Document V4jRgRG0GgYaZ6KB968GXe4Z
CHEST Official publication of the American C ollege of Chest Physicians
Presence of asbestos bodies in organs other than the lung.
O Auerbach, A S Conston, L Garfinkel, V R Parks, H D Kaslow and E C Hammond Chest 1980;77;133-137 DOI 10.1378/chest.77.2.133 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/77/2/133
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1980by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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CLINICAL INVESTIGATIONS
Presence of Asbestos Bodies in Organs
Other than the Lung*
Oscar Auerbach, M.D., F.C.C.P.;** Alfred S. Conston, M.D.;f Lawrence Garfinkel, Mi.;| Verta R. Parks, B.S.; Haven D. Kaslow, B.S.;| | and E. Cuyler Hammond, Sc.D.fl
This study was designed to test the hypothesis that subjects with many asbestos bodies in their lungs at autopsy would also have asbestos bodies in various other organs. The subjects included 19 cases with diagnosis of asbestosis at death (two of these had mesothelioma, five had lung cancer) and 18 with pleural plaques but not asbestosis. Occupational his tories were obtained from relatives. In subjects occu pationally exposed to asbestos, large numbers of
asbestos bodies were found in the lungs, and in most of these, asbestos bodies were found in many of the other organs examined. In the 18 cases with only pleural plaques found at autopsy, considerably fewer asbestos bodies were found in the lungs. The number of other organs with one or more asbestos bodies ranged from 32 percent to 62 percent of the sites examined. The findings seem to confirm the hypothesis of the study.
hen asbestos fibers are inhaled, some of those
which are entrapped in the lungs become
coated, by biological processes, with a material con
taining iron. These coated fibers have a unique ap-
For editorial comment, see page 129
pearance under the microscope. Unlike some or
ganic materials with which they might be confused, they are resistant to ashing, as well as to digestion by mild alkaline hydrolysis. These coated fibers are usually called asbestos bodies; the more general
term, "ferruginous bodies," is sometimes preferred
because objects of similar appearance can be formed
by the biological coating of certain other types of
mineral fibers.1*2
*From the Veterans Administration Medical Center, East Orange, NJ; the Department of Pathology, Somerset Medi cal Center, Somerville, NJ; and the Department of Epide miology and Statistics, American Cancer Society, Inc., New York. Distinguished Physician, Veterans Administration Medical Center, and Professor of Pathology, College of Medicine and Dentis cy of New Jersey, New Jersey Medical School, Newark. fDirector of Laboratories, Somerset Medical Center, and Clinical Associate Professor of Pathology, College of Medi cine and Dentistry of New Jersey, Rutgers Medical School, Piscataway, NJ. {Assistant Vice President, Department of Epidemiology and Statistics. Research Biologist, SMI Laboratory, Veterans Administra tion Medical Center. 11 Research Biochemist and Consultant, Department of Epidemiology and Statistics. IfVice President, Department of Epidemiology and Statistics. Manuscript received March 28; revision accepted May 8 Reprint requests: Dr. Auerbach, VA Medical Center, 151B, East Orange, New Jersey 07019
CHEST, 77: 2, FEBRUARY, 1980
Until recently, little attention has been given to the possibility that asbestos bodies might be present in locations other than the lungs. We became alerted to this possibility when we found one embedded in a tumor of the brain; at scientific meetings, several investigalors have reported verbally that they have found asbestos bodies in other organs. Godwin and Jagatic3 reported that they found asbestos bodies in mediastinal lymph nodes, spleen, and small in testines!.
The purpose of this study was to ascertain whether persons with a great many asbestos bodies in their lungs are likely to have asbestos bodies in various other organs. As it turned out, some of our subjects did not have many asbestos bodies in the specimens of pulmonary tissue which we examined.
Materials and Methods
Our plan was to confine the study to autopsies of persons whose lungs were likely to contain a large number of asbestos bodies. With this in mind, we reviewed the records of aU autopsies performed by one of us (A.S.C.) at Somerset Medi cal Center, Somerville, NJ, during 1970 and selected all of the cases in which asbestosis or mesothelioma had been recorded in the final diagnosis. Since many people in the area worked in an asbestos factory (and asbestos workers often develop pleural plaques), we also selected all cases in which pleural plaques had been recorded. A total of 37 such cases were found (34 men and three women). Asbestosis was recorded in 19 of the subjects, and all of these also had pleural plaques; two of these subjects died of mesothelioma, and five of them died of cancer of die lung. Pleural plaques but neither asbestosis nor mesothelioma were recorded in the
ASBESTOS BODIES IN ORGANS OTHER THAN LUNG 133
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Table 2--Asbestos Bodies Found in Nine Different Organs in Relation to Number Found in Small Specimen of Pulmonary Tissue
Group and
Organ
with Tissue Avail
able
No. of No. of Asbestos Bodies
.a
with 1+ Total Asbestos Defi- Mean Maximum
Bodies nite No. per per (percent) Bodies Subject Subject
All subjects (n -- 37) Kidney Heart Liver Spleen Adrenals Pancreas Brain Prostate Thyroid
TMTC in pulmonary tissue
(n-12)** Kidney Heart Liver Spleen Adrenals Pancreas Brain Prostate Thyroid
>100 Bodies in pulmonary tissue
(n-15)t
Kidney Heart Liver Spleen Adrenals Pancreas Brain Prostate Thyroid <100 Bodies in pulmonary tissue (n-10) Kidney Heart Liver Spleen Adrenals Pancreas Brain Prostate Thyroid
37 36 35 34 33 30 22 14
6
12 11 12 9 12 9 4
5 4
15 15 13 15 13 13 11
6
2
10 10 10 10 8 8 7
3 0
14 (38) 13 (36) 16 (46) 21 (62) 16 (48) 14 (47) 5 (23)
6 (43) 6(100)
132 218
84 660* 178 272
30 42 517*
3.6 6.1 2.4 19.4 5.4 9.1 1.4 3.0 86.2
9 (75) 7 (64) 9 (75) 9(100) 10 (83) 9(100) 3 (75) 5(100) 4(100)
122 204
70 469* 123 246
24 41 370*
10.2 18.6 5.8 52.1 10.3 27.3 6.0
8.2 92.5
3 (20) 5 (33) 5 (38) 10 (67) 5 (38) 5 (38)
1 (9) 1 (17) 2(100)
5 12 11 187 26 26 2
1 147
0.3 0.8 0.9 12.5 2.0 2.0 0.2 0.2 73.5
2 (20) 1 GO) 2 (20) 2 (20)
1 (12) 0
1 (14) 0 0
5 2 3 4 29 0 4 0 0
0.5 0.2 0.3 0.4 3.6 0 0.6 0 0
82 88 26 >100 29 116 20 12 >100
82 88 26 >100 25 116 20 12 >100
2 4 4 47 14 14 4 1 134
4 2 2 2 29 0 2 0 0
*In one specimen of spleen and two of thyroid, more than 100 asbestos bodies were found, but exact number could not be determined. We have arbitrarily assumed that 150 were present. **TMTC, Too many to count (asbestos bodies). fDoes not include specimens showing TMTC.
136 AUERBACH ET AL
whom less than 100 definite asbestos bodies had been found in the slide prepared from pulmonary tissue. The number of asbestos bodies refers to "def inite" asbestos bodies only; objects described as "probable" asbestos bodies are not included in this table.
As shown in the first part of Table 2, the propor tion of slides with one or more definite asbestos bodies varied from six out of six (thyroid) down to five out of 22 (brain). In the six organs for which 30 to 37 specimens were available, from 38 percent (14/37) to 62 percent (21/34) of the slides had one or more asbestos bodies. We were very surprised at how many asbestos bodies were found on some of the slides; for example, 88 were found on one slide prepared from the heart, and more than 100 were found on one slide prepared from the spleen.
The last three parts of Table 2 show that there was a definite relationship between the number of asbestos bodies found in pulmonary tissue and the number found in tissue from other organs. That is to say, far more asbestos bodies were found in other organs when a very large number (TMTC) were found in the pulmonary specimen than when rela tively few were found.
The fourth part of Table 2 is confined to the ten subjects described in Table 1. They had pleural plaques but neither asbestosis nor mesothelioma; and only 48 or fewer definite asbestos bodies were found in slides prepared from pulmonary tissue. From interviews, it appears that three had had some occupational exposure to asbestos dust; and perhaps a fourth (the auto mechanic) had repaired asbestos brake linings. For the remaining six subjects, inter views provided no evidence of exposure to asbestos dust. At least for these six subjects, it seems very unlikely that the lesions described as pleural plaques (because of their gross appearance at autopsy) were caused by asbestos. Furthermore, in the absence of proof of exposure to asbestos dust (and by lightmicroscopic examination alone), it is impossible to say whether an object having the appearance of an asbestos body was formed about an asbestos fiber. Some of them may have been "ferruginous bodies" formed about a fiber of some other sort
As previously mentioned, a few specimens were included from each of several sites other than the nine organs listed in Table 2. Other tissues in which one or more asbestos bodies were found include mediastinal lymph nodes, bone, duodenum, stom ach, colon, omentum, and spinal cord.
The number of organs in which definite asbestos bodies are found depends in part upon how many and which organs are examined for asbestos bodies. This is taken into account in Table 3. Twenty-five
CHEST, 77: 2, FEBRUARY, 1980
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Presence of asbestos bodies in organs other than the lung. O Auerbach, A S Conston, L Garfinkel, V R Parks, H D Kaslow and E C Hammond
Chest 1980;77; 133-137 DOI 10.1378/chest.77.2.133 This information is current as of May 10, 2011
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