Asbestos fibres detected by scanning electron microscopy in the gallbladder of patients with malignant pleural mesothelioma (MPM)

Our plain-English summary of Asbestos fibres detected by scanning electron microscopy in the gallbladder of patients with malignant pleural mesothelioma (MPM), by F. Grosso, A. Croce, N.F. Trincheri, et al (Journal of Microscopy, 2017).

The study

• Authors: F. Grosso, A. Croce, N.F. Trincheri, N. Mariani, R. Libener, D. Degiovanni, C. Rinaudo
• Journal: Journal of Microscopy
• Published: 2017;266(1):48-54
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Gallbladders from patients affected by both malignant pleural mesothelioma (MPM) and important gallbladder disorders were analyzed to verify the presence of asbestos fibres. Histological thin sections were analyzed by optical microscope and variable pressure scanning electron microscopy coupled with energy dispersive spectroscopy, allowing morphological and chemical characterization of each inorganic phase observed. Fibres of chrysotile and crocidolite, minerals regulated as asbestos, were identified. By immunohistochemical analysis, connective tissue was recognized as the incorporation site. These findings confirm that asbestos fibres can reach the gallbladders of patients with MPM, for whom the development of respiratory diseases confirms asbestos exposure.

© 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

In plain English

This article describes two patients with malignant pleural mesothelioma (MPM) at the hospital in Alessandria, Italy, whose gallbladder tissue the authors examined for asbestos fibres. The first was a 73-year-old man with MPM whose gallbladder was removed in surgery for pancreatitis caused by a gallstone in the bile duct. The second was an 80-year-old woman with work exposure to asbestos who died of MPM. Her gallbladder was examined after autopsy. Thin tissue sections were studied with a scanning electron microscope that also identifies the chemical makeup of particles, and with a light microscope on stained sections. In the man's gallbladder the authors found crocidolite fibres. In the woman's gallbladder they found clumps of very fine chrysotile fibrils and, less often, thicker crocidolite fibres. In both cases the fibres lay in connective tissue and were not coated with iron-rich material. The authors described the results as a first contribution and said many more cases are needed to confirm them. They added that although most fibres were of breathable size, other routes, such as ingestion or transport by body fluids, could be involved.

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 of two patients (one surgical gallbladder specimen, one autopsy specimen), with tissue analysed by variable pressure scanning electron microscopy with energy dispersive spectroscopy and by light microscopy of H&E-stained sections
• Who was studied: Two patients with malignant pleural mesothelioma treated at the Hospital of Alessandria (SS. Antonio e Biagio e Cesare Arrigo), Italy. Case 1 was a 73-year-old man operated on for pancreatitis caused by a gallstone in the bile duct. Case 2 was an 80-year-old woman who died of MPM. The dates of the cases are not given.
• Exposure: Asbestos fibres found in gallbladder tissue (crocidolite and chrysotile). Case 2 is described as having work exposure to asbestos. The article does not describe how Case 1 was exposed.
• Main results:
  • Case 1 (the man): fibres in the gallbladder sections ranged from 6 to 15 µm in length and 0.6 to 0.7 µm in thickness, with a length-to-thickness ratio of 10 to 20. The authors classed all of them as 'breathable' under the World Health Organization definition.
  • Case 1: the chemical analysis identified the fibres as crocidolite.
  • Case 1: the asbestos was located in connective/fibrous tissue of the gallbladder wall, next to lobules of fatty tissue. Microscopic examination of the gallbladder also showed chronic cholecystitis with reactive lymphoid hyperplasia.
  • Case 2 (the woman): clumps of very thin, flexible fibrils, 50 to 100 nm in diameter, were identified as chrysotile.
  • Case 2: less frequently, thicker and more rigid fibres were also seen. Their chemistry indicated crocidolite.
  • Case 2: the fibres and fibre clumps were located in connective tissue.
  • In both patients the fibres were uncoated, with no iron-rich coating (that is, they had not formed asbestos bodies).
  • The authors reported finding more asbestos fibres in these two cases than in their own earlier study of patients with benign biliary disease. No fibre counts are given.
• The authors' conclusion: The authors concluded that asbestos (chrysotile and crocidolite) was present in the gallbladders of these two patients with MPM and severe biliary tract or gallbladder disorders. They called the results a first contribution needing confirmation in many more cases.
• Limitations the authors state:
  • Only two cases were studied. The authors describe the observations as preliminary and say many more cases must be examined to confirm them.
  • In Case 2, tissue breakdown in the time between death and autopsy caused marked degenerative changes in the gallbladder tissue.
  • The route by which fibres reached the gallbladder was not determined. Although most fibres were of breathable size, the authors say ingestion or transport by body fluids could also be involved.

Topics

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

Medical terms in this study, explained in our Lexicon: Scanning Electron Microscopy (SEM), Pleural Mesothelioma, energy dispersive X-ray spectroscopy (EDS), Chrysotile, Crocidolite, Asbestos Exposure.

Related studies

• Asbestos fibre burden in gallbladder: A case study — A. Croce, S. Capella, et al. (2018)
• Asbestos fibers in the gallbladder of patients affected by benign biliary tract diseases — F. Grosso, L. Randi, et al. (2015)
• Environmental scanning electron microscopy technique to identify asbestos phases inside ferruginous bodies — A. Croce, M. Musa, et al. (2013)
• 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)
• Scanning electron microscopy — K.E. Carr, P.G. Toner, et al. (1982)
• Development of rapid and highly accurate method to measure concentration of fibers in atmosphere using artificial intelligence and scanning electron microscopy — Y. Iida, K. Watanabe, et al. (2021)

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