[SIDERO-CONIOSIS CO-EXISTING WITH SILICOSIS AMONG SHIPYARD WELDERS].
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Linear iron deposits in the corneal epithelium are well-documented phenomena in a variety of circumstances, both normal and pathologic. A characteristic annular pigmented line, appearing clinically as an "iron" line, occurred in the donor epithelium of approximately 13% of corneal grafts with retained sutures. Eight cases of normally functioning grafts had iron lines located just central to the sutures. These lines appeared at various intervals postoperatively and did not correlate with age or race. They were frequently found in association with other surface-related epithelial and subepithelial phenomena and were believed to be related to peripheral corneal topography and the lid-cornea interface. Although they are clinically iron, their precise histochemistry, cause, source, and natural history are yet to be determined.
Twenty-three of 55 patients who underwent refractive keratoplasty for the correction of aphakia were found to have a pigmented corneal epithelial line similar to the Fleischer ring. In 21 of 23 cases, the pigmented ring was adjacent to the superficial keratectomy scar that resulted from the keratorefractive operation. In two cases, the pigmented line was located central to the lamellar keratectomy scar. Histopathologic study demonstrated that the line was due to iron in the form of ferritin particles deposited within basal corneal epithelial cells. We believe that the steep anterior corneal curvature (average, 51.45 diopters) and changes in corneal topography at or central to the margin of the lamellar keratoplasty may lead to malapposition of the eyelid to the cornea and cause disturbances in the precorneal tear film. Iron from the tears may then be deposited in the corneal epithelium in areas of tear pooling.
Siderophores, defined as high affinity iron(III) ion transport agents, and their cognate membrane-bound receptor complexes, occur in the enteric bacteria Escherichia coli and Salmonella typhimurium. The total system is tightly regulated by iron repression. The transport properties of the specific siderophores enterobactin and ferrichrome (which is not made by these particular enteric bacteria) have been examined in detail. In E. coli the outer membrane receptor for ferrichrome is programmed by the tonA gene; the receptor also serves as the binding site for T1, T5, phi80, albomycin and colicin M. Similarly, in S. typhimurium phage ES18, ferrichrome and albomycin compete for the genetic equivalent of the tonA locus. The ability of ascorbic acid to protect against atherosclerosis as well as rhinovirus infection in humans may be related to the role of the vitamin in iron metabolism. Deferrisiderophores are clinically useful in the treatment of acute and chronic iron poisoning but, on the other hand, they could constitute a natural hazard by transporting actinides, such as 239Pu, through the food chain.
Recently, macroregenerative nodules in cirrhotic livers have been suspected to be among the putative precancerous lesions in human hepatocarcinogenesis. We examined the morphologies of 99 macroregenerative nodules in 44 cirrhotic livers with special emphasis on stainable iron. In 26 macroregenerative nodules (26%), stainable iron selectively accumulated within the macroregenerative nodules themselves, and little or no iron was found in the surrounding regenerative nodules. In nine macroregenerative nodules (9%), an appreciable amount of stainable iron was present in both the macroregenerative nodules and the surrounding regenerative nodules. In the remaining 64 macroregenerative nodules (65%), stainable iron was absent in both the macroregenerative nodules and the surrounding regenerative nodules. Hyperplastic hepatocellular foci were present within 19 (73%) of the 26 iron-accumulative macroregenerative nodules, one (11%) of the nine iron-positive macroregenerative nodules and 20 (31%) of the 64 iron-negative macroregenerative nodules. These findings suggest that iron-accumulative macroregenerative nodules are frequently associated with hyperplastic hepatocellular foci and should be included among the precancerous lesions in human hepatocellular carcinoma.
In the absence of genetic hemochromatosis and systemic hemosiderosis, patients with cirrhosis can accumulate focal iron within regenerative or dysplastic hepatic nodules, commonly referred to as 'siderotic nodules'. Siderotic dysplastic nodules are premalignant lesions while siderotic regenerative nodules are a marker for severe viral or alcoholic cirrhosis. The relationship of hepatic iron deposition to hepatic cirrhosis and neoplasia has not been fully clarified. This article will review the current literature regarding selective iron accumulation in siderotic nodules in chronic liver disease, followed by a discussion of current MR imaging techniques for detection and characterization of these nodules.
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