The second diagnosis: the role of the pathologist in identifying pneumoconioses in lungs excised for tumor

Our plain-English summary of The second diagnosis: the role of the pathologist in identifying pneumoconioses in lungs excised for tumor, by E.J. Mark (Human Pathology, 1981).

The study

• Author: E.J. Mark
• Journal: Human Pathology
• Published: 1981;12(7):585-7
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001996).

Summary of the article

This short review in the journal's Current Topics section, written by a lung pathologist at Massachusetts General Hospital, argued that pathologists examining lungs removed for tumor should also make a 'second diagnosis' of disease in the rest of the lung, including pneumoconioses. The author recommended inflating the lung with formalin, sectioning it at 1-centimeter intervals, and taking at least three sections per lobe away from the tumor. He reviewed links between lung carcinoma and dusts, chemicals and radioactive materials. Asbestos-associated carcinomas were described as arising more often in the lower lobes and spreading more often in the pleura. He stated that no correlation was strong enough for tumor type alone to mark exposure. He advised that asbestos bodies be sought in all such lungs, noting they may be hard to find below 100 per gram of wet tissue. He described an iron stain and a rapid technique of 20 successive scrapings of the cut lung surface onto one slide. He also covered telling asbestos bodies from pseudoasbestos bodies, interstitial fibrosis as possible evidence of asbestosis, and the pleural hyaline plaque as a marker of exposure. Beryllium disease, silicosis and other dusts were also discussed. He concluded that missing exposure history, such as shipyard work, does not absolve the pathologist from a thorough search for pneumoconiosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a commentary in the "Current Topics" section of Human Pathology. It did not report a new study of patients. The author explained how pathologists should look for dust-related lung diseases (pneumoconioses) in lungs surgically removed because of a tumor. The author calls this the "second diagnosis," made in addition to the diagnosis of the tumor itself. The author recommended that asbestos bodies be sought in sections of all such lungs. The article described a quick method for concentrating asbestos bodies: scraping the cut surface of the non-tumor lung 20 times onto a glass slide. It stated that the pleural hyaline plaque is a marker of asbestos exposure and should be diagnosed as such. It also stated that interstitial inflammation and fibrosis may be evidence of asbestosis. For mesothelioma biopsies, the author advised close examination of any attached lung tissue. The article also covered beryllium disease and silica, and recommended routine examination under polarized light. Reviewing earlier reports, the author wrote that no link between cancer type and exposure was strong enough to serve by itself as a marker of exposure. The author concluded that tissue evidence is more dependable than the clinical information passed to the pathologist.

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: Commentary giving practical guidance to pathologists ("Current Topics" article); no original patient data
• Who was studied: No patients were studied; the article concerns lungs surgically removed (resected) for tumor in general
• Exposure: Inhaled dusts causing pneumoconioses, chiefly asbestos (asbestos bodies and uncoated fibers), plus beryllium, silica and silicates, carbon and other dusts
• Main results:
  • The author recommended a scraping technique to concentrate asbestos bodies: scraping the cut surface of the non-tumor lung and layering 20 successive scrapings onto one glass slide
  • The author stated that the pleural hyaline plaque is a morphologic marker of asbestos exposure and should be diagnosed as such rather than as simple pleural fibrosis
  • The author stated that interstitial inflammation and fibrosis may be evidence of parenchymal asbestosis, particularly when asbestos bodies are present or when it is accentuated beneath the pleura and around airways and vessels
  • For biopsy specimens of malignant mesothelioma, the author advised intensive examination of any lung tissue under the pleura for asbestos bodies and for interstitial inflammation and fibrosis
  • The author recommended routine examination of lung specimens with polarized light so that silica and silicate crystals are not overlooked
  • Reviewing earlier reports on cancer types linked to different exposures, the author wrote that none of the correlations is strong enough for the cancer type alone to serve as a marker of exposure
• The authors' conclusion: The author concluded that the clinical information that reaches the pathologist is less dependable than the tissue evidence. Not being told of an exposure, such as past shipyard work, does not relieve the pathologist of a thorough search for and documentation of a pneumoconiosis.

Topics

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

Medical terms in this study, explained in our Lexicon: Carcinoma, Pleura, Asbestos Bodies, Iron Stain (Prussian Blue), Interstitial Fibrosis, Silicosis, Exposure History, Pneumoconiosis.

Related studies

• Identification of mineral particles in pneumoconiotic lungs — W.J. Henderson, J. Gough, et al. (1970)
• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)
• The past and present of pneumoconioses — P. De Vuyst, P. Camus (2000)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)
• Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses — J. Bourbeau, P. Ernst (1988)
• The classic pneumoconioses: new epidemiological and laboratory observations — A.S. Laney, D.N. Weissman (2012)

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