Pulmonary Asbestosis Associated With Primary Carcinoma Of The Lung, Bronchial Adenomas, And Adenocarcinoma Of The Stomach

Our plain-English summary of Pulmonary Asbestosis Associated With Primary Carcinoma Of The Lung, Bronchial Adenomas, And Adenocarcinoma Of The Stomach, by M. Telischi, A.I. Rubenstone (1961).

The study

• Authors: M. Telischi, A.I. Rubenstone
• Published: Archives Of Pathology 72(2):234-243, August (1961)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 002522. The article is still under copyright, so we describe it here rather than post it.

In plain English

This case report from Michael Reese Hospital, Chicago, describes one 65-year-old man who spent about 12 years as a plaster mixer in a casting company, mixing dry powdered materials known to contain some asbestos and to raise considerable dust. The fiber type is not named. He was admitted in December 1959 with an abdominal mass, weight loss and exertional breathlessness, and died on the third day. At autopsy the pleura was markedly thickened and the lungs showed fibrosis with asbestos bodies, which the authors called typical of asbestosis. The lungs also held a small squamous-cell carcinoma containing asbestos bodies, two bronchial adenomas, and metastases from a stomach adenocarcinoma. Asbestos bodies lay in the stomach lining and outer surface. Inside the stomach tumor the authors described refractile dots and short rods but no typical asbestos fibers or bodies, yet their summary mentioned broken-down asbestos fibers there. Rats given the workplace material into the windpipe developed foreign-body granulomas within one week. The authors leaned toward linking the adenomas to asbestosis, allowing they might be incidental. They judged the stomach cancer probably unrelated.

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 autopsied patient), with a small supplementary rat experiment using the patient's workplace material
• Who was studied: One 65-year-old man (described in the article as "Negro"), a plaster mixer, admitted to Michael Reese Hospital, Chicago, on Dec. 12, 1959, who died on the third hospital day and was autopsied
• Exposure: About 12 years as a plaster mixer in a casting company, mixing dry powdered materials for casts that contained an unstated amount of asbestos and produced considerable airborne dust. The fiber type and the dust concentration are not given.
• Main results:
  • The patient was admitted with an enlarging abdominal mass, black stools, vomiting of blood, weight loss, exertional dyspnea and jaundice, and died on the third day in hospital. No chest x-ray had ever been taken.
  • At autopsy the lungs did not collapse. Both pleural layers were markedly thickened. The right lung weighed 1,150 gm. and the left 1,000 gm.
  • Microscopy showed extensive interstitial fibrosis with asbestos bodies, foreign-body giant cells and granulomas. The asbestos bodies were segmented with bulbous ends and averaged 50μ in length.
  • One lung nodule was a primary squamous-cell carcinoma containing numerous asbestos bodies. It was small, seen only under the microscope, and its site of origin could not be determined.
  • Two bronchial adenomas were also found in the lungs, located beneath the pleura in both upper and lower lobes.
  • The patient's main disease was a primary adenocarcinoma of the stomach that had blocked the pylorus. It had spread to the lymph nodes, the liver and the lungs.
  • In the Comment section, the authors reported that sections of the stomach tumor showed numerous highly refractile dots and short rods but no typical asbestos fibers and no asbestos bodies. The nearby stomach lining and outer surface showed occasional asbestos fibers and asbestos bodies.
  • The authors' own Summary section stated that broken-down asbestos fibers were present within the stomach tumor itself.
  • Rats were given a 1% saline suspension of the patient's work material into the trachea and killed after one week. Their lungs showed foreign-body granulomas with long refractile fibers resembling asbestos fibers. No asbestos bodies had yet formed. The number of rats is not stated.
• The authors' conclusion: The authors were more inclined to believe the pulmonary adenomas were related to asbestosis, while allowing they might be incidental. They considered it unlikely that the stomach carcinoma was related to pulmonary asbestosis. They suggested that future asbestosis cases be examined with multiple lung sections to look for additional tumors.
• Limitations the authors state:
  • Clinical and laboratory data were meager because the patient was in hospital only 3 days and had no previous hospitalization.
  • No chest x-ray had ever been taken, so it is not known whether he had progressive pulmonary symptoms. The concentration of asbestos in his work air is not known.
  • The pulmonary adenomas may have been incidental findings.

Topics

Medical terms in this study, explained in our Lexicon: Asbestosis, Carcinoma, Adenocarcinoma, Autopsy, Pleura, Fibrosis, Asbestos Bodies, Granuloma.

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