Document RjGZLXRMJJa70BKbExpXEnOaV

February 1970 ASBESTOSIS AND HEMATOPOIETIC TUMORS 205 ie per 100.ml l tenderri'es| iver the le graphic el| m of several! and lympf! e contain ! days aftgfj tained modi and anthraSj emphysemiM e right vej : diaphragm^ dense hya-4$ d extensive-, lirly mature^ eloma withal 2) pulmo-: I ous emphy^ll iphragmaticifjf ventricle of an occupa:s*|t (phosphate)^;. an asbestostgf productive;^ kness, and\|^ a cliscloseqUl signs in the||| ullness, s of breaths Kinds. The hemoglobin was 10 Gm. per 100 hematocrit 32%, leukocyte count 5,400 ith a normal differential. The sedimentation |:te was 28 mm. per hr. Urinalysis revealed Moderate proteinuria and pyuria. Other labora ry tests disclosed no abnormalities. ^Roentgenogram of the chest showed atelecKrsis of the right middle lobe and base of the |ght upper lobe. Bronchoscopy revealed a fjjhor at the orifice of the right-upper-lobe Bronchus. Biopsy disclosed highly anaplastic Epidermoid carcinoma. The tumor was regarded ^ inoperable. The patient died four months ffter admission. t Autopsy findings. The parietal pleura con fined numerous hyaline plaques bilaterally. There was a fist-size tumor in the area of the jjilus of the right lung, causing partial obstrucJftion of the right main bronchus. Histologic ptudy confirmed the biopsy findings of a highly anaplastic epidermoid carcinoma. Disseminated Ifibrosis containing asbestos bodies was found in f|he pulmonary tissue. The right ventricle was Ihypertrophied. The liver weighed 1,270 Gm. pficroscopically, the portal fields were found to pontain diffuse plasma-cell infiltration. The ppleen weighed 100 Gm. Microscopically, the ifsplenic trabeculae and blood vessels were found Ito be infiltrated diffusely by large numbers of ffiplasma cells. Much hemosiderosis was' present. ||Both adrenals contained scattered nodules of Fmetastatic carcinoma. The kidneys appeared unEyremarkable grossly. Microscopic examination ^'disclosed dense deposits of plasma cells within fe'the stroma and hyaline alteration of the media :of veins, suggestive of amyloid. The bone marprow was partially replaced by compact homot';geneous infiltrations of plasma cells. Final diagnoses: 1) anaplastic epidermoid carJicirioma of the right main bronchus with meJStastases to both adrenal glands; 2) plasma-cell pimyelomatosis with diffuse infiltration of bone a.';marrow, liver, spleen and kidneys*; 3) pulmojp-nary asbestosis with pleural plaque formation; fet4) hypertrophy of the right ventricle of the f&hcart. jyCase 3 A 58-year-olcl Caucasian, male, bank clerk had |a history of gouty arthritis, proved histologically i; in 1962. In 1965 he was admitted to the hos pital because of progressive mental confusion, j-severe left temporal headache, and attacks of syncope. The liver was palpable 10 cm. below * Confirmed by S. E. Mooltcn, M.D., New Bruns wick, N. J. the costal, margin. Neurologic examination showed right hemiparesis. Laboratory tests gave essentially normal results except for elevated blood uric acid (11 mg. per 100 ml.) and a weakly positive Latex test for rheumatoid fac tor. A brain tumor was suspected and proved by cerebral arteriography. Craniotomy was per formed and a hemorrhagic, partly-necrotic tu mor was excised from the left frontal lobe. Microscopic examination indicated a poorlydifferentiated microglioma (reticulum-cell sar coma). Eight days postoperatively the patient died. Autopsy findings. Remnants of the left fron tal lobe of the cerebrum contained an infiltrat ing tumor composed of medium-sized cells with large round, oval, or lobulated, hyperchromatic nuclei, occasionally having giant-cell character istics, and minimal cytoplasm. The neoplastic cells were clustered most densely about blood vessels. The adrenal glands were markedly en larged, weighing 36 and 42 Gm., and the cells in them had been almost totally replaced by tumor cells identical to those in the brain, which had infiltrated freely into the surround ing adipose tissue. The liver weighed 2,560 Gm., showing on section pale brown-tan parenchyma with somewhat obscured lobular architecture. Histologic examination disclosed extensive infil tration of the portal fields and adjacent paren chyma by proliferating myeloblasts, myelocytes, granulocytes, plasma cells, and lymphocytes. The spleen weighed 1,140 Gm., and contained hyper plasia of the reticulum framework and wide spread myeloid metaplasia including mega karyocytes and myeloblasts. The endothelium of the large veins had been replaced by leu kemic cells. The vertebral bone marrow was hypercellular, with a cell-fat ratio of approxi mately 5:1, and contained an abundance of large atypical megakaryocytes and many primi tive cells resmbling myeloblasts. There were scattered areas of early fibrosis. Examination of the lungs showed severe chronic bronchitis and patchy interstitial fibrosis containing occasional asbestos bodies accompanied by much anthracotic pigment. The leaves of the diaphragm and the parietal surfaces of both pleural cavities posteriorly were covered with extremely hard, gray-white plaques of avascular hyaline scar tissue. Final diagnoses: 1) a myeloproliferative dis order involving the liver, spleen, and bone mar row t; 2) reticulum-cell sarcoma with massive involvement of the brain and adrenals t; 3) f Confirmed by AFIP, kindness of Dr. Bruce H. Smith (Captain USN).