominent mediastinal lymphadenopathy with anthracosis. Mediastinal lymphadenopathy is a common presentation of diverse granulomatous, malignant and infectious conditions like tuberculosis. Anthracotic pigment is found in different conditions such as tuberculosis or domestically acquired particulate lung disease. Accurate assessment of chronology and causative factors presents a challenge. Recognizing that pneumoconiosis can mimic or coexist with other granulomatous, infectious and malignant conditions presenting as mediastinal lymphadenopathy is important. Misdiagnosis may result in under- or over-treatment of potentially curable conditions such as tuberculosis, under-treatment of a lethal condition such as melanoma, or exposure of patients to inappropriate administration of costly therapy with potential untoward effects.

Cadaver programs at the undergraduate level: student‐led dissection with a focus on exploring pathologies and anatomical variations

At Westminster College, an undergraduate institution, a cadaveric gross anatomical dissection was completed using the thirteenth edition of Grant's Dissector. The objectives of this dissection were to determine possible indicated health conditions, pathologies, and anatomical variations present in a single cadaver. Anatomical variations in the cadaver included renal, pelvic, coronary, porta hepatic, and transverse cervical vasculature, as well as variations of rib structure. In addition to anatomical variations, pathologies were studied by comparing findings to anatomical standards. Pathologies included pleural adhesion of the left lung, bronchopulmonary lymph nodes with anthracotic pigmentation, and calcification of the abdominal aorta. The analyses of pathologies were conducted to include histopathology of pulmonary, vascular, and cardiovascular tissue, as well as a calcium analysis of the abdominal aorta. These pathological test results assisted in confirming the indicated health condition of the cadaver. Overall, students gained an understanding and appreciation of standard human anatomy, pathologies, and anatomical variations through this exploration.

General anesthesia in a patient with known bronchial anthracofibrosis -A case report-

Bronchial anthracosis was recently defined in the English radiology literature as a luminal narrowing associated with anthracotic pigmentation on bronchoscopy without a relevant history of pneumoconiosis or smoking. Anthracosis refers to the presence of carbon particles in the lungs, not to a disorder per se. Anthracofibrotic lesions carry the potential risk of massive hemorrhage during endobronchial procedures. This report describes a case of general anesthesia for a left modified radical mastectomy due to an intraductal carcinoma in a patient with known bronchial anthracofibrosis.

Pathology and Toxicology Findings for Search-and-Rescue Dogs Deployed to the September 11, 2001, Terrorist Attack Sites: Initial Five-Year Surveillance

A long-term surveillance study was conducted on 95 search-and-rescue (S&R) dogs deployed to the September 11, 2001, terrorist attack sites; an additional 55 nondeployed S&R dogs served as controls. After 5 years of surveillance, 32% of the deployed dogs have died and 24% of the nondeployed dogs. The mean age at the time of death in these 2 groups of dogs is not significantly different. Causes of death in both groups of dogs include inflammatory, degenerative, and proliferative conditions. No primary pulmonary tumors have been identified to date nor has any significant level of toxicant been found in the tissues from these dogs using assays for general organic compounds and metals or, specifically, for polychlorinated biphenyls. However, significant numbers of both deployed and nondeployed dogs have evidence of inhaled matter as demonstrated by the presence of anthracotic pigments or refractile particulate matter in pulmonary tissue. Although S&R activities in response to the 9/11 terrorist attacks exposed dogs to a wide variety of potentially toxic compounds, to date, these dogs do not appear to suffer from higher mortality or increased pulmonary disease compared with nondeployed dogs. To the authors' knowledge, the current survey represents the first long-term and large-scale survey of the pathology and toxicology of S&R dogs deployed to a major disaster site.

Bronchial anthracofibrosis and tuberculosis presenting as a middle lobe syndrome

Bronchial anthracofibrosis, a clinical entity described less than a decade ago, is characterised by anthracotic pigmentation of the bronchial mucosa with multifocal bronchial lumen narrowing. The right middle lobe is predominantly involved and is frequently associated with tuberculosis. The condition is generally seen in non-smoking elderly ladies with a longstanding history of wood smoke exposure. A 65 year-old lady presented to us with a one-month history of dry cough. The chest radiograph revealed a middle lobe syndrome which was confirmed on computed tomography (CT) scanning. In addition, narrowing of the right middle lobe bronchus was seen. This raised the suspicion of a malignancy. Fibreoptic bronchoscopy revealed anthracotic pigmentation, and bronchial aspirate showed acid fast bacilli. Culture of the aspirate grew Mycobacterium tuberculosis. The patient responded to standard antituberculous treatment.

The Clinical Characteristics of Endobronchial Anthracofibrotic Pigmentation

Objectives : Endobronchial anthracofibrotic pigmentation, which presents as dark black or brown pigmentation mucosal changes of multiple bronchi combined with bronchial fibrosis and obstruction, is not a rare finding when performing diagnostic bronchoscopy for Koreans. This study was performed to define the clinical characteristics and to determine the association of these finding with the Korean life style and such other diseases as coal workers, pneumoconiosis or tuberculosis in the patients with anthracofibrotic pigmentation. Methods : This retrospective analysis was conducted on 70 (5.2%) patients with endobronchial anthracofibrotic pigmentation, among a total of 1340 patients who underwent bronchoscopy. The distinctive clinical features, the personal life style, the past medical history, the histology and microbiology, the radiologic finding and the natures of the bronchoscopic lesions were analyzed. Results : This mean age of the patients with anthracofibrotic pigmentation was year old and the male to female ratio was 1:1.7. The common respiratory symptoms of these patients were coughing and sputum (81%, 57/70), and this was followed in order by dyspnea and hemoptysisir. The symptoms were not related with smoking and an occupational history such as being a coal worker and so on. Pneumonia was most common finding on the radiologic studies. On bronchoscopy, the right middle lobe bronchus was most commonly involved. The most common associated disease was tuberculosis, and 40 cases (57.1%) were diagnosed by AFB staining, TB PCR, bronchoscopic guided tissue biopsy and a past history of tuberculosis. Other diseases related with anthracotic pigmentation were hypertension, diabetes, COPD, lung cancer, pneumoconiosis and asthma. Conclusion : These results suggest that endobronchial anthracofibrotic pigmentation was mostly related with pulmonary tuberculosis rather than with coal- related disease. Endobronchial anthracofibrotic pigmentation was more prevalent in older age females in Korea.