Document 6RR4zzKQDe0ja1GGL6aYj4Ggd

\ `i -- r`* -".--9I. . -U. *\vr -* -*^*?'.?.{ i*o v'*^ J iiie ijiNctT jgiai r | r;j thwk Mr. tf. M. Ctr^rf f^,,prttniiin to ruWi'A the t tiw fi'w patient; Mr. Orosn.-Y Dat**c, who rrrfo.-nwil the .;' >;w1Hit iO il<n fiti.-Jiti anj Mr.Cliitlet lUttktt, who came 2nd and, though 2 urtJcr*_ came to necropsy, no prim-try" .lesion-was found. lltrin- the some p. cri.nl,- 1*> n. tcn ^rcr--* admitled with asbestosis. 15 of them arc known to have died, including 10 with lunr. canter anti 1 thou-tht to have" ,, _ ----------------------- ""V the one man thought to have a peritoneal ~ j^cjevant details of the other eases are s' ASHES! OSIS AND A1D0MINAL NEOPLASMS lablcs I and n, and will be briefly discussed. Many thcr _ atients with asbestosis attend the hospital, but only as *outpatients, and so do not appear in the diagnostic index. '~rn^ '. ^MWt REGISTRAR IS CUUT MEPICJNB, 11X01 CHEST CUNIC, AMD ``-Til |x 1953, an impression u-as formed at The London ___, ________ : Hospital that women sulTcring ] iiJ ovarian neoplasms more '~T>.e occurrence of further <.----- -------- -- --------- ----------- --- . . , . , , .. - V destination, which is based on a search of the records rv'r,IKcJreni,5 *!*"* 1 ?"tr,t??br rtf .thwe.'uhospital s.ncc 1!9,<IS>. -Jtn.t.1h--a.^i.c^riodj 23 svoincn -,-AewdiJiaog*n|opsiasnoclf faivsbcesytcoas,,is hwadliebtee3nntalcacefpoteid pby^,thioen pVne^umdo.* jjvc been inpatients with a 'diagnosis of `asbestosis. While in hospital she had retention of mine, and pelvic *;. .* 1) are known to have diet), 4 with him; cancers and examination revealed a swelling in the pouch of Douglas. A :n v uitii imra-ab.UmiiwBl neoplasms. Of these 9, 1 had week later site suddenly became unconscious, with signs of a , > ~ia ovarian carcinoma, and 4 had peritoneal growths, - left hemiplegia, and die died shortly afterwards. s fonibly of ovarian origin. In the other 4, the diagnosis Nceropty.--Death was due to an embolus in the right carotid 'Put work dune while the author was medical registrar at The Loudon artery. There was no pleural effusion, but there was a narrow Hospital, London, .1. .. band of fibrous adhesions over the anteromedial surface of the 7 ---a ... ->* n -tf Cia* h">_ 'iU l.nnd.>n tliMJl niimticf 22221114.4:0> 5i4.tr 44 j 42 47tl-> 5) 15421 54 4l5vJ 47 37203 >i Stt'Vt 1782b 44 202 VI 42 22167 43 21144 17 46720-44 162iI SO 53191 SO 10.1s | S3 2007JSI 20672 M 34046.35 14063 24Sol 41545.51 Promt a;* or ape at death PicJ 43 * Died 45. Died 6o Died 49 Died 32 Died SI Died 39 Died 59 Died 35 Died 66 Died 59 Died 45 Died 50 41 (1951) 44 (t950)x 57 51 <*. 72 Died 52 Died 63 53 59 ' TABLE I--CASES OF ASOESTOStS (WOMEN) Yean tines Ant expiMur* 3107*2 Deration of expature <7an) ^Tjrpe cf ccjioro* > - Aihnttn Rrindin^ -V.. .. Athetrut tpinmua ' Ailirilitl i[iinfiinr ' Cardin* ro>vn _J,.V Miiiiim iliturtmtnt r' Adsui'i tptnttm^ -7.' 5(jli.nuUne devjrrmenC Sljb-nukiuf ilcjuttntai Nnt known . \S'jri'in2 inaehiue Ad'CMm r.iinjing Asbovw wexvins Mjitrr.dr|i,riment A.brilm spinning :v2.--- UnapeciAed. :-',J Unapeeified ' ij1' UmpeciAed ' : j- Aiheitot weaver ' Sueepet in atbettot factory Spinnint* depxruuent Mittint {MitS Pipe Ij.to- lr . ' Unipeviued ' `Associated ducata w ./; -S i*?% Jw2 L<^,' -'fdiif-iZh;P Carcinoma of ovary .* '* mm* l'etitoneal Mrrinama. probably from ovary ** .'*'.** " ? ovary; ?nictothcliomA'' w,,^.l Carcinomatous peThmui pRitonexI cartinoma, probably from ovary Careinomawiis peritonei ^ ,. .7 -- Last Well, Well Well Contiesiivt heau-fcilur. ^ Chtilccystitit -_- Pulmonary hypvrtmsion; right ka.6.t.pj vut.' aiciomu of Krm Cer.-inonia vl iti';.udt *n' * -- a,,, ^ *' <** Carcinoma or |.fcast Congestive Itcatt-Dihu* 5 TABLE If--CUES 0? ASittSTOSIS (MM) ". -- -i .-7 -- ;,V; .vse-f-fii; Cate l^tnJnti j Present age If.ivpital I w -.20 at ftumlitt T death Years sine* fait rxpumre Duration of CxtHnur* (years) - - Type of exposure Associated dittite ' c'-- -;i .V. 272.S 46 22124 s| I4.VI 41 112.17 49 2 J\77 4.4 3WI4 46 24221 47 |m;,s 31126 ' 2n| I 56 42*2I 371V 14 442* I ,-l 2`tl? 2-.-I-I 4| 5.-62 42 173/9 JS mio 3)116 49 D.id 40 Died 60 Died 41 Died 47 Dim 34 I lie J 64 Di.-J 51 Died 76 D..-J 56 Died 51 Il.td 37 D.ed 65 46 Died 62 DieJ l*> Died 69 4v - 36 41 0951) 23 - 44 5 2 7 6 15 17 40 14 14 I'/.mn - 42 w 7 4 6 mot. 9 35 . t'teufiifift Ycntiljtow'' .. A0<f\fnb I..W |/ A1**, fit*** ronJcr Ki ficf in sM^\uv fjcioiy 1 irpm.n a*l *ta AHhtMoUjMtT Avt-r-.t"* -.aet.-ry * " AihnriM ' ** e*\ttcr I1i.!.>j2ip.; J"d taw/ng aibeitoe 15 ilrr einiier K A*ltM ** |***t*l<f *.! A**K'bA |* *ff A.I e-i-.s rutf A.I-tattis li.to.y lahomey ci* j*hf*ir . ; **/..!.evtn* u.f.ry *" Lri.ii.'xvAd Ultudiiif ttbtttoe Atal'Ciunt munthetiorn f (wiironeum Catciuouia of lung t j- .plavti.. splwteidal tell) . JDi'I'-naUrlll - m p M (uujiAuu* )'hfrpi4<2 rtll) (tvmioUtl) r>r^- / (VMilMt ffltl (>9t5Jtacui tcll> I 1",^. Ijfj.' m t* w 'L ' eOW m UNiMtlU .w *m (iflibUtitfttr^n^ceQ} ,,, - fp-'.X-nrlerm 5i<r putative pnfnm*w.iji f.irl.rrl absresa 7 *o m"*' "* ** - Vrv . I c ^-vr** . .* AVi-iiNt' r* ^ --*mrr -- tjt * ^ . - i m* - *. " ) fin | PijiSItrVi coIiubhu'i tnd Md>l<(tU cutiMmt, '*'*,* gj^.a Xmg. ppillnv.mImIu. Bid*IId nmmft wtth orauiosol e*T**otM of luttr, |>oI*4toininc polytonol c*Ua "'v--ti'-f' o( to* wboflisf toon in iqunWMill ukImdi. tudatai) Mtiofiac *kuriw primry. (X tli) -. f .-i.fv ii <x it0.) yj-jyjtgs-: ..r^r-^r~'--^ :',... t'-- Kceropty (Dr. B. E. Heard at St. Mary's Hospital).--T . ^.7.''. *" " ''I --were many fibrous adhesionsin both pleural us with nusw- tiiV right upper lobe. All lobes of lung showed a firm shorty ous, evenly mitered, dull nodules throughout both luaa. induration with almost confluent nodules of greyish-black Scrapings showed asbestos bodies. A great amount c:' pcVtrt^' fibrosis against a paler reddish-brown background. The fibrosis filled the peritoneum and invaded the wails of the uxcuiao. T vas more diffuse in the anterior parts of the right upper lobe and the greater omentum.' There was ens noiule in the Ion. ` -- end in the right lower lobe, showing a blue-grey interlacing The ovaries were, not identified in the mass of growth efi=< network of fibrous strands. The left ovary was enlarged the pelvis. The cause of death was given as eaieaaeas e _ . (11 cm. diameter) by a nodular necrotic cystic carcinoma, peritoneum, probably from ovary. -* unaccompanied by peritoneal or any other secondary deposits. Case 3.--She was found to have asbestosis in 1953, and w Histology.--The tumour was a papillary* columnar, end admitted one year later at the age of 61, with a five-week hiw " cuboidii-cell carcinoma, with occasional aggregates of larger of abdominal distension, anorexia, constipation, and preem- pale-staining polygonal cells suggestive of The whorling seen sive weight-loss. She was cachectic. There was ascites, tsi, in squamous-cell carcinoma (fig. 1). The lungs shelved peri- large hard irregular mass could be felt rising from the ;-e>r=. bronchiolar and peribronchial interstitial fibrosis with some She required repeated paracentesis, and died after twin slight broachiolar epithelial hyperplasia. Numerous asbestos ` ,'n hpilaL bodies were found, often entirely or partially ingested by pantcells of the foreign-body type. A few asbestos bodies were found in a partially fibrorie hilar lymph-node. Kta-opsy.--Fibrous adhesions were found ct tha apes of de left lung. There was conspicuous cilTuse err.phytemi. A*bru bodies were seen in smears from the cut surface of tha line Case 2.--Asbestosis had been diagnosed at the age of40. She fine fibrosis was present throughout both lungs with eiwres was a dmirted when she was 45, with a history of lower tbdontiual areas of anthracosis, maximal in the lower lobes. There w bearing-down pains for one year, followed by anorexia, ciiar- nodules of growth throughout the peritoneum, with pLsqva - xhcea and weight-loss. A large hard irregular mass was felt in growth surrounding the liver and spleen. A mass of pv*= the lower abdomen, arising from the pelvis. At laparotomy, filled the pelvis end the ovaries were not identified. Cfc , the whole of the posterior sheath of the rectus appeared histological examination, the lungs showed variable pirws infiltrated by growth and no further examination was made. fibrosis. Numerous asbestos bodies were seen, with pecs: ;-:.r A biopsy was taken and histological examination showed a fibrosis in the lung-substance. Sections of the rusne j _ carcinoma composed of papillary, tubular, and cuboids! celnl:s*n. showed a moderately scirrhous solid trabecular small-ai suggvwing an ovarian primary (tig. 2). She died it hospiitil r c^TjJaorna, with grouping of the cells suggestive of rows= after nine months. . He. 3. AW-*l,r*l,lr trlirbnu* lt tr,l,,cul>r m,lt [ml* run>l-('il i-mriwi; *1 ttw rll* it'|on>c of _ -- n**iln, (sKI.) * '---".V 5*T .4 Smalt culmMol poll Hot vl!r4 tubutir - . r*,ii..inio l,t omrnium, tKory I* ll (VUl) ^  v*-^ * TWioprCIMiUR 3, IhuO J.AWST ' ">**-* u.V, JV'/' : " ~ -"***->J* m-.+rUXi *- - Jv .ORIGINAL ARTICLES -'- " - . - v ;-v-^rvoi :2llS$3^P?i X.f-TUB LANCET I"1213 " .it %gaaiity carcinoma composed of small, cubnidal, tubular, I jsJ dit cells in omentum (tig. 4). The ovary uni thought to be | i probable primary site, though a peritoneal endothelioma ^T4t03ld not be excluded. She was admitted on two further . j aerations for paracentesis, but died at home and necropsy was .- . " cat performed. <%* - : j- Case S.--Admitted in February, 1953, at the age of 52, with i six-week history of bearing-down pains in the lower abdomen niiadng to the vagina and thighs. The pain was worse on jdxmtton and micturition, but there luid been no change in towel habits and no blood in stools or urine. She worked in rit.il).--There * with ntiW'it; both lunp* unt of growth the intcttioo* le in the lh'er> the mattress department of an asbestos company for three years {ram die age of 16, and had been breathless on exertion for tome years but denied having had a cough. She was ill and caned. The fingers were not clubbed. There were bilateral bull crepitations, and X-ray examination showed pleural thickening at the right base, and fm= reticulation throughout the ' gfOwris Mlm , 'catcinoma in , .sj . * 1m .-j *- -*'-v. A* e.v- ' Fit. S-C*t 7. Nodule of secondary carcinoma from peritoneum, ' -t compeicd of mild trobccul* of polytonol cell*. (xltO.) tTS . -`25- Case 7.--Thought to have asbestosis when she was admitted at the age of 33, complaining of abdominal swelling for six ^ weeks. She was obese and dyspnteic with impaired percussion note at both bases and bilateral basal crepitations. Chest X-ray showed diduse mottling throughout both lungs with pleural thickening at the left base. Xo asbestos bodies were `.;`i found in the one specimen of sputum examined. Free fluid was "/ the ."V * 1953, and was (i-wWi' history n, and procr- ana a [A I-**; \c^r.` iwdve at the ap * ^'c at identified. ft. j variable pl^nl seen, svith Piich* t of rise turnout abecular *ma\l-3 H;. S--Cue 6, Tutrjlirt ml octatlonaHy papillary, euboldiUcdt (itciAni iu;sf^tlvc f ovirlan ariiin. (XU4.) 1 .U hag-f.s!ds. The sputum contained asbestos bodies, but no --tele bacilli or neoplastic cells. 'Hie liver was enlarged, i the year i subsequent chest symp toms and the chest X-ray showed no abnormality, but her sputum contained numerous asbestos bodies. She complained of malaise for one year and of increasing girth for five months. There was gross ascites, with an irregular mass in the left hypochondiium and another in the pelvis. A barium enema showed Some narrowing in the icgion of the splenic flexure, thought to be due to extrinsic pressure, but no intrinsic lesion of the colon. At laparotomy, the mass in the upper abdomen was found to be rolled up omentum, invaded by growth, and there were nodules of growth throughout the peritoneum. The ovaries were atrophic and also studded with growth. Xo abnormality was found in the stomach or intestine. The appendix and a piece of omentum were removed for histological examination, which jC" '** n;eu, irr.-.tuur, anu lived. At laparotomy, /? ` , mi anJ the pelvis was liiied hy a mass of growth of V. f. ' .* Vhtetminedu.i.rin. There were of gross (h ihroi: ;hout -;r<fii"n;um. A biopsy specimen was taken and hidological `/a-.inaiion showed a carcinoma nude up of pjpillaty, tubular, tl cuboidil edit,-suggestive of an osurian primary (fig. 5).