Bronchiogenic Carcinoma in Association with Pulmonary Asbestosis: Report of Two Cases

Our plain-English summary of Bronchiogenic Carcinoma in Association with Pulmonary Asbestosis: Report of Two Cases, by H.B. Holleb, A. Angrist (The American Journal of Pathology, 1942).

The study

• Authors: H.B. Holleb, A. Angrist
• Journal: The American Journal of Pathology
• Published: 1942;18(1):123-35
• Read it: PubMed · Free full text

In plain English

This article reported two autopsy cases of bronchiogenic carcinoma with pulmonary asbestosis in men aged 52 and 58, from the Department of Pathology, Queens General Hospital, New York. Each had covered steam and water pipes with asbestos for 25 years. The second also used powdered asbestos cement and had no exposure in his last 10 years. The first had a squamous-celled carcinoma and the second an oat-celled carcinoma, and both cancers had spread to other organs. Both men's lungs showed interstitial fibrosis and asbestosis bodies. The dried lungs contained 240 mg per cent of silica in the first case and 4.5 mg per cent in the second. Earlier reports said lungs without histological silicosis may contain up to 200 mg per cent. Using that as a standard, the authors said the first value would be only slightly elevated and the second within non-pathological limits, so their attempt to show unusual silica failed. Of 2,451 routine hospital autopsies over 5 years, 59 showed bronchiogenic carcinoma. The authors called finding it in the only two pulmonary asbestosis cases seen there striking but of no statistical significance. They tabulated the ten reported cases, not necessarily as evidence that the cancer is occupational.

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 autopsied cases, with a tabulation of previously reported cases and a comparison with the hospital's autopsy records
• Who was studied: Two white men, aged 52 (case 1) and 58 (case 2), both long-term pipe coverers for asbestos product manufacturers, reported by the Department of Pathology, Queens General Hospital, Jamaica, N.Y. Case 1 was admitted to that hospital. The article does not say where case 2 was treated, and his history was taken from his son after the autopsy.
• Exposure: Covering steam and water pipes with asbestos fabric for about 25 years in each case. Case 2 also used large amounts of powdered asbestos cement, often in unventilated cellars, and had no exposure for the last 10 years of life. Fiber type was not named.
• Main results:
  • Case 1 (52-year-old man): bronchiogenic, non-keratinizing, squamous-celled carcinoma of the right upper lobe, with metastases to mediastinal lymph nodes, right kidney and a right adrenal adenoma, together with pulmonary asbestosis
  • Case 2 (58-year-old man): bronchiogenic, large oat-celled carcinoma of the right lower lobe, with metastases including liver, kidneys, cerebral cortex, ribs and vertebrae, together with pulmonary asbestosis
  • Lung tissue in case 1 showed diffuse interstitial fibrosis and a moderate number of asbestosis bodies. Case 2 showed widespread interstitial fibrosis but only occasional asbestosis bodies.
  • The dried lungs of case 1 contained 240 mg per cent of silica, and those of case 2 only 4.5 mg per cent
  • Earlier reports said lungs may contain as much as 200 mg per cent without histological evidence of silicosis. The authors said that if that value were used as a standard, case 1 would be only slightly elevated and case 2 would fall within known non-pathological limits.
  • In the hospital's 2,451 routine autopsies over a 5-year period, there were 401 carcinomas of all types (16.36 per cent), of which 59 were bronchiogenic (14.71 per cent of all carcinomas)
  • The authors found bronchiogenic carcinoma in the only two cases of pulmonary asbestosis seen in their department, which they called striking but of no statistical significance
  • The two cases brought the number of reported cases of carcinoma with pulmonary asbestosis in the literature to ten
• The authors' conclusion: The authors presented the two cases. They reported that their attempt to show unusual amounts of silica in the lungs failed. They explained the low silica values by the dissolution and phagocytosis of inhaled asbestos fibers and by long periods of relatively low exposure. They tabulated all reported cases without presenting them as proof that lung cancer is an occupational disease of asbestos workers.
• Limitations the authors state:
  • The case 2 history was obtained from the patient's son after the autopsy, and the son's knowledge of some details was admittedly inaccurate
  • No strict criteria for diagnosing pulmonary asbestosis could be found in the literature, so the diagnosis rested on exposure history, symptoms and microscopic findings
  • Finding carcinoma in the only two asbestosis cases seen in the department had no statistical significance
  • The table of reported cases was offered only as a summary, not necessarily as supporting evidence for Nordmann's view that lung cancer is occupational in asbestos workers

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Asbestosis.

Related studies

• Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos — B.T. Mossman, M. Lippmann, et al. (2011)
• Asbestos bodies in carcinoma of colon in an insulation worker with asbestosis — A. Ehrlich, A.N. Rohl, et al. (1985)
• Does asbestos or asbestosis cause carcinoma of the lung? — V.L. Roggli, S.P. Hammar, et al. (1994)
• Asbestosis associated with bronchogenic carcinoma — R. Stoll, R. Bass, et al. (1951)
• Squamous cell carcinoma occurring in asbestosis of the lung — R.J. Cureton (1948)
• Asbestosis and carcinoma of the lung; case report and review of the literature — J. Anderson, F.A. Campagna (1960)

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