Document 93D70na9OLbvZGdROnyrxKDrL

*\ co C*4 CM O > CM -3' <--i i O' f-t t--t r* ST0566725 Orf 2 w Q oz M zoM Q Q X Q S X X H erf <M 9k N 4-1 " CQ e oCO 9k Uo Q H X C co o COO e CO a< XSB Xi-t XCO M44 X4J < X4J 30 COf CO w M XZ CeO CO s; CoO M03 M CO **4 ct u Hi CO w 03 CO < H CO Cd CCoOO eo a. co << era EE 04 *> te4 4J U CO X I--1 f-l z o CO X4J K iXs DOW 05828 Asbestosis and Carcinoma of the Larynx A Possible Association Herman I. Libshitz. MO; Martin S. Wershba, MO; 6. William Atkinson, MD; Martha E. Southard. MO Three patients had carcinoma of the larynx, history of asbestos expo January 1973 for increasing hoarseness of sure, and evidence of Intrsthoraclc changes characteristic of asbestosis. The data suggest an association between asbestosis and carcinoma of the larynx. (JAMA 228:1571-1572, 1974) M years' duration. Biopey of several ir regular growths on the left vocal cord re vealed intermediate grade epidermoid car cinoma. A total of 6,400 rads was given from Jan 18, 1973, through March 5,1973. He is well and asymptomatic eight months INCREASED incidence of various area of ships from 1952 to 1954. He had after therapy. malignant neoplasms has been re lated to exposure to asbestos. The as sociation between asbestosis and pul monary and pleural neoplasms has ssHWewyuek oTtignrets per day fdrW yean.. A chest roentgenogram demon strated changes consistent with asbestosis (Fig 2). Laryngoscopy was performed in Case 3.--The patient, s 60-year-old man, had been a steam pipe fitter and welder for 30 years.-He he4 --k4 Swa-paahsie#1 aapeate^ae-day 4aeJM yean, stopping 18 been well established. We have re cently seen three patients with pri mary laryngeal cancers, a history of Fig 1.--Posteroanterior roentgenogram of chest of patient 1, showing marked pleural thickening and extensive bibasalar interstitial fibrosis. Changes are typical of asbestosis. asbestos exposure, and intrathoracic changes on their chest roentgeno grams consistent with asbestosis. In this communication we briefly detail our cases to alert our colleagues to this possible association. Report of Cases Case 1.-A 65-year-old man, with asbestosis (Fig 1) had been employed for 26 yean as an insulator in a naval yard. He had nii)i]liad lies pash irf ri[smhi pw da; far many yeafs, stopping three yean be fore admission. Progressive dyspnea, wheezing, and hoarseness prompted him to seek medical attention. On Nov 29, 1971, bronchoscopy performed in conjunction with biopsy disclosed epidermoid carci noma of the anterior commissure and right vocal cord. A total laryngectomy with radi cal neck dissection was performed, and postoperative radiation therapy was given from Dec 7,1971, through Jan 27,1972, for a total of 6,600 rads. He currently has no complaints. Case 2.-The patient was a 54-year-old man who had installed wiring in the cargo From the departments of radMogy (Drs. Libshitz and Wsrshba), internal medicine (Dr. Atkinson), and radiation therapy and nuclear medicine (Dr. SouthardX Thomas Jefferson Uni versity Hospital. Phladatptiia. Raprint rsquests to 11th and Walnut SL Phila delphia. PA 19107. JAMA. June 17. 1974 Vol 228. No 12 Larynx Carcinoma--Libshitz et al 1S71 DOW 05829 ST056672I7 Fig 2.--Posteroanterior roentgenogram ofehestof patient 2. Pleural thickening to present at lower lateral pleural surfaces (double arrows). Pleural calcification to seen at left bemldiaphragm (single arrow). . Fig 3.--Poateroanterior roentgenogram ofehestof patient 3. Pleural thickening (double arrows) is present at lower lateral pleural surfaces. Calcification of both diaphragmatic ; pleurae is seen (single arrow). yean ago. Investigation of gradually in creasing hoarseness prompted laryngos copy and biopsy of the right vocal cord, which showed moderately well-differ entiated eipdermoid carcinoma. A chest roentgenogram at that time demonstrated changes consistent with asbestosis.(Fig 3). " Radiation therapy, to the larynx over a seven-week interval totaled 6,580 rads. He u well 15 months after therapy. Comment . Selikoff and co-workers' investi gated 632 asbestos workers in the New York-New Jersey area who had beenexpoeed before 1942. Since their study was done in 1964, a 20-year pe riod was ensured between time of ex-, posure and the study. Of 255 deaths, 45, were from pulmonary carcinoma, ihree from pleural mesothelioma, one from peritoneal mesothelioma, and 29 from gastrointestinal cancers. Vigliani and co-workers1 in a report in 1965 of pulmonary malignant neo plasms associated with asbestoeis re ported one .case o/ducinoma of the larynx. Of the' 19 respiratory tract malignant' neoplasms reported, 15 were1 of the lung and three of the pleura.- Stell and McGill' in a recent report . (1973) of 100 patients with carcinoma of the head and neck, noted 59 cases of carcinoma of the larynx, 17 of whom had a history of asbestos expo sure. No: mention was'made of evi dence ofintrathoracicmanifestations' of asbestoeis. , It is difficult to ascertain the pre cise causative role, if any, of asbestosis as a factor in laryngeal carcinoma in our patients. All three patients in thiareport smoked cigarets heavily. The possibility of a synergistic effect of both cigaret smoking and asbestos exposure is en tertained. i the possibility ofanAssociation be tween carrinomaof the larynx and asbeetosis is suspected. We would ap preciate receiving comments and ad ditional case material, or would share; our case material, to Anther docu ment this possible association. 1S72 JAMA, June 17. 1974 Vol 226, No 12 l Mikoff U, Chug I, Hammood EC: A*bootoo oxpoooro and noophoia JAMA 18822-26, 1964 1 YlgBanl BC.MotaamO, Muiiiwm P: Amoelation ttf pulmmury turnon with oobwtooii iu Piedmont-and Lombardy: AnnNY Acad Sei 182268-6741966. . 1 StaD Flf. MeGm T: Aobootoo tad cancer of hoad ohd aodk. Lanctt L-678,1972. Larynx Carcinoma-Ubehits at al DOW 05830