Document LKvR04KgYXX8R5RVNmXDJwk7q

. S&T'X I. .. s a"..- , I LJ Mye oid Metaplasia as U a Result of Chronic Benzene Iritoxication MUR RAY PORT, M.D. New York City JULIAN 8. HYMAN, M.D. New York City Frcn the Deprrhcnt of Ifilernsl Medicine, I;aw Ycrk Pc!yclinic Mcdicel School and Hospilal Clinoslc ExwxwitY t o tlre iirilalatiotr of benzene (benzol) haqiieiitly remlts in depression of oiic or iiioro olcmeiits of the bone marrow.'+t The period of ex- poriure necessary to produce this e1Tect varies from individual t.o individual. T h e tinie iniervnl between exposure and the production ;and clinical recognition of bone innrrow elasmetits may difftr coneiderr\bly. There may be occmnsionnl stiuiulatioii of the bone marrow wibh the prcsmcc of R lcuko- cytasis prior to t.he appearttnce of the da- prcsssion. T n severnl jirstaiisefi acute. leu- kemia has occurred moiiy yenrs after benzene One patient BS- to benzene for t.h:irtteen years dc- veloped MI agltwt,ic anemia from which he recovered. Fifteen yeare after recovery he developed ncute Isukemie.5 The develop, moiit of myeloid nietsgkzia a conse-. quei1c.e of exposure to chronic betizcne in- toxication is known,"-' but the cases re- ported in the literature are few in number. Other niniiifestations such a8 aplastic mernin, leukopenia, nnd !rukainia nre more frequent!y observed. Siiice beiviene intoxicat.ion m a y still represent a problem in certain industries, we are presenting this unusunl additiotisl cam of iiiyeloid metaplasia resulting frorn - 4chronic benzene intoxicdun. Tho patient WRS asymptomatic, nnd the disenr;e waa recognized only a t the time of ai1 acute% condit.ion necessitating operation. d: ;.115 Case report A fifty-yenr-old Negro wornall. cnhr the New York Polyclinic Hospital September 11, 1963, with a diagiioeis right inguinal lreriiia that lind 6udde bccoino paiiiful on the day of admissi She had nlwaye enjoyed good hen1t.h cept for hyt&rektomy iir 1545. She b worked continuoudy AS .p l i ~ t i d pre in c;everRl cleaning factories i n Georgin a period o f thirty p a r s niid had been sub jccted to chronic .inhalation of &mini fluids containing bciizene (benzol) iit poorly veiitilnted estnblishruents.c*v She had con.-. tinued to work in cleaning factories three weeks before adrnlsion. up t...o g When examined in tlre emergency r o o k g of New York Polycliiiic Hospital she corn-..-, ylained of severe pain in the right goin. 2She WRL) admit.ted to the surgical wrvicu,: kR t i d an emergelicy right itiguitisl hemior-,% .:&rhaphy W88 ~xrfortned. On adnijsion tliq pnticnt's blood pres- sure was 160/$G inm. of merciiry, her pd- throat \vas Tho heart revealed tlie Grnde I11 systolic murmur at the region propagated slightly to abdomen W ~ Hsoit and nontender. liver was smooth. tiontender, and 4 cm. below the right costnl spleen was felt 6 to 8 cm. below the l e f t s costal margin. fluctuant mass, There easily r was" a educibl firm, e, and ntoenn-.--, s5 der to touch in the right inguind region= The rectal and vaginal examinations showed; negative results. The adrnittillg herno- 4:. globin w m 10.2 Gm.per 100 mi..IiernatOC~t- 33, with 11,250 white blood cells, 77 HP mented neutrophils, 22 lymphocytes, dad X eorjinoghil per cubic millimeter of b l o d The orytlirocyte scrdimeiitntion rcrte 24 mm. per hour (Westcrgron), tho f d h g 3.blood sugar was 124 mg. per 100 d., blood urea nitrogen 9 mg. per 100 d @ L cr .i I ! z FIGURE 1. Section of liver tiSSUe showing focel Breas of txtramedulfary hematopoiesis. (A) tow.povrer megnificetion. ( 8 )Higher magnification. (Hematoxylin and Eosin Stain) '. i a t s r the riglit inguinal herniorrhaphy, was performed. T h e report of this study the pztisnt ' ~ 3 strnnefcrred t o the medical shOw*cd a well-preserved architecture in *mice becaurn of the findings of ancniia the section of liver tissue. There were focal wid ~Jegatoglcnome~aly. The patient ::a=. was quest.ioncd again about hcr past history without nny additional information areas <*it11 sinusoidal dilatation and iiccuuiulation 'of immature henratoyoietic cells including megakaryocytes within the -J..k i n g ol>tsined. She denied any known sinusoidal spnce. The interpretotion of :j; hematologk disease. in J w family or in her the wct-ion was liver tissue consistent w i t h 1- . ' own past lhtorj'. She denied any alcohol 4.or drug infakc. She ngain emphasiad .'ithe fact that she had alwaya worked in the myeloproliferative dieorder (Fig. I). A bone marrow aspiration was performed on Qct.obw 3, 1963. There was diminished :$ aunt type of ~ t m o s p b r e.,"alwayg breath- cslluhrity t.hroughout the marrow with $'ins in the =me mrn that had the smcll increnwd fat present. The erythroid ?of cheniicals mid benzene." striee was roveaied to be undergoing normo- .2 Additional hczn8tologic study yielded bkstic maturstion. The myeloid series 5 the following results: the mean corpuscular ;..;Y-idvoolbuinme 3w1asm1i0c0rocmuibcircogmraicmrosn, s,retthiceuhloecmyotc- revealed a distinct shift to the laft with an hicream in prornyelocytea suggesting 8 maturation arrest. No foreign cells were JcOunt 2 per cent, and the pIatelet count seen. The megakaryocytes were diminished '* 3'76,000 per cubic milliinek'r. The p r i p h - in rrurnber. T h e bone marrow was inkr- feral w e a r revealed slight hypochromia, preted a$ being hypoplastic and compatible 5,moderate aniuoc.ytQsis,poikiIoc.ytosis,many with a diagno~ieof inyeloid metaplasia. $macrocytes, and a few tnrget ceb. T h e -.c:%sicklscell and lupus erythematosus prep- k.$amt.;ons showed negRtivo results. Liver i ' x b c t i o n st.udies st&ed the follo\ving: Comment The prcsenhtion of thio case is of in- !: the prothrombin t h e was sixteen seconds terest for severnl reamne. As stated in the wrum bilirubin introduction it re.emphaeizes the yotantial The smxu at- danger of the inhalation of a toxin which way less than 4 Eo- may produce marrow hypoplasia or aplasia. the cephalin flocculation I plus Benzene, sometimes cdled benzol, haG been hours, thymol turbidity used e x t e d v e l y in industry bemuso of its serum proteins 7 Gm. per solvent property for rubber, gums, resins, with 4.5 Gin. of nlbumin and 2.6 and fats. It js not to. be confused with oi globulin, cholesterol 214 mg. per benzine, a mixture of short-changed ali- ml., transarninaw (SGOT) 16 units. phatic hydrocarbons. EulfobromoirhthRlcirr 6 per cent re-' Also of importance is the relationhhip in forty-five minutes. The Serum between the dweloprnent of myeloid meta- plasia and chronic benzol intoxication. Mg-eloid metaplasia QCCUrS frequently September 1. 1965 / New York State Journal of Medicine 2261 ~~ ~~~~ ~~ I i I! I ... li .; I i i I I .i in arsodntjon with !o1Ig-$tanding polycy- tJremin vcril."J It is clafisifiad as one of the grauf>of ~npeloprc>liferativedisorders. 1 1 It is comidcred to be a compensatory mccllanism on the part of the reticuloendothelial system to raplacc the function of R failing or exhausted marrow with extramedullsry production of all the marrow elemIents. Othcr diseases in which maturation nrrest o r excessive marrow function liavc rasuited in nisrrow failure have also bcen associated with myeloid metapIrisin. One of us recontIy saw 3 severe case of untreated pernicious anemia in which SI liver biapsy revealcd extc?rit+iivemyclaid xneta. plash prior t.0 therapy with vitainin B12I. t appcsrs tkaL myeloid metaplasin may develop 8s a reaponso to long-standing depression of the inarrow due to chronic intoxication or chronic ovcractivity. Summasy A case of chronic exposure to benzol with deve1vpment of myeloid metaplasia is .. . .. Tips on bathroom safety Don't s l i p u p nii buthroom safoty, mya a rccant issue of Tochy'r Hrafth, thu magaaiire of the American Medical Aosncinbion. T h e magazine givta the fcd.h+tg poiaterr on bathroom SRfeLy: IJse siiction-typw ha111 mats or lion-dip s~n'p3 in t ~ J GSild sho\vi.i* S L ~ U S . Install wall-mount& grab bars or hand rails nenr showarn a d tube. Use skid-proof mnts on the bnthroom floor. 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