Peritoneal tumours in asbestosis

Our plain-English summary of Peritoneal tumours in asbestosis, by J.B. Enticknap, W.J. Smither (British Journal of Industrial Medicine, 1964).

The study

• Authors: J.B. Enticknap, W.J. Smither
• Journal: British Journal of Industrial Medicine
• Published: 1964;21(1):20-31
• Cited by: 100 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001554).

Abstract

Eleven cases of diffuse abdominal tumours in association with exposure to asbestos were discovered in the years 1958 to 1963. There were eight men and three women, all of whom had worked at the same factory. In seven of the men the age at death ranged from 38 to 78 years; one man is still alive at the age of 46. The women died at 44, 61, and 67. The survival time after the first exposure varied from 20 to 46 years. The shortest period of exposure was 10 months and the longest 32 years. All three of the main commercial types of asbestos had been involved in their working operations. Histological confirmation of the nature of the tumour has been obtained at necropsy in nine of the 10 deceased and at biopsy in six, including the survivor. A remarkable feature of these cases is the minimal fibrosis found in the lungs. In three men and one woman, asbestosis was not diagnosed during life, and no patient was completely disabled by pulmonary fibrosis.

In plain English

This article described 11 asbestos-exposed people with diffuse abdominal tumours, found 1958 to 1963. Eight were men and three were women. All had worked at one factory with dust of chrysotile, crocidolite and amosite; exposure to each type could not be determined. The authors stressed that exposure was often small. Exposure lasted from 10 months to 32 years, and symptoms began 20 to 46 years after first exposure. One man was still alive. Lung changes were generally below average in severity, though some patients had advanced asbestosis; four had no asbestosis diagnosis during life. Several had been diagnosed as other cancers, such as of the stomach, ovary or pancreas; one man also had a separate tonsil cancer. Of 52 asbestosis necropsies the authors saw over five and a half years, nine had tumours appearing to start in the peritoneum. Of a possible 9,550 people exposed at the factory, the authors estimated an incidence of peritoneal tumour of about 1 in 1,000, possibly an undercount. They did not accept the tumours as proven mesotheliomas, proposing the name 'the peritoneal tumour of asbestosis'.

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 series of 11 patients (two previously reported by other authors, nine new), with clinical histories and examination of tissue from biopsies and necropsies
• Who was studied: 11 asbestos-exposed workers (8 men, 3 women) from one factory, with cases found 1958 to 1963. Ten had died. One man was alive at age 46. The men who died were aged 38 to 78 at death, and the women died at 44, 61 and 67.
• Exposure: Mixed asbestos dust (chrysotile, crocidolite and amosite) at the same factory. The degree of exposure to each type could not be determined. Exposure was often small and lasted from 10 months to 32 years.
• Main results:
  • Across the 11 cases, exposure lasted from 10 months to 32 years.
  • Symptoms (abdominal pain, discomfort or ascites) began 20 to 46 years after first exposure.
  • In most cases the illness lasted less than six months.
  • Tissue examination confirmed the nature of the tumour at necropsy in nine of the 10 who died, and at biopsy in six patients, including the survivor.
  • The authors described the lung changes due to asbestos in these patients as below average in severity.
  • In three men and one woman, asbestosis was not diagnosed during life, and no patient was completely disabled by pulmonary fibrosis.
  • Some individual patients did have advanced lung disease. For example, the lung lobe removed from case 5M showed advanced asbestotic fibrosis.
  • The authors noted that the abdominal condition was often diagnosed as some other form of cancer. Examples in this series included carcinoma of the stomach and pancreas, and pathologists judged two of the three female cases to be ovarian carcinoma.
  • One man (case 7M), whose death was certified as carcinoma of the tonsil, had a genuine primary tonsil cancer. Under the microscope it was distinct from the peritoneal growth. He also had peritoneal nodules and plaques of the same tissue seen in the other cases.
  • A few small birefringent particles were seen in the tumours, which the authors compared to asbestos. However, no asbestos fibres were recovered when material from three tumours was calcined.
  • Of 52 cases of asbestosis the authors saw at necropsy over five and a half years, 19 (36%) had carcinoma of the lung, none pleural in origin. Fourteen (27%) had abdominal tumours, and nine (17%) of these appeared to originate in the peritoneum.
  • A possible total of 9,550 people had been exposed at the factory since 1913. From this, the authors estimated an incidence of peritoneal tumour of about 1 in 1,000 of those exposed.
  • The authors did not exclude that the abdominal masses were mesotheliomas, but did not believe the evidence justified that assumption.
• The authors' conclusion: The authors concluded that this condition should be recognized as part of the asbestosis syndrome. They described the predominant tissue as 'wild fibrous tissue', possibly a reaction to foreign material, and proposed the name 'peritoneal tumour of asbestosis' until its exact nature becomes clear.
• Limitations the authors state:
  • Exposure to each type of asbestos could not be determined.
  • Exposed workers were not systematically followed up, so some cases may have been missed and the true incidence may be higher.
  • Tests for hyaluronic acid were negative, but only two tumours had been fixed in the recommended way.
  • The authors felt that conventional examination of tissue was unlikely to permit more than an informed opinion on the nature of the tumours.

Topics

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

Medical terms in this study, explained in our Lexicon: Autopsy, Biopsy, Fibrosis, Pulmonary Fibrosis.

Related studies

• The pathology of mesotheliomata and an analysis of their association with asbestos exposure — D.O. Hourihane (1964)
• Diffuse mesothelioma and exposure to asbestos dust in the Merseyside area — W.G. Owen (1964)
• Exposure to asbestos and mesothelioma of the pleura — P.B. Fowler, J.C. Sloper, et al. (1964)
• Asbestos bodies in human lungs at autopsy — D. Cauna, R.S. Totten, et al. (1965)
• Functions of mesothelioma panels — M. Kannerstein, J. Churg, et al. (1979)
• Rheumatoid pneumoconiosis in association with asbestosis — W.K. Morgan (1964)

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