Whorled appearance

The nodules of silicosis are well defined and located in the perivascular and peribronchiolar interstitium as well as in the paraseptal and sub-pleural interstitium (Fig. 5.1) and are preferentially distributed in the upper lobes. The silicotic nodule starts as a central zone of mononuclear cells surrounded by fibroblasts and collagen tissue. With time, the central zone becomes hypocellular, with concentric laminar deposition of reticulin, proteins, phospholipids and collagen in the periphery, giving a whorled appearance (Fig. 5.1). Adjacent vessels and bronchioles may become involved and destroyed by these nodules, with occlusion of their lumen. 

Hilar and mediastinal lymph nodes are enlarged and pigmented, with a whorled appearance similar to that found in the silicotic nodule. Calcification is also a frequent finding. Features characterized... 

Fig.5.2a,b. A 72-year-old retired tunnel worker with silicotic nodules and mixed dust fibrosis, a Posterior-anterior chest radiograph shows ill-defined multiple small nodules and reticular opacities in both upper lobes, b Photomicrograph obtained at autopsy performed 2 years after chest radiograph shows two pneumoconiotic nodules with stellate appearance. The left nodule shows irregular shape without whorled appearance (arrows) typical of silicotic nodule. The right nodule also shows irregular shape but has a central whorled appearance of silicotic nodule. Emphysema is identified around the nodules... 

In verse 16 we have a most wonderful description of the circulations taking place in the matter of the Art, which D Espagnet refers to as so many "whorls." Ezekiel terms them "wheels" - "a wheel in the middle of a wheel." The key, as usual, is the color, being that of beryl, a crystal of a sea-green color, or of a rose-red. Both these colors appear in the Stone at this stage. 

The flowers of most species have six sepals, arranged in two cycles. Sepals are the outermost whorl of a flower, typically leaf-like in appearance. The stamens, or male organs, of laurel flowers occur in three or four cycles, with three stamens in each. The flowers usually have a single pistil, or female organ, which contains a single ovule that develops into a seed after fertilization. The fruit of most species is aromatic, and is classified as a drupe, in that is has a fleshy outer layer and a hard inner layer with a single seed. 

When development of a single stem is inhibited, the distances between leaves or branches telescopes down so the leaves or branches grow close together. The result is what appears to be a whorl of leaves or broomlike growth of branches. 

The histopathologic appearance of MRT is a densely cellular neoplasm composed of sheets or cords of cells with large vesicular round or oval nuclei, prominent central eosinophilic nucleoli, and abundant eccentric eosinophilic cytoplasm (Fig. 17.26). Histologic variability is typical, and some cases have smaller numbers of characteristic rhabdoid cells or display a primitive small blue cell pattern, a myxoid background, a lack of cellular cohesion, increased collagen deposition between bands of tumor cells, and scattered non-neoplastic osteoclastlike giant cells. Occasionally cases have focal epithelial areas. Mitoses are frequent. Electron microscopy reveals cytoplasmic whorls of intermediate filaments, which correspond to the eosinophilic globules of cytoplasm in the classic rhabdoid cells. 

CORNEAL SroE EFFECTS OF SYSTEMIC MEDICATIONS The cornea, conjunctiva, and even eyelids can be affected by systemic medications. One common drug deposit foimd in the cornea is from the cardiac medication amiodarone. It deposits in the inferior and central cornea in a whorl-like pattern termed cornea verticillata. It appears as fine tan or brown pigment in the epithelium that seldom affects vision and rarely causes discontinuation. The deposits disappear slowly if the medication is stopped. Other medications can cause a similar pattern, including indomethacin, atovaquone, chloroquine, and hydroxychloroquine. 

Perianth - The perianth appears to consist of two alternating, trimerous whorls that are fused into a short floral tube at the base. The outer whorl consists of broad, possibly five-veined, tepals. The inner whorl consists of narrower, three-veined tepals (Fig 3.5G). Scattered gland-like structures, presumably oil glands, are present on the inside of the floral cup (not shown). 

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