Asbestosis Mimicking Metastatic Lung Cancer: Case Report

Our plain-English summary of Asbestosis Mimicking Metastatic Lung Cancer: Case Report, by J. An, M. Song, B. Chang (Medicina, 2021).

The study

• Authors: J. An, M. Song, B. Chang
• Journal: Medicina
• Published: 2021;57(5)
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

The clinical diagnosis of asbestosis is primarily based on chest radiographic evidence of pleural thickening and interstitial fibrosis combined with a history of exposure to asbestos. We report herein the case of a 65-year-old man with asbestosis pathologically diagnosed after surgical lung biopsy. He had a work history including farming, cementing, and casting and was admitted with dyspnea. Chest computed tomography revealed multiple well-defined nodules in both lungs and a 4.1 cm peribronchial consolidation with fibrotic changes in the right lower lobe. We suspected metastatic lung cancer and video-assisted thoracoscopic biopsy was performed in the lung lesion of the right lower lobe. Asbestosis was confirmed following histological examination. The patient is currently completing outpatient visits without significant changes.

In plain English

This case report describes one 65-year-old man with a 20 pack-year smoking history who came to a hospital emergency department in Seoul, Korea, with shortness of breath, cough and purulent sputum. The patient had worked in dairy farming for 20 years, cementing for 8 years and casting for 9 years. He had also replaced asbestos ceilings for 1 year at age 63 without a mask. The article does not name a fiber type. Chest CT showed multiple well-defined nodules in both lungs and a 4.1 cm consolidation with fibrotic changes in the right lower lobe. Suspecting metastatic lung cancer, the authors performed a surgical lung biopsy. It showed asbestos bodies in the air spaces with pleural fibrosis, and the patient was diagnosed with asbestosis. Follow-up CT scans at 3 and 12 months showed no interval changes. The authors concluded that asbestosis should be considered when chest images are unusual in a patient with asbestos exposure, and that early surgical biopsy may help ensure an accurate diagnosis. A single case shows what happened to one patient, not how often this occurs.

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)
• Who was studied: One 65-year-old man with a 20 pack-year smoking history, seen at Kyung Hee University Hospital at Gangdong, Seoul, Korea, with two days of shortness of breath; the date of the visit is not given
• Exposure: Work in dairy farming (20 years), cementing (8 years) and casting (9 years), plus 1 year in construction replacing asbestos ceilings at age 63 without a mask. No fiber type, concentration or exposure measurement is reported.
• Main results:
  • Chest CT showed multiple well-defined nodules in both lungs and a 4.1 cm peribronchial consolidation with fibrotic changes in the right lower lobe
  • The patient's lung function tests were within normal limits
  • Tumor markers (CEA and SCC) were normal, but the authors suspected metastatic lung cancer
  • A video-assisted thoracoscopic biopsy of the right lower lobe consolidation showed asbestos bodies inside the air sacs (intra-alveolar) with pleural fibrosis on iron staining
  • The patient was diagnosed with asbestosis caused by occupational asbestos exposure, based on the tissue findings
  • Follow-up chest CT scans at 3 and 12 months after diagnosis showed no interval changes; the multiple nodules in both lungs remained
  • The authors presumed the lung nodules were anthracofibrotic nodules because they did not change on follow-up scans
• The authors' conclusion: The authors concluded that asbestosis should be considered when chest radiograph findings are unusual in a patient with a history of asbestos exposure, and that early surgical biopsy may help ensure accurate diagnosis and timely preventive steps, including stopping asbestos exposure and smoking.
• Limitations the authors state:
  • Limited information was available about the patient's work environment and asbestos exposure
  • The authors did not assess asbestos concentration or exposure period at the workplace
  • FDG PET scanning combined with CT was not performed

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleural Thickening, Interstitial Fibrosis, Biopsy, Work History, Dyspnea, Consolidation, Thoracoscopic Biopsy.

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