Asbestos fiber identification in liver from cholangiocarcinoma patients living in an asbestos polluted area: a preliminary study

Our plain-English summary of Asbestos fiber identification in liver from cholangiocarcinoma patients living in an asbestos polluted area: a preliminary study, by F. Grosso, A. Croce, R. Libener, et al (Tumori, 2019).

The study

• Authors: F. Grosso, A. Croce, R. Libener, N. Mariani, M. Pastormerlo, A. Maconi, C. Rinaudo
• Journal: Tumori
• Published: 2019;105(5):404-410
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To assess whether asbestos fibers may be observed in liver tissue of patients with cholangiocarcinoma (CC) with environmental or working asbestos exposure.

Methods: Detection of fibers was performed directly on histologic sections of liver from 7 patients with CC using optical microscope and variable pressure scanning electron microscopy equipped with energy-dispersive spectroscopy (VP-SEM/EDS). All patients were from Casale Monferrato, Italy, a highly asbestos-polluted town. Due to ethical constraints, observers were blinded to patients' clinical features.

Results: Fibers/bundles of fibers of chrysotile were detected in 5 out of 7 patients (71%). The boundary between healthy and neoplastic tissue or the fibrocollagen tissue produced by the neoplasia were identified as areas of fiber incorporation.

Conclusions: This study is the first report about the detection of chrysotile asbestos fibers in the liver of patients with CC. Further studies on larger cohorts are needed to corroborate our preliminary findings.

In plain English

This preliminary study looked for asbestos fibers in liver tissue from 7 patients with cholangiocarcinoma, a rare bile duct cancer. All lived in Casale Monferrato, Italy, home to a large Eternit asbestos-cement plant until 1986, and the cases date from 2011 to 2017. The authors assumed lifelong exposure from living there. The samples were anonymized, so the authors had no information on age, sex, other illnesses or work history. Three patients had surgery. Four had only diagnostic biopsies and were not operated on because of disease extent. Samples were examined by light microscopy and by electron microscopy that reads a fiber's chemical make-up. Chrysotile fibers were found in 5 of the 7 patients (71%), and no other asbestos type was seen in the liver. Fibers lay at the healthy-cancer border, in the tumor's supporting tissue, or in the tumor itself. None were seen in the other 2 patients, whose tumors were at an advanced stage. The chemical analysis could only be qualitative. The authors concluded that asbestos fibers can reach the liver, that the route is unknown, and that larger studies are needed.

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: Exploratory (preliminary) study analyzing liver tissue sections for asbestos fibers, with no comparison group
• Who was studied: 7 patients with cholangiocarcinoma living in Casale Monferrato, Italy, with cases dated 2011 to 2017. Liver came from surgery for 3 patients (CM1 to CM3) and from diagnostic biopsies for 4 (CM4 to CM7), who were not operated on because of disease extent.
• Exposure: Assumed environmental (residential) asbestos exposure from living near the Eternit asbestos-cement plant in Casale Monferrato. Individual exposure and occupational history were not known.
• Main results:
  • Fibers identified as asbestos (chrysotile) were found in the liver of 5 of the 7 patients (CM1, CM2, CM4, CM5, CM6), which the authors give as 71%. Table 1 lists CM1 and CM2 as having 'many' fibers.
  • Only chrysotile fibers were observed in the liver tissue.
  • In CM1, chrysotile fibers were located at the boundary between healthy and cancerous liver tissue or in the fibro-collagen tissue forming the tumor's stroma. In CM2 and in CM4 to CM6, fibers were in the neoplastic tissue.
  • No asbestos was observed in 2 patients (CM3 and CM7), whose tissue showed poorly differentiated, highly developed cancer.
  • The fibers found were never coated with the iron proteins that form ferruginous (asbestos) bodies.
• The authors' conclusion: The authors concluded that these preliminary findings show asbestos fibers can reach the liver, but the pathway (lymphatic spread from the lungs, or the digestive system after ingestion) remains unsolved. They called for larger studies and laboratory experiments to define the relationship between asbestos and cholangiocarcinoma.
• Limitations the authors state:
  • Small number of samples, because this cancer is often diagnosed at an advanced stage and few cases are suitable for surgery.
  • Because of ethical constraints the observers were blinded and could not link findings to patients' sex, age, other diseases or occupational history.
  • Large liver samples were available for only 3 patients; the others had only small biopsy samples.
  • Under the study's experimental conditions, only qualitative chemical analysis of the fibers was possible.
  • With no pathology registry, the authors could not define an incidence rate of cholangiocarcinoma in the area.

Topics

Medical terms in this study, explained in our Lexicon: Fiber Identification, Asbestos Exposure, Scanning Electron Microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), Casale Monferrato, Chrysotile.

Related studies

• Asbestos and Intrahepatic Cholangiocarcinoma — G. Brandi, S. Tavolari (2020)
• Cholangiocarcinoma and Occupational Exposure to Asbestos: Insights From the Italian Pooled Cohort Study — S. Curti, M. Gallo, et al. (2024)
• Asbestos: a hidden player behind the cholangiocarcinoma increase? Findings from a case-control analysis — G. Brandi, S. Di Girolamo, et al. (2013)
• New insights into the molecular pathogenesis of intrahepatic cholangiocarcinoma — T. Patel (2014)
• Occupational exposure to asbestos and risk of cholangiocarcinoma: a population-based case-control study in four Nordic countries — A. Farioli, K. Straif, et al. (2018)
• Intrahepatic cholangiocarcinoma development in a patient with a novel BAP1 germline mutation and low exposure to asbestos — G. Brandi, M. Deserti, et al. (2020)

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