A case of lung adenocarcinoma complicated by pulmonary talcosis occurring in a patient employed in the confectionery industry

Our plain-English summary of A case of lung adenocarcinoma complicated by pulmonary talcosis occurring in a patient employed in the confectionery industry, by K. Kobayashi, N. Watanabe, T. Oka, et al (Pathology International, 2019).

The study

• Authors: K. Kobayashi, N. Watanabe, T. Oka, H. Tomita, N. Suzui, Y. Oumi, A. Hara, T. Miyazaki
• Journal: Pathology International
• Published: 2019;69(4):229-234
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

A 73-year-old Japanese man, who worked at a confectionery company for more than 20 years, was diagnosed with a 28 mm nodular lesion in the superior lobe of the right lung by whole-body computed tomography examination. A biopsy revealed the presence of adenocarcinoma. With a diagnosis of a primary lung cancer, a right upper lobectomy was performed. A nodular lesion, 25 × 23 mm in size, was observed in the upper right lobe lung field, and was diagnosed histopathologically as a papillary adenocarcinoma. In addition, fibrous scars in the central part of the tumor showed numerous Langhans and/or foreign body giant cells, and histiocytic cells that had phagocytized numerous small transparent crystals, together with coal powder deposition. The extracted crystals were observed with a scanning electron microscope, and although plate-like structures were observed, ferruginous bodies suggestive of asbestos were not found. The crystals were demonstrated to be talc by powder X-ray diffraction. Herein, we investigated a case of lung adenocarcinoma in a patient with talcosis, with discussions based on a literature search. This collision of talcosis and lung adenocarcinoma adds to an increasing body of knowledge on an apparent association between talc and cancer cases.

© 2019 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

In plain English

This was a case report of one 73-year-old Japanese man who had worked for more than 20 years at a confectionery company that made candies containing talc. He had smoked 20 cigarettes a day for 10 years from age 20 and then quit. A CT scan showed a 28 mm nodule in the upper right lung, and no pleural plaques were seen. A biopsy showed adenocarcinoma, and the upper right lobe of the lung was removed. Under the microscope the tumor was a lepidic adenocarcinoma with a central scar. The scar contained many giant cells and immune cells that had taken up small crystals, along with coal dust. Electron microscopy found plate-like crystals but no ferruginous bodies suggestive of asbestos. X-ray diffraction identified the crystals as talc, and the authors considered the lung condition to be pure talcosis. Their literature search did not reach a clear conclusion about talc and lung cancer. The authors concluded that this case adds to knowledge on an apparent association between talc and cancer and called for larger studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a literature search discussed
• Who was studied: One 73-year-old Japanese man treated in Japan (Gifu University Hospital), who had worked at a confectionery company for more than 20 years
• Exposure: Work for more than 20 years at a confectionery company where candies containing talc were made. He was also a former smoker: 20 cigarettes a day for 10 years from age 20, then quit.
• Main results:
  • CT showed a 28 mm nodule in the upper right lung. No pleural plaques were evident on CT.
  • A biopsy showed adenocarcinoma, and a right upper lobectomy was performed.
  • The resected tumor was a primary lung lepidic adenocarcinoma with central fibrotic scarring.
  • The central scar contained many Langhans giant cells and immune cells (histiocytes) that had taken up small transparent crystals. Coal powder was also deposited there.
  • Crystals extracted from the lung tissue showed plate-like structures under the scanning electron microscope. No ferruginous bodies suggestive of asbestos were found.
  • 0.5 g of crystals was extracted from 12 g of lung tissue.
  • Powder X-ray diffraction identified the crystals as talc, and the authors considered the lung disease to be (pure) talcosis.
• The authors' conclusion: The authors concluded that their literature search did not settle the relationship between talc and lung cancer. They said this co-occurrence of talcosis and lung adenocarcinoma adds to knowledge on an apparent association between talc and cancer, and that larger studies are warranted.
• Limitations the authors state:
  • The authors state it is difficult to determine whether talc directly contributes to carcinogenesis.
  • The authors state their literature search on talc and lung cancer did not reach a clear conclusion.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Lung Adenocarcinoma, Biopsy, Adenocarcinoma, Lung Cancer, Deposition, Ferruginous Bodies, Talc, X-Ray Diffraction (XRD).

Related studies

• Pulmonary ventilatory function in talcosis of lung — M. Kleinfeld, J. Messite, et al. (1964)
• Particle size for differentiation between inhalation and injection pulmonary talcosis — J.L. Abraham, C. Brambilla (1980)
• Mixed pneumoconiosis: silicosis, asbestosis, talcosis, and berylliosis — G.J. Mark, C.B. Monroe, et al. (1979)
• Commercial talc and talcosis — B. Weiss, E.A. Boettner (1967)
• Bronchiolitis in a patient with talcosis — K. Reijula, P. Pääkkö, et al. (1991)
• Talc dust pneumoconiosis — A. Berner, B. Gylseth, et al. (1981)

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