North american erionite-associated mesothelioma with pleural plaques and pulmonary fibrosis: a case report

Our plain-English summary of North american erionite-associated mesothelioma with pleural plaques and pulmonary fibrosis: a case report, by C.R. Kliment, K. Clemens, T.D. Oury (International Journal of Clinical and Experimental Pathology, 2009).

The study

• Authors: C.R. Kliment, K. Clemens, T.D. Oury
• Journal: International Journal of Clinical and Experimental Pathology
• Published: 2009;2(4):407-10
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

Erionite, a fibrous zeolite mineral, has been categorized as a class I carcinogenic agent for its causative role in mesothelioma. In select villages in Turkey, erionite is the cause of more than 50% of mesotheliomas. In contrast, in the United States mesotheliomas are frequently associated with asbestos exposure. We describe the first reported case of a patient with erionite-associated pleural mesothelioma with classic pathologic changes typical of asbestos-related pulmonary and pleural pathology. This case report indicates that in addition to Turkey, erionite-associated disease can occur in North America and that subjects with erionite exposure are not only at risk of developing mesothelioma, but may develop interstitial fibrosis and additional pulmonary pathology impacting lung function and patient survival.

In plain English

This was a case report of one patient, a 47-year-old man with right pleural mesothelioma that had spread to the lymph nodes. He had lived 20-25 years in Mexico and then in the United States. His work history showed a possible exposure to asbestos-containing floor tiles for two years, 1988 to 1990, in janitorial and maintenance work for a supermarket. Under the microscope the tumor was epithelial. The authors also found parietal pleural plaques, interstitial fibrosis, and abundant ferruginous bodies in the lung. A lung digest showed 1,097 ferruginous bodies per gram of wet lung by light microscopy and, by electron microscopy, 124,000 uncoated fibers longer than 5 microns per gram of wet tissue. Of 30 uncoated fibers analyzed, 24 had a chemistry indicative of erionite, a fibrous zeolite mineral. The analysis found no spectral evidence of commercial amosite, crocidolite or chrysotile asbestos, or of non-commercial amphiboles. The authors called this the first reported case of erionite-associated pleural mesothelioma in North America. They concluded it was the first human report indicating that erionite can produce all four classical findings of asbestos-related lung disease.

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), with pathology and lung fiber analysis
• Who was studied: one 47-year-old man with right pleural mesothelioma that had spread to the lymph nodes; he lived 20-25 years in Mexico, then in the United States
• Exposure: erionite (a fibrous zeolite mineral) fibers found in his lung tissue; his reported work history also showed a possible exposure to asbestos-containing floor tiles for 2 years (1988-1990) in supermarket janitorial and maintenance work
• Main results:
  • The tumor was epithelial and its cells were positive for pan-cytokeratin and calretinin
  • Areas of the parietal pleura contained pleural plaques
  • Ferruginous bodies were abundant throughout lung tissue not involved by tumor, and were also present in areas of interstitial fibrosis
  • Light microscopy of the lung digest found 1,097 ferruginous bodies per gram of wet lung
  • Electron microscopy, counting fibers greater than 5 microns in length, gave 124,000 uncoated fibers per gram of wet tissue
  • Of 30 uncoated fibers analyzed, 24 had element ratios indicative of erionite; the other 6 contained only Al and Si in a proportion similar to the erionite fibers
  • There was no spectral evidence of commercial amosite, crocidolite or chrysotile asbestos, nor of non-commercial amphiboles
  • Electron microscopy gave a burden of 2,480 ferruginous bodies per gram of wet tissue; of 10 ferruginous bodies analyzed, 8 contained elements in proportions indicative of erionite and the other 2 contained only Al and Si in a similar proportion
• The authors' conclusion: The authors described this as the first reported case of erionite-associated pleural mesothelioma in North America. They stated it was the first report in humans indicating that erionite can result in all 4 classical pathological findings of asbestos-related pulmonary disease, and they stated that in this case there was no evidence of asbestos exposure.

Topics

Medical terms in this study, explained in our Lexicon: erionite, Mesothelioma, Pleural Plaques, Pulmonary Fibrosis, Zeolite, Carcinogenic, Asbestos Exposure, Pleural Mesothelioma.

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