Immunoblastic lymphadenopathy and asbestosis

Our plain-English summary of Immunoblastic lymphadenopathy and asbestosis, by F.W. Maguire, R.C. Mills, F.P. Parker (Cancer, 1981).

The study

• Authors: F.W. Maguire, R.C. Mills, F.P. Parker
• Journal: Cancer
• Published: 1981;47(4):791-7
• Type of article: Case report
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001981).

Abstract

Immunoblastic lymphadenopathy was diagnosed in a 71-year-old white man who had weakness, with weight loss, fever, cough, and generalized lymphadenopathy. The patient had a long occupational history of shipyard work. Diagnosis of asbestosis was made clinically by chest x-ray, and ferruginous bodies were found in the lung at autopsy. Recent reports have suggested a possible association between asbestos exposure and lymphoproliferative neoplasms. Chronic antigenic stimulation by asbestos could predispose one to the immunoproliferative disorder seen in this patient or be responsible for it. The possible significance of this relationship, previously unreported, is discussed for future consideration.

In plain English

This was a case report of one patient: a 71-year-old white man admitted with profound weakness, fever and shortness of breath. He had a 29-year history of shipyard work as an 'inside' mechanic. The article did not name any asbestos fiber type. His chest x-ray showed pleural thickening and calcifications of the pleura and diaphragm. A biopsy of a lymph node from his left armpit was read as most consistent with immunoblastic lymphadenopathy. Prednisone treatment dramatically shrank his lymph nodes. About 30 days after admission he developed streptococcal sepsis and died. At autopsy, the authors found that the disease had progressed to a cancer, immunoblastic sarcoma, in lymph nodes, spleen and liver. Iron stains found ferruginous bodies in moderate numbers in scarred lung tissue. The authors stated that his history and findings indicated asbestosis, and that the two conditions had not been reported together before. They suggested that asbestos exposure was perhaps the long-term immune stimulus behind his disease. They also said further studies must determine whether the combination is coincidental.

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 (one patient, including autopsy findings)
• Who was studied: One 71-year-old white man brought to the emergency room with profound weakness; seen in the Departments of Hematology and Pathology, Wilmington Medical Center, Wilmington, Delaware
• Exposure: 29 years of shipyard work as an 'inside' mechanic; no fiber type or dose was reported
• Main results:
  • Chest x-ray showed pleural thickening and bilateral pleural and diaphragmatic calcifications, along with a left lower lobe infiltrate and a mildly enlarged heart
  • A repeat lymph node biopsy from the left axilla was interpreted as a florid hyperimmune reaction most consistent with immunoblastic lymphadenopathy
  • Treatment with prednisone led to dramatic shrinking of the lymph nodes
  • Thirty days after admission the patient developed streptococcal sepsis, did not respond to antibiotics, and died
  • At autopsy the lymph node findings were judged to show progression to malignancy, immunoblastic sarcoma, with similar infiltrates in the spleen and, to a lesser degree, the liver; bone marrow showed no lymphoma
  • Iron stains of lung tissue from areas of gross fibrosis showed ferruginous bodies in moderate numbers; no active inflammatory or neoplastic disease was seen in the lungs
  • The authors stated that the occupational history, clubbing, chest x-ray and postmortem findings indicated asbestosis
  • The authors stated that immunoblastic lymphadenopathy and asbestosis occurring together had not been previously reported
• The authors' conclusion: The authors suggested that asbestos exposure was perhaps the chronic antigenic stimulus responsible for this patient's immunoblastic lymphadenopathy
• Limitations the authors state:
  • The authors stated that further studies will have to determine whether this combination of diseases is coincidental or clinically and pathologically relevant

Topics

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

Medical terms in this study, explained in our Lexicon: Lymphadenopathy, Occupational History, Chest X-Ray, Ferruginous Bodies, Autopsy, Asbestos Exposure, Neoplasm.

Related studies

• The role of endobronchial ultrasound guided transbronchial needle aspiration cytology in the investigation of mediastinal lymphadenopathy and masses, the North Tees experience — S. Natu, J. Hoffman, et al. (2010)
• Pleural mesothelioma with initial presentation as cervical lymphadenopathy — E.J. Wills (1995)
• Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child — Y.S. Gong, Y.T. Rong, et al. (2013)
• Asbestos-related cancer risk in patients with asbestosis or pleural plaques — J. Ameille, P. Brochard, et al. (2011)
• Excessive accumulation of asbestos fibre in the bronchoalveolar space may be a marker of individual susceptibility to developing asbestosis: experimental evidence — R. Bégin, P. Sébastien (1989)
• Risk of asbestosis in crocidolite and amosite mines in South Africa: an erratum — L.M. Irwig, R.S. du Toit, et al. (1984)

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