Carcinoma of the lung in the absence of asbestosis: The value of lung fiber burden analysis

Our plain-English summary of Carcinoma of the lung in the absence of asbestosis: The value of lung fiber burden analysis, by V.L. Roggli, T.A. Sporn (Ultrastructural Pathology, 2016).

The study

• Authors: V.L. Roggli, T.A. Sporn
• Journal: Ultrastructural Pathology
• Published: 2016;40(3):151-4
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos is universally recognized as a carcinogen for the lower respiratory tract. However, asbestos is a contributory factor in a small fraction of lung cancers, the vast majority of which are related to cigarette smoking. The challenge for the pathologist is to determine when a lung cancer may be attributed to past asbestos exposure. The finding of asbestosis either clinically or pathologically is a useful marker for such a determination. However, in the absence of asbestosis, it has been suggested that a fiber burden as determined by analytical electron microscopy within the range of asbestosis is sufficient for determination of a causal contribution. We report here an example of a case of lung cancer in which fiber burden studies showed an asbestos concentration within the range of asbestosis as determined by scanning electron microscopy (SEM).

In plain English

This is a report of a single case. A 78-year-old man had part of his left lung removed for lung cancer (an adenocarcinoma). He had worked 10 years as a shipyard joiner/carpenter and 14 years in construction. His smoking history was not provided. His lung tissue showed several asbestos bodies but did not meet the criteria for asbestosis. Some sections showed a pattern typical of pleural plaque. By light microscopy, the authors counted 12,200 asbestos bodies per gram of wet lung, far above their normal range of 0 to 20. By scanning electron microscopy they found 24,600 asbestos bodies and 68,600 uncoated fibers per gram. Of 20 uncoated fibers analyzed, 18 were amosite, one was crocidolite and one was talc. All 10 asbestos body cores examined were amosite. The total of 89,800 commercial amphibole fibers per gram exceeded two levels: the 50,000 fibers per gram the authors cited as needed to relate lung cancer to asbestos, and their fifth percentile for asbestosis (26,300 fibers per gram). The authors concluded it was reasonable to consider asbestos a substantial contributing factor to this patient's lung cancer.

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) with lung fiber burden analysis; the journal labels the article a review
• Who was studied: one 78-year-old man who had a left lower lobectomy for lung cancer (papillary and acinar adenocarcinoma); smoking history not provided
• Exposure: 10 years as a shipyard joiner/carpenter and an additional 14 years in construction; lung fibers found were mainly amosite, with one crocidolite fiber
• Main results:
  • Lung tissue showed a few pulmonary blue bodies and several asbestos bodies but did not meet histologic criteria for asbestosis
  • Some sections showed hyalinized collagen in a pattern typical of parietal pleural plaque
  • Light microscopy: 12,200 asbestos bodies per gram of wet lung tissue, compared with the authors' normal range of 0 to 20 per gram
  • Scanning electron microscopy: 24,600 asbestos bodies per gram plus 68,600 uncoated fibers per gram
  • Of 20 consecutive uncoated fibers analyzed, 18 were amosite, 1 was crocidolite and 1 was talc
  • All 10 asbestos body cores examined were amosite
  • Total commercial amphibole fibers in this case were 89,800 fibers per gram. This exceeded the 50,000 fibers per gram the authors cited as needed to relate lung cancer to asbestos exposure, and their fifth percentile for asbestosis (26,300 fibers per gram).
• The authors' conclusion: The authors concluded it was reasonable to consider asbestos a substantial contributing factor to this patient's lung cancer
• Limitations the authors state:
  • Smoking information was not available for this patient

Topics

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

Medical terms in this study, explained in our Lexicon: Carcinoma, Fiber Burden Analysis, Lung Cancer, Asbestos Exposure, Fiber Burden, Scanning Electron Microscopy (SEM).

Related studies

• Asbestos bodies in carcinoma of colon in an insulation worker with asbestosis — A. Ehrlich, A.N. Rohl, et al. (1985)
• A clinical evaluation and tissue fiber burden analysis of a lifetime resident of Libby, Montana with adenocarcinoma of the lung — R.F. Dodson, B. Black, et al. (2020)
• Black spots concentrate oncogenic asbestos fibers in the parietal pleura. Thoracoscopic and mineralogic study — C. Boutin, P. Dumortier, et al. (1996)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• Value of the Ber-EP4 antibody in differentiating epithelial pleural mesothelioma from adenocarcinoma. The M.D. Anderson experience and a critical review of the literature — N.G. Ordóñez (1998)
• Value of the MOC-31 monoclonal antibody in differentiating epithelial pleural mesothelioma from lung adenocarcinoma — N.G. Ordóñez (1998)

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