Significant Asbestos Exposure Research Articles

Molecular and Immunohistochemical Testing in Mesothelioma and Other Mesothelial Lesions.

Molecular testing has increasingly been utilized in the evaluation of mesothelioma. Diffuse mesothelioma comprises multiple distinct genetic subgroups. While most diffuse mesotheliomas lack oncogenic kinase mutations and instead harbor alterations involving tumor suppressors and chromatin regulators, a minor subset of tumors is characterized by uncommon alterations such as germline mutations, genomic near-haploidization, ALK rearrangement, ATF1 rearrangement, or EWSR1::YY1 fusion. To provide updates on the salient molecular features of diffuse mesothelioma, mesothelioma in situ, and other mesothelial lesions: well-differentiated papillary mesothelial tumor, adenomatoid tumor, peritoneal inclusion cyst, and others. We consider the diagnostic, prognostic, and predictive utility of molecular testing in mesothelial lesions. We performed a literature review of recently described genetic features, molecular approaches, and immunohistochemical tools, including BAP1, MTAP, and merlin in mesothelioma and other mesothelial lesions. Our evolving understanding of the molecular diversity of diffuse mesothelioma and other mesothelial lesions has led to considerable changes in pathology diagnostic practice, including the application of immunohistochemical markers such as BAP1, MTAP, and merlin (NF2), which are surrogates of mutation status. In young patients and/or those without significant asbestos exposure, unusual mesothelioma genetics such as germline mutations, ALK rearrangement, and ATF1 rearrangement should be considered.

A PRIMARY EMPYEMA OF UNKNOWN DURATION DUE TO ANAEROBIC GRAM-NEGATIVE BACILLUS HAFNIA ALVEI

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Empyema is the presence of pus or bacteria in the pleural space. Incidence is increasing gradually with higher rates in the elderly with a greater prevalence in males [1]. Empyema is a fatal infection with a mortality rate of 20% [2]. Anaerobic Enterobacteriaceae accounting for less than 6% of empyema cases, are an infrequent cause [1]. CASE PRESENTATION: An 80-year-old male with a history of coronary disease, hypertension, hyperlipidemia, peripheral vascular disease, moderate aortic stenosis, a former smoker was seen at the pulmonary clinic for intermittent dyspnea with right-sided abdominal fullness of unknown duration and no symptoms of infection. He had significant asbestos exposure from his shipyard work. Around six months back, he underwent superior mesenteric artery (SMA) stenting for chronic abdominal angina. He was taking a super enzyme supplement to enhance his digestion. Chest x-ray review revealed right-sided effusion, which was also present before SMA stenting (Figure A1-2). A diagnostic thoracentesis showed brownish-green fluid with analysis indicative of empyema (Figure B). His blood work was normal. He was admitted, and a pigtail catheter was inserted into the right pleural space with purulent fluid drainage. He also underwent fibrinolysis. The pleural fluid culture grew Hafnia alvei sensitive to quinolones, aminoglycoside, and carbapenems (Amp C resistance pattern). At discharge, computed tomography and x-ray of the chest revealed empyema resolution, and the chest tube was removed (Figure C1-2). The initial antibiotic ertapenem was transitioned to levofloxacin for one month at discharge. At four weeks after discharge, his symptoms had entirely resolved DISCUSSION: H. alvei is a gram-negative facultative motile anaerobe of the Enterobacteriaceae family, a commensal in the gastrointestinal (GI) tract of humans and animals. It colonizes the oropharynx in humans [3]. It produces a cytolytic toxin, a virulent factor, causing acute gastroenteritis. It is a rare cause of nosocomial and community-acquired infection with a preference for biliary tree infection and has lower mortality [4-5]. In patients with multiple comorbidities and immunosuppressed, it causes extraintestinal diseases such as endophthalmitis, bronchopneumonia, gastroenteritis, and meningitis [5]. The infection source is the GI tract via gut translocation or oropharynx venous drainage draining into the heart and forced into the visceral pleura or alveolar capillary bed [5-6]. In our patient, another source could be the contaminated supplement (it contains Ox bile) CONCLUSIONS: In primary empyema of remote duration and an infrequent cause, a possible source could be the GI tract or the oropharynx. Clinicians should be aware of supplement contents that could be a source of infection REFERENCE #1: Godfrey MS, Bramley KT, Detterbeck F. Medical and Surgical Management of Empyema. Semin Respir Crit Care Med. 2019;40(3):361-74 REFERENCE #2: Corcoran JP, Wrightson JM, Belcher E, DeCamp MM, Feller-Kopman D, Rahman NM. Pleural infection: past, present, and future directions. Lancet Respir Med. 2015;3(7):563-77 REFERENCE #3: Fazal BA, Justman JE, Turett GS, Telzak EE. Community-acquired Hafnia alvei infection. Clin Infect Dis. 1997;24(3):527-8 DISCLOSURES: No relevant relationships by Phillip Beck, source=Web Response no disclosure on file for Wilson Grace; No relevant relationships by Ethan Karle, source=Web Response No relevant relationships by AARON MILLER, source=Web Response No relevant relationships by Shakuntala Patil, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by ANTONY RAWINDRARAJ, source=Web Response

INCIDENTAL SOLE CONTRALATERAL PLEURAL METASTASIS FROM RENAL CELL CARCINOMA SEVEN YEARS POST NEPHRECTOMY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Renal cell carcinoma (RCC) accounts for 3% of all adult male cancers, and half of them are incidental findings on imaging [1]. 18% of patients have synchronous metastasis at RCC diagnosis, and 85% have metachronous metastasis within five years after surgery. A better prognosis is seen with a metachronous metastasis occurring after a long disease-free interval [2] CASE PRESENTATION: A 68-year-old male presented to an outside emergency department with generalized weakness, fatigue, and loss of appetite for a week's duration with no respiratory complaints. He was a former smoker who quit 40 years back. He had significant asbestos exposure as a sandblaster and changing railroad brake shoes. His initial blood work revealed an acute kidney injury with a serum creatinine of 14.8 mg/dL with no leukocytosis. Computed tomography (CT) abdomen revealed an obstructive right ureteropelvic junction stone (1.4 x 1 cm) with moderate hydronephrosis. Chest x-ray and CT revealed multiple right pleural soft tissue masses (largest measuring 7.7 x 3.1 x 3.5 cm) with no effusion concerning for malignancy (Figure A). Past medical history was significant for left clear cell RCC grade 3/4 with no invasion (T1bNxMx) treated by left radical nephrectomy seven years ago. His obstruction was relieved by urological intervention. A nuclear positron emission tomography showed hypermetabolic right pleural masses and a right paratracheal lymph node (Figure B). A CT-guided biopsy returned positive for metastatic RCC (Figure C1-C2). His creatinine improved, and he was discharged with an oncology follow-up DISCUSSION: The risk of RCC metastasis via hematogenous or lymphatic spread increases if it is locally advanced (stage 3-4), higher nuclear grade, and clear cell histology [2]. The lung is the frequent site of metastasis (45%), and pleural lesions occur in 12% along with lung spread [3]. Isolated pleural spread without an effusion is rare. Dormant metastasis uses Batson's venous plexus draining into thoracic veins (bronchial and intercostal) and reaches the pleura rather than by lung parenchyma direct extension [2]. Most reported cases of solitary pleural spread are symptomatic with effusion. Our patient was asymptomatic with incidental contralateral pleural metastasis without pleural effusion seven years postresection with a rare combination of pleural and paratracheal lymph node spread. 5-15% of patients recur with a distant spread questioning the current five-year surveillance strategy [4] CONCLUSIONS: Metastatic RCC to the pleura is a rare finding. This diagnosis should be considered in patients with RCC history, even if the presentation is many years after initial diagnosis and treatment. Postnephrectomy, the surveillance should be based on an individual's RCC risk factors REFERENCE #1: Ohnishi H, Abe M, Hamada H, et al. Metastatic renal cell carcinoma presenting as multiple pleural tumours. Respirology. 2005;10(1):128-31 REFERENCE #2: Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted antiangiogenic therapy by using multidetector CT. Radiographics. 2013;33(6):1691-716 REFERENCE #3: Saitoh H. Distant metastasis of renal adenocarcinoma. Cancer. 1981;48(6):1487-91 DISCLOSURES: No relevant relationships by Mohammed Alnijoumi, source=Web Response No relevant relationships by Cliff Chen, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response

Nodular Pulmonary Amyloidosis: A Case over Fourteen Years

A 75-year-old man presented with pleuritic chest pain, haemoptysis and dyspnoea. Imaging found multiple pulmonary nodules, concerning for malignancy. CT-guided biopsy was consistent with amyloid. The patient has a history of pulmonary amyloidosis, with a single nodule resected 14 years prior. This case allows comparison between imaging fourteen years apart, providing insight into the progressive nature of these benign nodules. Nodular pulmonary amyloidosis is a rare condition with few case reports published. Of those published, few are of nodular amyloidosis in the absence of underlying neoplastic aetiology. This case presents a 14-year interval of a patient with nodular amyloidosis, allowing insight into disease progression which has not previously been well described. A 75-year-old man presented to a regional hospital in Australia with right sided pleuritic chest pain, and a 2-week history of productive cough, haemoptysis, dyspnoea and reduced exercise tolerance. Further questioning revealed a 3-month history of worsening dyspnoea, haemoptysis and cough, with no orthopnoea, paroxysmal nocturnal dyspnoea or weight loss. The patients’ past medical history included resection of an amyloid tumour from the left lower lobe of the lung in 2004, ex-smoker with a 30-pack year history, significant occupational asbestos exposure through work as a diesel mechanic, and hypercholesterolaemia. The patient lives at home with his partner and is independent with the activities of daily living. On examination, the patient appeared well, in no respiratory distress. Observations were within normal limits, with oxygen saturations of 94% on room air, respiration rate of 18. On auscultation, there were late inspiratory crackles, as well as decreased hepatic dullness to percussion. There was a central trachea and no palpable cervical lymphadenopathy. Cardiovascular examination was unremarkable, and the patient was euvolaemic. Abdominal examination was unremarkable with no palpable organomegaly, and he did not have a rash or skin abnormalities seen. The initial investigations were conducted to investigate a potential lung malignancy underlying malignancy, based on the appearance on CT scan. The patient advised us that he had a previous diagnosis of primary pulmonary amyloidosis, first diagnosed 14 years ago. The diagnosis was made after a chest x-ray and CT showed a nodule, suspicious for cancer. Pulmonary function tests were performed and he was referred to a Cardiothoracic surgeon for consideration of a left lower lobectomy. He was treated with a wedge resection. Histopathology from this specimen showed primary pulmonary amyloidosis. There was a delay in the understanding of how the patient came to have this rare diagnosis, as it took five days for the medical records to be sourced from the archive.

Malignant Mesothelioma Presenting After Resolution of a Seemingly Benign Asbestos Related Pleural Effusion

A male patient presented with a signs and symptoms of a respiratory tract infection associated with a pleural effusion. The effusion had negative cytological analysis and a CT scan showed mild pleural thickening. The effusion resolved completely on chest radiographs and the patient was discharged from the respiratory service, but the effusion recurred. After further investigations and elucidating significant asbestos exposure in the medical history, mesothelioma was eventually diagnosed. The patient is currently receiving chemotherapy with palliative intent. This paper highlights the importance of ongoing follow-up in a patient with a label of benign asbestos-related pleural effusion.

Malignant Mesothelioma Presenting After Resolution of a Seemingly Benign Asbestos Related Pleural Effusion

A male patient presented with a signs and symptoms of a respiratory tract infection associated with a pleural effusion. The effusion had negative cytological analysis and a CT scan showed mild pleural thickening. The effusion resolved completely on chest radiographs and the patient was discharged from the respiratory service, but the effusion recurred. After further investigations and elucidating significant asbestos exposure in the medical history, mesothelioma was eventually diagnosed. The patient is currently receiving chemotherapy with palliative intent. This paper highlights the importance of ongoing follow-up in a patient with a label of benign asbestos-related pleural effusion.

Ultra low dose CT screen-detected non-malignant incidental findings in the Western Australian Asbestos Review Programme.

Computed tomography (CT)-based studies of asbestos-exposed individuals report a high prevalence of lung cancer, but the utility of low dose CT (LDCT) to screen asbestos-exposed populations is not established. We aimed to describe the prevalence of indeterminate pulmonary nodules and incidental findings on chest LDCT of asbestos-exposed subjects in Western Australia. A total of 906 subjects from the Western Australian Asbestos Review Programme underwent LDCT of the chest as part of regular annual review. An indeterminate (solid) nodule was defined as >50 mm3 and part-solid/non-solid nodules >5 mm. The presence of asbestos-related diseases was recorded with a standardized report. Subjects were mostly (81%) men with a median age of 70 years. Fifty-eight (6.5%) participants were current smokers, 511 (56.4%) ex-smokers and 325 (36.4%) never-smokers. One hundred and four indeterminate nodules were detected in 77 subjects (8.5%); of these, eight cases had confirmed lung cancer (0.88%). Eighty-seven subjects (9.6%) had incidental findings that required further investigation, 42 (4.6%) from lower airways inflammation. The majority of nodules were solid, 4-6 mm and more common with age. Five hundred and eighty (64%) subjects had pleural plaques, and 364 (40.2%) had evidence of interstitial lung disease. The prevalence of LDCT-detected indeterminate lung nodules in 906 individuals with significant asbestos exposure was 8.5%, lower than many other CT studies. Clinically important incidental findings were found in 9.4%, predominantly related to lower respiratory tract inflammation. LDCT appears to effectively describe asbestos-related diseases and is likely to be an acceptable modality to monitor asbestos-exposed individuals.

Coexistent Malignant Pleural Mesothelioma and Pulmonary Adenocarcinoma: An Autopsy Case With Review of Literature

Synchronous or metachronous malignant pleural mesothelioma and pulmonary adenocarcinoma are vanishingly rare, most occurring with a history of significant asbestos exposure. We report a unique case of metachronous malignant pleural mesothelioma and pulmonary adenocarcinoma in a 70-year-old man with a significant history of smoking (one pack per day for 50 years) and a remote history suspicious of asbestos exposure. …

Bronchoalveolar neutrophilia inversely correlates with DLCO at diagnosis in asbestosis but not lung function decline at 1 year.

The role of bronchoalveolar lavage (BAL) in the assessment of interstitial lung disease (ILD) remains controversial. Previous studies have demonstrated that BAL cell differential is useful in predicting disease progression in many forms of ILD. We wished to investigate whether BAL had a similar use in predicting disease progression in asbestosis. 21 patients who had significant asbestos exposure, findings of UIP radiologically and BAL performed as part of their investigation were reviewed. There was a significant inverse correlation between percentage BAL neutrophils and percentage predicted DLCO at diagnosis (n=21; P=0.02; r(2)=(-)0.25; CI, (-)0.77(-)0.08), but not with DLCO decline over 1 year. Unlike previous reports in IPF, BAL cell differential is not predictive of decline in classic asbestosis with a UIP pattern and its routine use in this cohort of patients provides little if any additional benefit.

Peritoneal mesothelioma presenting as a skin nodule

Mesothelioma is a malignancy of the pleura, pericardium and peritoneum that is rarely seen in cutaneous biopsies. We present a case of a 75-year-old man with significant occupational exposure to asbestos who developed peritoneal mesothelioma that presented as a skin nodule in an old appendectomy scar. The patient presented with a complaint of increased hardness along his appendectomy scar. Physical examination revealed an anterior abdominal wall mass overlying the appendectomy scar, which was subsequently biopsied. Histologic examination of the abdominal wall mass revealed an infiltrating epithelioid and papillary neoplasm within the dermis and subcutaneous tissue. Immunohistochemical stains showed immunoreactivity for cytokeratin (CK) 7, CK 5/6, calretinin and vimentin. CK 20, monoclonal carcinoembryonic antigen, prostate-specific antigen and prostate-specific acid phosphatase were negative. The profile supported the diagnosis of mesothelioma. Cutaneous presentation of mesothelioma is rare but should be considered in the differential diagnosis of patients with significant asbestos exposure.

Autoantibodies from mice exposed to Libby amphibole asbestos bind SSA/Ro52-enriched apoptotic blebs of murine macrophages

Asbestos exposure is associated with increased autoimmune responses in humans. For example, in Libby, MT where significant asbestos exposure has occurred due to an asbestos-contaminated vermiculite mine near the community, residents have developed increased autoimmune responses compared to an unexposed population. However, the exact mechanism by which Libby amphibole asbestos generates autoimmune responses is unclear. A murine model of amphibole asbestos-induced autoimmunity was recently established, and one of the targets of the autoantibodies (AAs) was the SSA/Ro52 autoantigen. The purpose of this study was to determine whether the SSA/Ro52 autoantigen is exposed at the surface of cells as a result of asbestos exposure as a possible mechanism leading to antigenicity. Our results indicate that Libby asbestos induces apoptosis in murine macrophages as determined by phosphatidylserine exposure, cleavage of poly(ADP-ribose) polymerase and morphological changes such as nuclear condensation. Moreover, asbestos-induced apoptosis results in the formation of apoptotic cell surface blebs enriched in SSA/Ro52 as determined by confocal microscopy. Most importantly, apoptotic cell surface blebs are recognized by AAs from mice exposed to amphibole asbestos suggesting that these cell surface structures may be antigenic when presented in a pro-inflammatory context. This study supports the hypothesis that the induction of apoptosis plays a key role in environmentally induced autoimmunity through cell surface exposure of a known autoantigen.

Internalization of Libby Amphibole Asbestos and Induction of Oxidative Stress in Murine Macrophages

The community members of Libby, MT, have experienced significant asbestos exposure and developed numerous asbestos-related diseases including fibrosis and lung cancer due to an asbestos-contaminated vermiculite mine near the community. The form of asbestos in the contaminated vermiculite has been characterized in the amphibole family of fibers. However, the pathogenic effects of these fibers have not been previously characterized. The purpose of this study is to determine the cellular consequences of Libby amphibole exposure in macrophages compared to another well-characterized amphibole fiber; crocidolite asbestos. Our results indicate that Libby asbestos fibers are internalized by macrophages and localize to the cytoplasm and cytoplasmic vacuoles similar to crocidolite fibers. Libby asbestos fiber internalization generates a significant increase in intracellular reactive oxygen species (ROS) as determined by dichlorofluorescein diacetate and dihydroethidine fluorescence indicating that the superoxide anion is the major contributing ROS generated by Libby asbestos. Elevated superoxide levels in macrophages exposed to Libby asbestos coincide with a significant suppression of total superoxide dismutase activity. Both Libby and crocidolite asbestos generate oxidative stress in exposed macrophages by decreasing intracellular glutathione levels. Interestingly crocidolite asbestos, but not Libby asbestos, induces significant DNA damage in macrophages. This study provides evidence that the difference in the level of DNA damage observed between Libby and crocidolite asbestos may be a combined consequence of the distinct chemical compositions of each fiber as well as the activation of separate cellular pathways during asbestos exposure.

Nodular glomeruloid pleuroblastoma: a biphasic pleural-based malignant tumor with immature elements

An unusual diffuse pleural-based tumor arising in an elderly asbestos-exposed male is presented. The tumor presented in a 72-year-old male with a 30-year history of dockyard work and likely significant asbestos exposure. Macroscopically, at post mortem, the pleural tumor diffusely encased the right lung and was composed of an admixture of neoplastic macro-, and by light microscopy, micro-nodules. Histologically, the tumor had a biphasic growth pattern with glomeruloid epithelioid elements and immature blastematous mesenchymal stroma. Immunophenotypically, the tumor had a complex pattern with epithelioid elements expressing cytokeratins, desmin, carcinoembryonic antigen (CEA), Ber EP4 and E-cadherin. The diagnostic problems and medicolegal issues surrounding the diagnosis and differentiation from malignant pleural mesothelioma and other tumors are discussed.

CT findings and serum ca 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature.

The aim of this study was to review and reappraise the clinical and CT features of malignant peritoneal mesothelioma (MPM), and to discuss differential diagnosis. The history, clinical, and laboratory data, and imaging studies of 11 patients with a histologically proven diagnosis of MPM, were retrospectively reviewed. Our patients consisted of 7 women and 4 men, with a median age of 48 years (age range 40-55 years). There was a definite history of significant asbestos exposure in 6 patients. Abdominal swelling (9 of 11) was the most common presenting symptom. The mean serum CA-125 (normal value 1.2-32 U/ml) level was 230 U/ml (range 19-1000 U/ml). The most common radiological findings were extensive or moderate amounts ascites (11 of 11), irregular or nodular peritoneal thickening (11 of 11), omental involvement (10 of 11), mesentery involvement (9 of 11), pleural thickening, plaques or calcification (7 of 11), pleural effusion (6 of 11), and bowel wall thickening (5 of 11). Two patients had large upper abdominal masses. Computed tomography findings of MPM are nonspecific and inadequate to pinpoint specific diagnosis. The diagnosis requires histological demonstration which is commonly made by an image or laparoscopic-guided biopsy. Pleural changes suggesting asbestosis combined with CT findings and high CA-125 levels can suggest, but are not diagnostic of, mesothelioma. Suggesting the diagnosis of MPM is important because histological and immunohistochemical tests are needed for diagnostic accuracy.

Respiratory Findings Among Millwright and Machinery Erectors: Identification of Health Hazards from Asbestos in Place at Work

Asbestos-associated diseases are prevalent in the construction trades primarily because of the previously widespread use of asbestos-containing insulation materials. Workers in metal-related trades, employed at construction sites and power facilities, but who do not routinely handle such materials as part of their work, may also be at risk for significant asbestos exposure. In order to evaluate such risk, a clinical field survey was conducted of 110 millwright and machinery erectors from the New York metropolitan area. A high prevalence of chest roentgenologic abnormalities was found. Forty-nine (44.5%) of the examined workers had pleural abnormalities consistent with asbestos-induced effects. Eighteen workers showed evidence of unilateral pleural thickening. Duration from onset of employment was significantly longer for those with pleural abnormalities (mean 32.3 years) as compared to those with normal chest radiographs (mean 18.5 years). Thirteen workers (11.8%) had radiographic signs of interstitial lung disease. The workers with pleural abnormalities had lower mean values of restrictive and obstructive lung function parameters than those with normal pleura. Multivariate and logistic regression analyses demonstrated association between duration of employment in the millwright trade and pleural abnormalities which was independent of smoking status. These findings suggest that millwright and machinery erectors employed in work environments where there is potential for primarily indirect exposure to airborne asbestos-containing dust are at risk for adverse effects from such exposure.

Bronchoalveolar lavage analysis, gallium-67 lung scanning and soluble interleukin-2 receptor levels in asbestos exposure

This study examined different markers of lung immunologic and inflammatory responses to previous asbestos exposure. We performed bronchoalveolar lavage (BAL) and gallium-67 (67Ga) lung scans and measured serum and BAL soluble interleukin-2 receptor (IL-2R) and angiotensin-converting enzyme (SACE) levels in 32 subjects with a history of significant asbestos exposure, 14 without (EXP) and 18 with (ASB) radiographic evidence of asbestosis. BAL analysis revealed increases in neutrophils in both ASB and EXP when compared to controls (P less than 0.01), which persisted after adjustment for smoking category. Although significant abnormalities of macrophage and total lymphocyte profiles were not found in the study population, lymphocyte subpopulation analysis revealed elevation of BAL T4/T8 ratios in the entire study group (ASB + EXP) when compared to controls (P less than 0.05), independent of smoking category. 67Ga lung scan activity was increased in 56% of ASB and in 36% of EXP: no correlations between positive scans and different radiological and functional parameters could be found. There was no significant elevation of mean SACE, serum, or BAL IL-2R levels in any of the study categories. These data suggest that asbestos exposure may be associated with parenchymal inflammation, even in the absence of clinical criteria for asbestosis. Abnormalities of gallium uptake and of BAL analysis reflect the clinically inapparent inflammation. The increased BAL T4/T8 ratios observed suggest that abnormal local pulmonary immunoregulation may play a role in the pathogenesis of asbestos-related lung diseases.

The Relationship Between Lung Cancer and Asbestos Exposure

This study supports the theory that asbestos exposure may be implicated in a recent upsurge of terminal lung cancer cases in Kure, Japan. The number of asbestos bodies found in the lung during autopsy of 158 subjects from 1984 to 1986 suggests that 70.4 percent of the 51 diagnosed lung cancer cases could be attributed to asbestos exposure. Of the 107 subjects in whom death was not caused by cancer, 38.4 percent had significant asbestos exposure. Types of asbestos bodies found in diagnosed lung cancer cases were analyzed using scanning electron microscopy and x-ray analyzer. Chrysotile was the most widely found component, but amphiboles such as crocidolite and amosite also were detected. Residents of Kure had high exposure to the inhalation of asbestos bodies, possibly related to the upsurge in lung cancer deaths. In our earlier report, asbestos exposure was implicated in the increased incidence of malignant mesothelioma in Kure, an active Japanese ship-building port since the 1920s. Our current findings indicate that asbestos exposure may be a pathogenic factor in lung cancer in world seaports where asbestos exposure has been prevalent.

Asbestos exposure and gastrointestinal malignancy review and meta-analysis.

The epidemiologic literature linking asbestos exposure with gastrointestinal malignancy is reviewed. Problems in comparing studies are discussed, appropriate strategies for comparison are developed, and study results are pooled using a model which accounts for both intrastudy and interstudy variability. Stratification of cohorts by dose reveals that significant asbestos exposure, as indicated by a lung cancer standardized mortality ratio (SMR) of at least 200, is associated with an elevated gastrointestinal cancer of SMR for five of six points examined [corrected].

Drywall construction and asbestos exposure.

The rapid development of the drywall construction trade in the United States is described. It is estimated that some 75,000 U.S. construction workers are currently employed in this trade. The use of a variety of spackle and taping compounds is shown to be associated with significant asbestos exposure; air samples taken in the breathing zone by drywall tapers during sanding of taping compounds show fiber concentrations exceeding, by several times, the maximum level permitted by United States Government regulations. These findings are given together with the result of a clinical field survey of drywall construction workers demonstrating that asbestos disease may be an important health hazard in this trade.

Malignant mesothelioma presenting in the pleura and peritoneum

Malignant mesothelioma presenting in the pleura and peritoneum is described in a middle-aged man. The patient lacked significant asbestos exposure which is not unexpected from both the clinical literature and animal inhalation tumor data. Computerized axial tomographic correlation is provided. Partial remission was achieved with the administration of adriamycin and DTIC.