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ͼ Æ× µ¼ ¶Á **²¿·Ö ·ÎÔàµÄ»ù±¾½á¹¹ÓëÐÎ̬ѧÌصã 1 ·ÎÔàµÄ½âÆÊѧ/ 2 2 ·ÎÔàµÄ×éÖ¯ÐÎ̬ѧ /3 2.1 ·ÎʵÖÊ£ºµ¼Æø²¿ºÍºôÎü²¿ /3 2.2 ·Î¼äÖÊ£º·ÎµÄѪ¹Ü¡¢Áܰ͹ܺÍÉñ¾­×éÖ¯/ 6 µÚ¶þ²¿·Ö ú¹¤³¾·ÎÐÎ̬ѧÌصã 1 ú¹¤³¾·Î´óÌåÐÎ̬ѧÌصã /8 1.1 ú°ßÔ°üÀ¨ÐØĤú°ßÔîºÍ·ÎÄÚú°ßÔî/ 8 1.2 ½á½Ú²¡±ä/9 1.3 ¿é×´ÏËά»¯ 9 1.4 ÃÖÂþÐÔ¼äÖÊÏËά»¯/ 9 1.5 ·ÎÆøÖײ¡±ä/ 9 1.6 ÁܰͽáµÄ²¡±ä(¶à¼û·ÎÃÅÁܰͽáµÄÀÛ¼°)/ 10 1.7 ÐØĤ²¡±ä /10 1.8 ú¹¤³¾·Î°é·¢·Î½áºË²¡/ 10 1.9 ú¹¤³¾·Î°é·¢·Î°© /10 1.10 ú¹¤³¾·Î°é·¢·ÎÔ´ÐÔÐÄÔಡ/ 10 2 ú¹¤³¾·Î×éÖ¯ÐÎ̬ѧÌصã/10 2.1 úÎù·Î /10 2.2 Îùú·Î(Îù·Î) /12 2.3 ú·Î /13 2.4 °é·¢ÐÔ²¡±ä/ 13 2.5 ÆäËû²¡±ä /14 ²Î¿¼ÎÄÏ× /16 Atlas Guide Part I Anatomy and Histology of Lung 1 Anatomy of the lung/ 20 2 Histology of the lung/21 2.1 Parenchyma: It includes conduction portion and respiratory portion / 21 2.2 Mesenchyma: It contains blood vessels, lymphatic vessels and nerves / 25 Part II Pathology of Coal Workers' Pneumoconiosis 1 Gross appearance of coal workers' pneumoconiosis/ 27 1.1 Coal dust maculae/27 1.2 Coal dust nodules /28 1.3 Massive fi brosis /28 1.4 Diffuse interstitial fi brosis / 29 1.5 Emphysema /29 1.6 Lesions in the lymph nodes (usually in hilar lymph nodes)/ 29 1.7 Lesions in pleura /29 1.8 Coal works' pneumoconiosis with tuberculosis / 29 1.9 Coal works' pneumoconiosis with lung cancer /30 1.10 Coal works' pneumoconiosis with cor pulmonale /30 2 Histological changes of coal workers' pneumoconiosis/ 30 2.1 Anthracosilicosis/ 30 2.2 Silicosis/32 2.3 Anthracosis/33 2.4 Complicated lesions / 34 2.5 Others /35 References /37 ͼÆײ¿·ÖAtlas **²¿·Ö ú¹¤³¾·Î´óÌåÐÎ̬ѧÌصãPart I Gross Appearance of CoalWorkers' Pneumoconiosis ͼ1 ÐØĤú°ßÔî/43 Fig.1 Pleural coal dust maculae / 43 ͼ2 ÖÁͼ4 ·ÎÄÚú°ßÔî/43 Fig.2 to Fig.4 Pulmonary coal dust maculae / 43 ͼ5 ·ÎÄÚú°ßÔî°é´óÅÝÐÍ·ÎÆøÖ×ÐγÉ/ 45 Fig.5 Pulmonary coal dust maculae accompanied by bullous emphysema /45 ͼ6 ·ÎÄÚú°ßÔî°éÄÒÅÝÐÍ·ÎÆøÖ×ÐγÉ/ 45 Fig.6 Pulmonary coal dust maculae with cystic emphysema / 45 ͼ7 ºÍͼ8 ·ÎÄÚú°ßÔî(È«·Î´óÇÐƬ±ê±¾) / 46 Fig.7 and Fig.8 Pulmonary coal dust maculae(the large slice) / 46 ͼ9 ºÍͼ10 ·ÎÄÚú°ßÔî(·ÎÒ¶´óÇÐƬ±ê±¾) / 47 Fig.9 and Fig.10 Pulmonary coal dust maculae(the large slice)/ 47 ͼ11 ºÍͼ12 ·ÎÄÚú°ßÔú³¾ÏËάÔî(ú½á½Ú)ÐγÉ/ 48 Fig.11 and Fig.12 Pulmonary coal dust maculae and fi brotic lesions( coal dust nodule) / 48 ͼ13 ºÍͼ14 ·ÎÄÚú°ßÔúÎù½á½Ú/ 49 Fig.13 and Fig.14 Pulmonary coal dust maculae and coal silicotic nodules /49 ͼ15 ºÍͼ16 ·ÎÄÚú°ßÔúÎù½á½Ú/ 50 Fig.15 and Fig.16 Pulmonary coal dust maculae and coal silicotic nodules/ 50 ͼ17 ºÍͼ18 ·ÎÄÚú°ßÔî51 Fig.17 and Fig.18 Pulmonary coal dust maculae 51 ͼ19 ºÍͼ20 ½øÐÐÐÔ¿é×´ÏËά»¯/ 52 Fig.19 and Fig.20 Progressive massive fi brosis/ 52 ͼ21 ºÍͼ22 ½øÐÐÐÔ¿é×´ÏËά»¯(·Î´óÇÐƬ±ê±¾) / 53 Fig.21 and Fig.22 Progressive massive fi brosis(the large slice) / 53 ͼ23 ºÍͼ24 ½á½ÚÈÚºÏÐÍ¿é×´ÏËά»¯/ 54 Fig.23 and Fig.24 Nodular confl uent massive fi brosis / 54 ͼ25 ºÍͼ26 ½á½ÚÈÚºÏÐÍ¿é×´ÏËά»¯(ͬͼ23 ·Î´óÇÐƬ±ê±¾) / 55 Fig.25 and Fig.26 Nodular confl uent massive fi brosis( this large slice shares the samplewith Fig.23)/55 ͼ27 ºÍͼ28 »ìºÏÐÍ¿é×´ÏËά»¯/ 56 Fig.27 and Fig.28 Mixed massive fi brosis / 56 ͼ29 ÖÁͼ38 ú¹¤³¾·Î°é½áºË²¡/ 57 Fig.29 to Fig.38 Coal works' pneumoconiosis with tuberculosis / 57 ͼ39 ú¹¤³¾·Î°é·Î°©(ÖÜΧÐÍ) / 62 Fig.39 Coal works' pneumoconiosis with lung cancer( Peripheral type) / 62 ͼ40 ú¹¤³¾·Î°é·Î°©(ÃÖÂþÐÍ) / 62 Fig.40 Coal works' pneumoconiosis with lung cancer( Diffuse type)/ 62 ͼ41 ºÍͼ42 ú¹¤³¾·Î°éÐØĤճÁ¬ÓëÔöºñ/ 63 Fig.41 and Fig.42 Coal works' pneumoconiosis with pleural adhesion and thickening/ 63 ͼ43 ºÍͼ44 ú¹¤³¾·ÎºÏ²¢·ÎÔ´ÐÔÐÄÔಡ/ 64 Fig.43 and Fig.44 Coal works' pneumoconiosis with cor pulmonale / 64 µÚ¶þ²¿·Ö ú¹¤³¾·Î×éÖ¯ÐÎ̬ѧÌصã Part II Histological Appearance of Coal Workers' Pneumoconiosis ͼ45 ÖÁͼ48 ÐØĤú°ß/66 Fig.45 to Fig.48 Coal dust dots of pleura/ 66 ͼ49 ÖÁͼ52 ·ÎÄÚú°ß/68 Fig.49 to Fig.52 Coal dust dots of lung /68 ͼ53 ºÍͼ54 ú³¾Ï¸°ûÔî70 Fig.53 and Fig.54 Cellular coal dust foci / 70 ͼ55 ÖÁͼ58 ú³¾ÏËάÔî/71 Fig.55 to Fig.58 Fibrous coal dust foci / 71 ͼ59 ÖÁͼ74 ´óС²»µÈ¡¢ÐÎ×´¸÷ÒìµÄú³¾Ôî/ 73 Fig.59 to Fig.74 Coal dust lesions varying in size and shape / 73 ͼ75 ÖÁͼ78 ¾ÞÊÉϸ°ûÐÔ·ÎÅÝÑ×/ 77 Fig.75 to Fig.78 Macrophage alveolitis / 77 ͼ79 ÖÁͼ82 ú³¾Ï¸°ûÐÔ½á½Ú/ 79 Fig.79 to Fig.82 Cellular coal dust nodules / 79 ͼ83 ÖÁͼ86 ϸ°ûÏËάÐÔ½á½Ú/ 81 Fig.83 to Fig.86 Cellular fi brous nodules /81 ͼ87 ÖÁͼ94 úÎù½á½Ú/83 Fig.87 to Fig.94 Coal silicotic nodules / 83 ͼ95 ²»µäÐÍúÎù½á½Ú/88 Fig.95 Atypical coal silicotic nodule / 88 ͼ96 ÖÁͼ103 ÈÚºÏÐÍúÎù½á½Ú/ 89 Fig.96 to Fig.103 Confl uent coal silicotic nodules/ 89 ͼ104 Îù½á½Ú/93 Fig.104 Silicotic nodule /93 ͼ105 ÈÚºÏÐÍÎù½á½Ú/93 Fig.105 Confl uent silicotic nodules / 93 ͼ106 ÖÁͼ109 Îù½á½Ú/94 Fig.106 to Fig.109 Silicotic nodule/ 94 ͼ110 ÖÁͼ113 ½øÐÐÐÔ¿é×´ÏËά»¯/ 96 Fig.110 to Fig.113 Progressive massive fi brosis / 96 ͼ114 ºÍͼ115 ÈÚºÏÐÍ¿é×´ÏËά»¯ / 98 Fig.114 and Fig.115 Confl uent massive fi brous lesion / 98 ͼ116 ºÍͼ117 ÃÖÂþÐÔ³¾ÐÔ¼äÖÊÏËά»¯ / 99 Fig.116 and Fig.117 Diffuse coal interstitial fi brosis/ 99 ͼ118 ºÍͼ119 ¼äÖÊÏËά»¯°éƽ»¬¼¡Ï¸°û¾ÖÔîÐÔÔöÉú / 100 Fig.118 and Fig.119 Interstitial fi brosis with local proliferated smooth muscle cells / 100 ͼ120 ºÍͼ121 ú¹¤³¾·Î°é½áºË²¡±ä/101 Fig.120 and Fig.121 Coal workers' pneumoconiosis with tuberculosis / 101 ͼ122 ·ÎÄÚÔçÆÚúÎù½áºË½á½Ú/ 102 Fig.122 Early stage of coal silicotic tuberculous nodule / 102 ͼ123 ·ÎÄÚµäÐ͵ÄúÎù½áºË½á½Ú/ 102 Fig.123 Classic coal silicotic tuberculous nodule / 102 ͼ124 ·ÎÄÚúÎù½áºË½á½Ú/103 Fig.124 Coal silicotic tuberculous nodules/ 103 ͼ125 ÖÁͼ127 ·ÎÄÚÈÚºÏÐÍúÎù½áºË½á½Ú/103 Fig.125 to Fig.127 Confl uent coal silicotic tuberculous nodules / 103 ͼ128 ºÍͼ129 ú¹¤³¾·ÎÎù½áºË½á½Ú/105 Fig.128 and Fig.129 Silicotic tuberculous nodules of coal works' pneumoconiosis / 105 ͼ130 ½á½ÚÈÚºÏÐÍ¿é×´ÏËά»¯/ 106 Fig.130 Nodular confl uent massive fibrosis / 106 ͼ131 ÖÁͼ134 ú¹¤³¾·Î°é²¥É¢ÐÔËÚÁ£ÐԷνáºË/ 106 Fig.131 to Fig.134 Disseminated miliary tuberculosis of coal workers' pneumoconiosis / 106 ͼ135 ³¾ÐÔ½áºËÐÔ½á½Ú/108 Fig.135 Coal dust tuberculous nodules / 108 ͼ136 ºÍͼ137 ³¾ÐÔ½áºËÐÔÈâÑ¿Ö×(½á½Ú)/ 109 Fig.136 and Fig.137 Coal dust tuberculous granuloma( nodule) / 109 ͼ138 ºÍͼ139 ³¾ÐÔ½áºËÐÔÖ§Æø¹ÜÑ×/ 110 Fig.138 and Fig.139 Coal dust tuberculous bronchiolitis / 110 ͼ140 ú¹¤³¾·Î°é½áºËÐÔÐØĤÑ×/ 111 Fig.140 Tuberculous pleuritis of coal workers' pneumoconiosis / 111 ͼ141 ú¹¤³¾·Î½áºËÐÔ¿Õ¶´/ 111 Fig. 141 Tuberculous cavity of coal workers' pneumoconiosis . 111 ͼ142 ºÍͼ143 ú¹¤³¾·Î°é·¢·ÎÏÙ°©/ 112 Fig.142 and Fig.143 Coal workers' pneumoconiosis with pulmonary adenocarcinoma / 112 ͼ144 ºÍͼ145 ú¹¤³¾·Î°éÁܰͽáתÒÆÏÙ°©/ 113 Fig.144 and Fig.145 Coal workers' pneumoconiosis with lymph node adenocarcinoma metastasis / 113 ͼ146 ºÍͼ147 ú¹¤³¾·Î°é·¢·ÎÏÙ°©/ 114 Fig.146 and Fig.147 Coal workers' pneumoconiosis with pulmonary adenocarcinoma / 114 ͼ148 ÖÁͼ151 ú¹¤³¾·Î°é·¢ÏÙÁÛ°©/ 115 Fig.148 to Fig151 Coal workers' pneumoconiosis with pulmonary adenosquamous carcinoma / 115 ͼ152 ºÍͼ153 ú¹¤³¾·Î°é·¢¶ñÐÔ¼äƤÁö/117 Fig.152 and Fig.153 Coal workers' pneumoconiosis with malignant mesothelioma/ 117 ͼ154 ú¹¤³¾·Î°é·¢¶ñÐÔ¼äƤÁöÁܰͽáתÒÆ/ 118 Fig.154 Coal workers' pneumoconiosis with lymph node malignant mesothelioma metastasis 118 ͼ155 Ѫ¹ÜÄÚÁö˨ÐγÉ118 Fig.155 Carcinoma cells emboli in small blood vessels / 118 ͼ156 ÖÁͼ159 Áܰͽáú³¾³Á»ý. 119 Fig.156 to Fig.159 Lymph nodes with coal dust deposition . 119 ͼ160 ÖÁͼ163 ÁܰͽáÄÚúÎù½á½Ú. 121 Fig.160 to Fig.163 Coal silicotic nodules in lymph nodes / 121 ͼ164 ÁܰͽᲡ±ä/123 Fig.164 Silicotic lesions in lymph nodes/ 123 ͼ165 ÖÁͼ167 ÁܰͽáÄÚÎù½á½Ú/ 123 Fig.165 to Fig.167 Silicotic nodules in lymph node / 123 ͼ168 ÖÁͼ171 ÁܰͽáÄÚÈÚºÏÐÍÎù½á½Ú/ 125 Fig.168 to Fig.171 Confl uent silicotic nodules in lymph node / 125 ͼ172 ºÍͼ173 ÁܰͽáÄÚúÎù½áºË½á½Ú/ 127 Fig.172 and Fig.173 Coal silicotic tuberculous nodules in lymph nodes / 127 ͼ174 ºÍͼ175 ÁܰͽáÄÚÎù½áºË½á½Ú. 128 Fig.174 and Fig.175 Silicotic tuberculous nodules in lymph nodes / 128 ͼ176 ÖÁͼ180 ú³¾ÇÖ¼°Ö§Æø¹Ü/129 Fig.176 to Fig.180 Coal dust deposition in bronchi /129 ͼ181 ÖÁͼ183 ³¾ÐÔÂýÐÔϸ֧Æø¹ÜÑ×/ 131 Fig.181 to Fig.183 Coal chronic bronchiolitis /131 ͼ184 ÖÁͼ189 ÐØĤ²¡±ä/133 Fig. 814 to Fig.189 Pleural lesions / 133 ͼ190 ú³¾³Á»ýÔÚ·ÎÄÚС֧Æø¹Ü/ 136 Fig.190 Coal dust deposition in small bronchia / 136 ͼ191 ú³¾³Á»ýÔÚ·ÎÄÚϸ֧Æø¹Ü¼°ÖÕĩϸ֧Æø¹Ü/ 136 Fig.191 Coal dust deposition in small bronchia and terminal bronchia / 136 ͼ192 ºÍͼ193 ú³¾³Á»ýÔÚºôÎüÐÔϸ֧Æø¹Ü¼°Æä·ÖÖ§/ 137 Fig.192 and Fig.193 Coal dust deposition in respiratory bronchia and its branaches /137 ͼ194 ³¾ÐÔСҶÖÐÐÄÐÍ·ÎÆøÖ×/138 Fig.194 Coal dust-induced centriacinar emphysema /138 ͼ195 ȫСҶÆÆ»µÐÍ·ÎÆøÖ×/ 138 Fig.195 Destructive panacinar emphysema / 138 ͼ196 ºÍͼ197 ÀÛ¼°·Î¶¯Âö/ 139 Fig.196 and Fig.197 Lesions in pulmonary artery / 139 ͼ198 ·ÎÄÚС¶¯Âö²¡±ä/140 Fig.198 Lesions in pulmonary small arteries / 140 ͼ199 ·ÎÄÚСѪ¹Ü²¡±ä/140 Fig.199 Lesions in pulmonary small vessels / 140 ͼ200 ºÍͼ201 С¶¯Âö²¡±ä/141 Fig.200 and Fig.201 Lesions in small arteries / 141 ͼ202 ú³¾ÀÛ¼°ÁܰͽἰÆäÖ¬·¾×éÖ¯/ 142 Fig.202 Coal dust deposits involve lymph nodes and adipose tissue / 142 ͼ203 ú³¾ÀÛ¼°Ö§Æø¹Ü¼°ÆäÖÜΧ֬·¾×éÖ¯/ 142 Fig.203 Involvement of bronchi and adjacent fat tissue by coal dusts / 142 ͼ204 ºÍͼ205 Áܰ͹ܲ¡±ä/ 143 Fig.204 and Fig.205 Lesions in the lymphatic vessels / 143 ͼ206 ºÍͼ207 ÐØĤÏÂÉñ¾­ÏËάÊÜÀÛ/144 Fig.206 and Fig.207 Coal dusts involve subpleural nerve fi bers / 144 ͼ208 ú¹¤³¾·Î°é½¬Òº³öѪÐÔÑ×/ 145 Fig.208 Coal workers' pneumoconiosis with serous hemorrhagic infl ammation / 145 ͼ209 ú¹¤³¾·Î°é·ÎË®Ö×/145 Fig.209 Coal workers' pneumoconiosis with pulmonary edema / 145 ͼ210 ºÍͼ211 ú¹¤³¾·Î°é·ÎÓÙѪ¡¢·ÎË®Ö× /146 Fig.210 and Fig.211 Coal workers' pneumoconiosis with pulmonary congestion and edema/ 146 ͼ212 ú¹¤³¾·Î°é»¯Å§ÐÔÑ×/ 147 Fig.212 Coal workers pneumoconiosis with purulent infl ammation / 147 ͼ213 ú¹¤³¾·Î°éŧÖ×/147 Fig.213 Coal workers' pneumoconiosis with abscess / 147 ͼ214 ú¹¤³¾·Î°é½¬Òº¡¢ÏËάËØÐÔÑ×/ 148 Fig.214 Coal workers' pneumoconiosis with serous fi brinous infl ammation / 148 ͼ215 ú¹¤³¾·Î°é½¬Òº¡¢»¯Å§ÐÔÑ×/ 148 Fig.215 Coal workers' pneumoconiosis with serous purulent infl ammation / 148 ͼ216 ºÍͼ217 ú¹¤³¾·Î¡°°ô״СÌ塱ÐÎ³É /149 Fig.216 and Fig.217 ¡°Rod-shaped¡± bodies of coal workers' pneumoconiosis / 149 ͼ218 ÖÁͼ223 ¼¡³ÉÏËάϸ°û·Ö»¯/ 150 Fig.218 to Fig.223 Myofi broblasts differentiation / 150 ͼ224 Õý³£Ðļ¡×éÖ¯(ÓÒÐÄÊÒ)/ 154 Fig.224 Normal heart tissue( from right ventricle)/ 154 ͼ225 ·ÎÔ´ÐÔÐÄÔಡÐļ¡×éÖ¯(ÓÒÐÄÊÒ)/ 154 Fig.225 Right ventricle with cor pulmonale / 154 µÚÈý²¿·Ö ú¹¤³¾·Î°¸Àý Part III Cases of Coal Workers' Pneumoconiosis °¸ÀýÒ» úÎù·Î¢ñÆÚ(½á½Ú+ ³¾°ß- ÆøÖ×) /156 Case 1 Anthracosilicosis(stage ¢ñ£¬Nodules and maculae surrounded by emphysema) / 157 °¸Àý¶þ ú·Î¢ñÆÚ(ú³¾°ßÔî+ ϸ°ûÐÔ½á½Ú) / 161 Case 2 Anthracosis(stage ¢ñ£¬Coal dust maculae and cellular nodules) /162 °¸ÀýÈý úÎù·Î¢òÆÚ(³¾°ß- ÆøÖ×ÐÍ) 166 Case 3 Anthracosilicosis( stage ¢ò£¬Coal dust maculae and emphysema) / 167 °¸ÀýËÄ ÃºÎù·Î¢óÆÚ(´ó¿éÏËά»¯) / 170 Case 4 Anthracosilicosis(stage ¢ó£¬Massive fi brosis) / 171 °¸ÀýÎå úÎù·Î¢óÆںϲ¢·Î½áºË²¡/ 176 Case 5 Anthracosilicosis( stage ¢ó) with pulmonary tuberculosis /177 °¸ÀýÁù úÎù·Î¢óÆںϲ¢·Î°© /182 Case 6 Anthracosilicosis( stage ¢ó) with lung cancer / 183 °¸ÀýÆß Ãº·Î¢ñÆÚ(ú°ß- ÆøÖ×)ºÏ²¢·ÎÔ´ÐÔÐÄÔà / 189 Case 7 Anthracosis( stage ¢ñ£¬Coal dust maculae and emphysema) with cor pulmonale /191 ºó¼Ç /198 Acknowledgement/ 199