The possibility of cancer should be investigated in all cases of workplace asbestos exposure, researchers report in a case study. They also argue that a lung biopsy is essential to distinguish between mesothelioma and adenocarcinoma, so that the proper treatment can be given.
According to Dr. Agripina Rascu and co-authors of the study, “Distinction between mesothelioma and lung adenocarcinoma based on immunohistochemistry in a patient with asbestos bodies in bronchoalveolar fluid – case report,” asbestosis, or chronic lung disease caused by the inhalation of asbestos, could be diagnosed using screening methods that detect asbestos bodies in the lungs, but cancer should also be systematically assessed. The study was published in the Romanian Journal of Morphology and Embryology.
The authors report the case of a 61-year-old man who was admitted to the Clinic of Occupational Diseases at Clinical Hospital Colentina in Bucharest, Romania, in November 2014. He had chronic lung disease complicated by fluid accumulation in the space surrounding his right lung.
Two years earlier, the man had been treated for tuberculosis, and almost a year after that, in December 2013, a chest X-ray detected a nodule measuring 3 cm in his right lung, but he refused further investigation at the time.
Bronchoalveolar lavage, where salt water is injected into a lung section and then immediately sucked out to obtain cells from the air sacs, revealed the presence of asbestos bodies in his lungs.
An analysis of the man’s occupational history found that he worked in the asbestos-cement industry for 29 years, between 1978 and 2007.
The retention time of the asbestos particles in his lungs was calculated as 36 years (from 1978 to 2014). Based on this information, the man was diagnosed with asbestosis and possible mesothelioma. Further analysis, however, revealed that the lung cancer was mucinous adenocarcinoma, a cancer that starts in the epithelial cells that line certain organs.
The authors concluded that fluid retention in the space surrounding the lungs in patients with asbestos exposure may not be a sign of mesothelioma, and a careful evaluation of a lung biopsy sample is essential for accurate diagnosis.
“Malignant mesothelioma development was initially suspected but immunohistochemistry examination of pleural samples established the positive diagnosis a lung adenocarcinoma with secondary malignant pleural effusion,” they wrote. “Occupational cancer must be suspected in all cases with workplace asbestosis exposure.”
According to the World Health Organization (WHO), more than 100,000 people worldwide die of asbestos-related diseases every year, with lung cancer being the most common disease related to asbestosis. Workplace asbestos exposure is regulated in many countries, including Romania, but new cases caused by past exposure are still being diagnosed.
