Malignant peritoneal mesothelioma in a 17-year-old boy with evidence of previous exposure to chrysotile and tremolite asbestos

Our plain-English summary of Malignant peritoneal mesothelioma in a 17-year-old boy with evidence of previous exposure to chrysotile and tremolite asbestos, by A. Andrion, S. Bosia, L. Paoletti, et al (Human Pathology, 1994).

The study

• Authors: A. Andrion, S. Bosia, L. Paoletti, E. Feyles, C. Lanfranco, D. Bellis, F. Mollo
• Journal: Human Pathology
• Published: 1994;25(6):617-22
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe a case of malignant peritoneal mesothelioma arising in a 17-year-old boy. The diagnosis was based on a comprehensive study including light microscopy, histochemistry, immunohistochemistry, evaluation of the clinical course, and autopsy examination. Analytical transmission electron microscopy showed a concentration of 510,000 asbestos fibers/g dry lung tissue. The fibers were represented by chrysotile (62%) and tremolite (38%) asbestos. About 40% of the total fibers were longer than 5 microns. The presence of tremolite fibers was probably due to environmental exposure to contaminated cosmetic talc. This is the first reported case of pathologically proven exposure to asbestos dust in malignant mesothelioma of childhood and adolescence.

In plain English

This case report described a previously healthy 17-year-old boy, a nonsmoker, who was referred to a hospital in Asti, Italy, in May 1991 and was diagnosed with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. Chemotherapy did not help. He died 8 months after his symptoms began, and autopsy confirmed the diagnosis. His history included the following:

• He once sawed an asbestos cement sheet, wearing a mask, while working in construction.
• There was an asbestos cement water tank at his rural home.
• From about age 9 to 12 he used large quantities of cosmetic talc every day.

Electron microscopy of his lung tissue found 510,000 asbestos fibers per gram of dry lung. Of these, 62% were chrysotile and 38% were tremolite, and about 40% of all fibers were longer than 5 micrometres. No asbestos bodies were seen. The authors judged this fiber level unusual for a rural resident. They thought the tremolite was probably caused by inhaled cosmetic talc. They cautioned that most people in industrialized countries carry asbestos in their lungs and that definite proof was not possible. They concluded that asbestos exposure remained the most coherent explanation.

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 clinical, pathological, autopsy and lung mineral-fiber analysis
• Who was studied: One previously healthy 17-year-old boy, a nonsmoker, referred to City Hospital, Asti, Italy, in May 1991; he had been born and lived in a rural vineyard area
• Exposure: Self-reported and family-reported history:
• Sawed a sheet of asbestos cement once, using a protective mask, while employed as a construction worker from age 16.
• Worked 2 months at age 15 in a plastic tools plant.
• Lived in a home with a large asbestos cement water tank; the father said the tank water was never used for drinking.
• Used large quantities of cosmetic talc daily from age 9 until about age 12.

Lung analysis found chrysotile and tremolite asbestos.

• Main results:
  • The boy died 8 months after symptom onset; autopsy confirmed malignant mesothelioma (MM)
  • Analytical transmission electron microscopy found asbestos at 510,000 fibers per gram of dry lung tissue in the patient
  • Of the asbestos fibers in the patient's lung, 62% were chrysotile and 38% were fibrous tremolite
  • Fibers longer than 5 micrometres made up 45% of chrysotile fibers and 30% of tremolite fibers, which the authors described as about 40% of the total burden
  • Many talc particles were also found in the patient's lung, at about 720,000 per gram of dry lung tissue
  • Neither lung tissue sections nor digested lung sediment showed asbestos bodies
  • The authors compared the patient's level with earlier findings from their reference laboratory, in which 84% of 85 urban forensic autopsies were below 200,000 fibers per gram. They judged the patient's level unusual for a rural dweller and similar to the highest-burden urban subgroup.
  • The interval from the start of exposure to the start of symptoms was 8 years
• The authors' conclusion: The authors stated that definite proof that this mesothelioma was asbestos-related could not be established with certainty. They concluded that asbestos exposure remained the most coherent explanation, and that the tremolite was probably caused by inhaled cosmetic talc.
• Limitations the authors state:
  • Asbestos fibers are found in the lungs of most people in industrialized countries, so the authors said one must be exceedingly cautious about inferring cause and effect
  • Fiber-burden results vary appreciably between laboratories, so the patient's values were compared only with the same laboratory's experience
  • The tremolite fibers had unusual morphology, and only x-ray spectrography confirmed their identity
  • Definite proof of an asbestos-related cause could not be established with certainty

Topics

The National Library of Medicine indexes this study under subjects our site covers: Chrysotile, Mesothelioma, Peritoneal mesothelioma, Tremolite.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Chrysotile, Tremolite, Immunohistochemistry, Autopsy, Analytical Transmission Electron Microscopy (ATEM), Environmental Exposure, Cosmetic Talc.

Related studies

• An elaboration of "proof" of peritoneal mesothelioma from tremolite free chrysotile — D. Egilman (2011)
• Comparison of Calidria chrysotile asbestos to pure tremolite: final results of the inhalation biopersistence and histopathology examination following short-term exposure — D.M. Bernstein, J. Chevalier, et al. (2005)
• Carcinogenic implications of the lack of tremolite in UICC reference chrysotile — A.L. Frank, R.F. Dodson, et al. (1998)
• Comparison of Calidria chrysotile asbestos to pure tremolite: inhalation biopersistence and histopathology following short-term exposure — D.M. Bernstein, J. Chevalier, et al. (2003)
• Chrysotile and tremolite asbestos fibres in the lungs and parietal pleura of Corsican goats — P. Dumortier, F. Rey, et al. (2002)
• Chrysotile, tremolite, and mesothelioma — J.C. McDonald, A.D. McDonald (1995)

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