Asbestos fibers in the gallbladder of patients affected by benign biliary tract diseases

Our plain-English summary of Asbestos fibers in the gallbladder of patients affected by benign biliary tract diseases, by F. Grosso, L. Randi, A. Croce, et al (European Journal of Gastroenterology & Hepatology, 2015).

The study

• Authors: F. Grosso, L. Randi, A. Croce, D. Mirabelli, R. Libener, C. Magnani, D. Bellis, M. Allegrina, M. Bertolotti, D. Degiovanni, C. Rinaudo
• Journal: European Journal of Gastroenterology & Hepatology
• Published: 2015;27(7):860-4
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: This exploratory study aimed to evaluate the presence of asbestos fibers in the biliary tract of patients living in an asbestos-polluted area using scanning electron microscopy.

Methods: Thin gallbladder sections were obtained from five patients who were operated on for gallbladder stones and the bile fluid of one of the patients was analyzed using variable-pressure scanning electron microscopy coupled with energy-dispersive spectroscopy. All patients were from Casale Monferrato, Italy, a well-known asbestos-polluted city, where the Eternit factory had operated since the beginning of the century until 1985.

Results: All the inorganic phases found in the gallbladder were analyzed for morphology and chemistry. Fibers and particles consistent with minerals defined by law as 'asbestos' were detected in three out of five patients.

Conclusion: These findings suggest that asbestos fibers can be found in the gallbladder of patients exposed to asbestos, although how they reach the biliary tract remains unknown. Further studies to confirm these results are under way.

In plain English

This exploratory study looked for asbestos fibers in gallbladder tissue from five patients who had surgery for gallstones in 2010–2013 at a hospital in Alessandria, Italy. All five were women (average age 55.6, range 13 to 79) living in Casale Monferrato, a town where the Eternit asbestos-cement factory operated until 1985. The authors regarded them as environmentally exposed, but no personal exposure histories were collected. The youngest patient, who lived there after production stopped, was chosen as a kind of control. Tissue sections, and bile from one patient, were examined by scanning electron microscopy with chemical analysis. In three of the five patients, the authors found fibers and particles with the chemistry of serpentine minerals, and they attributed one fiber to chrysotile. In the bile, after chemical treatment, they found crystals identified as actinolite and tremolite, which they considered consistent with asbestos fibers. None of these were seen in the other two patients, including the youngest. The authors called the findings very preliminary and said how fibers reach the gallbladder remains unknown.

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 laboratory study of surgical tissue samples (a series of five patients), using variable-pressure scanning electron microscopy with energy-dispersive spectroscopy (VP-SEM/EDS)
• Who was studied: Five female patients living in Casale Monferrato, Italy, operated on for gallstones in 2010–2013 at Santi Antonio e Biagio Hospital in Alessandria. They were selected by age: one younger than 15 (case 5, treated as a kind of control), one older than 75 (case 4), and three aged 30 to 70. Average age at operation was 55.6 years (range 13–79).
• Exposure: Environmental exposure to asbestos assumed from residence in Casale Monferrato, where the Eternit factory produced asbestos-cement until 1985. Personal exposure histories were not collected. Case 5 lived there after production ceased.
• Main results:
  • In three of five patients (cases 1, 3 and 4), inorganic forms with the chemical composition of serpentine minerals were found in gallbladder tissue.
  • One fiber in gallbladder tissue measured 6.24 μm long and 1.26 μm thick (length-to-thickness ratio 4.9). It was defined as breathable under WHO rules and ascribed to chrysotile.
  • In the bile of case 4, after digestion, one elongated crystal indicated actinolite (3.44 μm long, 458 nm thick) and was considered an asbestos fiber. Another indicated tremolite and was described as coherent with an asbestos fiber.
  • None of these inorganic phases were observed in the tissues of case 2 or case 5 (the youngest patient).
  • The authors stated that the iron and aluminium seen in the spectra are typical of chrysotile from the Balangero quarry.
• The authors' conclusion: The authors concluded that these very preliminary findings showed asbestos fibers can be detected by VP-SEM/EDS in gallbladder and bile samples of people with asbestos exposure. They said the route by which fibers reach the gallbladder is still to be clarified.
• Limitations the authors state:
  • Because samples were anonymized, no personal information on exposure and life history could be collected, so asbestos exposure information was missing for the cases.
  • The authors noted that the finding in the youngest patient must be read in light of her age and her residence in Casale Monferrato after the plant shut down.

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Balangero mine, Balangero, about 20 km north of Turin, Piedmont

All asbestos mines

Topics

The National Library of Medicine indexes this study under subjects our site covers: Chrysotile, Crocidolite.

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

Related studies

• Asbestos fibres detected by scanning electron microscopy in the gallbladder of patients with malignant pleural mesothelioma (MPM) — F. Grosso, A. Croce, et al. (2017)
• Asbestos fibre burden in gallbladder: A case study — A. Croce, S. Capella, et al. (2018)
• Blue-collar work is a risk factor for developing IgG4-related disease of the biliary tract and pancreas — L.M. Hubers, A.R. Schuurman, et al. (2021)
• Study of inorganic particles, fibers, and asbestos bodies by variable pressure scanning electron microscopy with annexed energy dispersive spectroscopy and micro-Raman spectroscopy in thin sections of lung and pleural plaque — C. Rinaudo, A. Croce, et al. (2010)
• Germline mutations in DNA repair genes predispose asbestos-exposed patients to malignant pleural mesothelioma — M. Betti, E. Casalone, et al. (2017)
• Environmental scanning electron microscopy technique to identify asbestos phases inside ferruginous bodies — A. Croce, M. Musa, et al. (2013)

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