MESOTHELIOMA ASSOCIATED WITH ASBESTOSIS 














T peritoneum and pleura with asbestosis has been recognized recently. The number of cases reported to date has been small and the causal relationship requires additional confirmation. Recent reports from South Africa,l‘, 14 Great Britain22 3959 7911 and this countryst 9 have incriminated pulmonary asbestosis in a causal role with respect to pleural and peritoneal mesothelioma. Wagner et al.14 described 33 cases of pleural mesothelioma, which they related to asbestos exposure. Thornson12 associated 7 cases of mesothelioma, 4 in the pleura and 3 in the peritoneum with pulmonary asbestosis. Selikoff, Churg and Hammondg described 4 cases of pleural mesothelioma and 6 of peritoneal mesothelioma in 307 consecutive deaths among asbestos insulation workers from January 1943 through August 1964. The same authors found asbestos bodies in 12 of the 45 inesotheliomas in the Armed Forces Institute of Pathology material upon review. These investigators emphasized the importance of a diligent search for asbestos bodies in the lungs of autopsied patients who have mesothelioma. In a study6 covering 1940 through 1965 autopsies were performed on 54 patients with pathologic evidence of asbestosis at the Lancaster General Hospital; 22 patients had bronchogenic carcinoma; 3 individuals had From the Departments of Medicine and Pathology, Lancaster General Hospital, Lancastcr, Pa. Receircd for publication August 27, 1969. mesotheliomas of the peritoneum and one had associated mesothelioma of the pleura. The 3 patients with mesothelioma had been admitted to the medical or surgical service of the Lancaster General Hospital. Two of the 3 individuals had been employed in the same plant involved in the textile phase of the asbestos industry. We do not know the manner of exposure of the third patient. CASE REPORTS Case I (S.B., D-65820). A 53-year-old male factory worker was admitted to the hospital in October 1964 with a chief complaint of abdominal distress and distention of 2-week duration. He gave a history of smoking a pack of cigarettes daily for most of his adult life. On physical examination, the patient appeared to be chronically ill. Rales and coarse rhonchi were heard throughout both lung fields. The abdomen was distended; shifting dullness was present in the flanks and tympanic percussion was elicited over the anterior portion of the abdomen. There were no palpable organs or masses in the abdomen. The bowel sounds were normal. The blood count, urinalysis and blood indices were within normal limits. An x-ray of the colon was not remarkable except for evidence of ascites. Infiltration of the bases of both lungs, blunting of the costophrenic angles and adhesions to the diaphragm were present on x-ray study. Calcification over the right diaphragmatic and mediastinal areas was present. The x-ray findings were interpreted as compatible with the fibrosis associated with asbestosis. A history of exposure to asbestos




 

 

 

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