Quantitative x ray microanalysis of pulmonary mineral particles in a patient with pneumoconiosis and two primary lung tumours

Our plain-English summary of Quantitative x ray microanalysis of pulmonary mineral particles in a patient with pneumoconiosis and two primary lung tumours, by S. Anttila, S. Sutinen, P. Pääkkö, et al (British Journal of Industrial Medicine, 1984).

The study

• Authors: S. Anttila, S. Sutinen, P. Pääkkö, T. Alapieti, R. Peura, S.J. Sivonen
• Journal: British Journal of Industrial Medicine
• Published: 1984;41(4):468-73
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The right upper lung lobe of a 74 year old man was resected for a central tumour. Two primary cancers were found; a central small cell carcinoma and a peripheral squamous cell carcinoma. In addition, the peripheral lung tissue showed generalised peribronchiolar fibrosis extending from the non-respiratory bronchioles to the level of the alveolar ducts. Abundant asbestos bodies and large amounts of black dust were seen around the bronchioles. Pulmonary mineral particles were studied by quantitative energy dispersive x ray microanalysis (EDS) using scanning transmission electron microscopy (STEM). The x ray spectra for mineral particles were measured in thin sections, and the characteristic peak intensities of the elements were converted to weight fractions (in oxides). The results enabled the minerals present to be identified and their presence confirmed by calculating the mineral formula. These originated from nine natural minerals, anthophyllite and chrysotile asbestos, talc, and quartz, feldspars, and muscovite, which are components of sand, and also from two artificial mullites used in fire clay. The exposure history of the patient explained the most likely origins of the minerals detected. The patient had been a mason for 23 years, repairing and demolishing stoves and fireplaces and using asbestos for insulation work.

In plain English

This case report described one patient and tested a laboratory method for identifying dust particles in lung tissue. The patient was a 74 year old man who had smoked for 50 years and had worked as a mason for 23 years, repairing and demolishing stoves and fireplaces. He had also built asbestos-insulated fireproof doors for six months and used asbestos in plumbing insulation for one month. His removed right upper lung lobe contained two separate primary cancers: a central small cell carcinoma and a peripheral squamous cell carcinoma. The surgeon reported fibrous plaques in the parietal pleura. The pathologists diagnosed asbestosis with heavy mixed dust. Using electron microscopy with quantitative x ray analysis, the authors examined 16 particles. Fourteen were natural minerals, including anthophyllite and chrysotile asbestos, talc and sand minerals. Two were mullite, an artificial fire clay mineral. The authors concluded the method reliably identified individual particles. They noted it cannot show whether the dust caused the tissue reaction, and that the particles analysed probably did not represent all minerals present.

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 of a single patient, applying quantitative energy dispersive x ray microanalysis with scanning transmission electron microscopy to mineral particles in resected lung tissue
• Who was studied: One 74 year old man who had smoked for 50 years. His right upper lung lobe was resected in February 1983 for a tumour.
• Exposure: 23 years as a mason repairing and demolishing stoves and fireplaces. For six months in 1966-7 he built fireproof doors insulated with asbestos plates sawn and ground at the site. For one month he used asbestos as insulation in plumbing work.
• Main results:
  • The resected lobe contained two primary cancers. One was a central small cell carcinoma of the intermediate cell type, 5 cm in diameter. The other was a peripheral, scar-associated, well differentiated keratinising squamous cell carcinoma, 1 cm in diameter.
  • At thoracotomy the surgeon reported fibrous plaques in the parietal pleura.
  • The peripheral lung tissue showed peribronchiolar fibrosis graded 2 in severity and C in extent in the Craighead et al asbestosis scheme. It also contained abundant ferruginous bodies (at least ten per bronchiolus) and large amounts of black dust. The histopathological diagnosis was evident asbestosis with heavy accumulations of undefined inorganic mixed dust and two primary carcinomas.
  • Of the 16 particles analysed, 14 were characterised as natural minerals and 2 as mullite, an artificial mineral used as a fire clay.
  • The particles came from nine natural minerals: anthophyllite and chrysotile asbestos, talc, quartz, feldspars (andesine, oligoclase, orthoclase), muscovite and almandine. The authors' table gave their probable origins as sand, asbestos, contaminant in asbestos (talc), abrasive paper (almandine) and fire clay (mullite).
  • Some fibres looked like chrysotile but had a magnesium content that fitted talc better. The authors assigned them to chrysotile because magnesium depletion from chrysotile has been reported.
  • The most likely origins of the minerals detected were compatible with the patient's exposure history.
• The authors' conclusion: The authors concluded that quantitative x ray microanalysis proved an effective tool for reliably identifying individual mineral particles inhaled into the patient's lungs. In their view it cannot show whether the tissue reaction was induced by the dust, but it gives an opportunity to examine the relation between known dust and a tissue reaction.
• Limitations the authors state:
  • The method is laborious, so only 20-40 spectra per case can be analysed in a reasonable time.
  • The particles identified probably do not represent all the minerals present in the lung tissue.
  • Only particles of about 1 micrometre diameter or less, or larger particles cut to 1 micrometre thickness at most, can be reliably analysed. Minerals with larger particles may be missed.
  • The method cannot show whether the tissue reaction seen by the pathologist was induced by the dust.

Topics

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

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Carcinoma, Squamous Cell Carcinoma, Fibrosis, Asbestos Bodies, Transmission Electron Microscopy (TEM), STEM, Anthophyllite.

Related studies

• Pulmonary mineral dust. A study of ninety patients by electron microscopy, electron microanalysis, and electron microdiffraction — J.P. Berry, P. Henoc, et al. (1976)
• A striking deposition of mineral particles in the lungs of a farmer: a case report — B. Gylseth, L. Stettler, et al. (1984)
• Identification of mineral particles in pneumoconiotic lungs — W.J. Henderson, J. Gough, et al. (1970)
• Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case — K. Matsuda, T. Yamaryo, et al. (2015)
• Accumulation of mixed mineral dusts in the lungs of rats during chronic inhalation exposure — C.H. McMillan, A.D. Jones, et al. (1989)
• Nonasbestos pulmonary mineral fibers in the general population — A. Churg (1983)

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