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FILE NAME Brakes BRK DATE 1979 Aug DOC BRK074 DOCUMENT DESCRIPTION Journal Article - Associated Neoplasms - American Journal of Medicine Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms Neoplasms of of of of Lineage Lineage Lineage Lineage . fl x * ytd To i} Lo a uy , of D 534717 Gnd Tos t a te pooh seat Medicine Medicine the tog eye son of hematol hematol : . PHA Was Tri- pont Ston DC JULF terne Md PE South a , eo anton Ja and Reques Reques SP ae * fa ) " insent t 270 GeorgetoaT GeorgetoaT SOE rea Dent San ON AN OU shingtor 2) Three different neoplasms of Rice'l lincage lincage chronic lumpbac + leukemia immunoglobuia myeloma and immunoglobul G IgG myeloma were detected in three patients who ha,,bezus occupational exposure to asbestos dust Two of era en ned coexistent pulmonary asbestosis whereas the third patient beca pleural mesothelioma subsequent to his initial presentation with myeloma Defective mediated immunity and speractivity of cell function have previously been noted in patiers with eshectasis eshectasis We suggest the possibility that these ach y tag Ye liferative and lymphoproliferative neoplasms immunoprimemunospres imunopres since such traners have been observed in variety of other s characteri " [ protracted hyperactivity of the immune sys e Exposure asbestos asbestos dust ba br Joc ey ce tod Paar roan cariety of malignancies malignancies at cause relationship relationship has be " fof ge eestor Niner, tb USP : sey malignant mesotheliomas mesotheliomas ei 1 PLOU 9 increasing CVR het esas tebe the subsequent development development development oth ot } ayt ryan, oasht neni cae the fen Ppa bo ge 108 There have been trot Cd. Pyar etween etween achostas achostas prasg ' aah pas See P apts to, sre dine] rn System However m the pistes en sre fitter dermented there has Jeep a sen 1 arr ed syn Interative and sataunoproliferative non sms The berech berech - cinded lymphor tre n phoma phoma ) chempionate chempionate chempionate leg Adonstion meloma 168 H and Addonstion Addonstion dar rogleter peche report three cast inschiinschic ch inh schich inschich shoes NOS te a at cell lineage tone case of choric lymp lymp lymp cote NEL POPHILE tes of plas~-naraveloma found CASE REPORTS Case Clure of 12 The patien a dobye ated, P the Johatn ye. kapal~- kapal~- } Tie 8 , ppt 6 arr de ate bee bo ae SPSS of asbestos asbestos TE hit | psthe oS Peo at ground for approxamater three years tn i mine the Transvaal Transvaal S prospect Sty Fass rest eep had been beats n Since * bt wt te } mine The " sn beet yt vip oe bye gta variops gorden nes in South South yt 440am ate a his refertachree fertas ches +> teh ba oboptbet wath streptonceisn SOBEZPE SOBEZPE anes tue sae de yal H - August 1979 The American Journal Medicine Volume Volume 67 2 ASSOCIATED NEOPLASMS ET AL enced progressive dyspnea on effort and a chronic cough productive of mucoid sputum Physical examination disclosed no cyanosis or clubbing but decreased air entry was evident bilaterally affecting the left side predominantly Rales were present in the left zone and left basal regions There was no cardiomegaly or congestive heart failure and no bone tenderness hepatosplenome- galy or lymphadenopathy were noted A roentgenograph of the chest demonstrated bilateral reticulonodular infiltrates involving the lower lobes of both lungs and perihilar regions The horizontal and oblique fissures on the right side were thickened and blunting of the left costophrenic angle was noted Figure 1 There was also pleural thickening along the diaphragmatic surface These findings were consistent with healed tuberculosis asbestos pleural thickening and parenchymal asbestosis A roentgenographic skeletal survey did not reveal any osteolytic lesions low not ma bes tos 1 ron! Figure 1. Case 1. Chest roentgenogram demonstrating obliteration of the left costophrenic angle as well as thickening of the right horizontal and oblique fissures Bilateral reticulonodular infiltrates are noted in lower lobes of both lungs Arterial blood gas analysis showed an oxygen tension pO2 of 52.5 mm Hg a carbon dioxide tension pCO2 of 35.5 mm Hg a pH of 7.38 and a blood oxygen saturation of 85 per cent The blood urea nitrogen was 12 mg and the serum calcium 9.0 mg The hemoglobin level was 16.9 dl the hematocrit value 50.7 per cent the white cell count 7,700 69 per cent segmented neutrophils 25 per cent lymphocytes 5 per cent monocytes and 1 per cent eosinophils and the platelet count 155,000 The erythrocyte sedimentation rate was 55 mm hour The total protein was 8.6 dl with 3.9 dl of albumin A prominent serum M component was detected measuring 2.7 dl The serum immunoglobulin A IgA measured 2,972 ml immunoglobulin G IgG 145 ml immunoglobulin M IgM 163 IU and immunoglobulin E IgE 900 ml Bence Jones protein was not detected on electrophoretic analysis of the urine The patient's serum was positive for rheumatoid factor by the latex fixation test 12 titer 1280 A bone marrow aspirate revealed 20 per cent plasma cells including numerous atypical and immature forms The mor- phologic features of the bone marrow aspirate in association with an abnormal serum IgA component were consistent with a diagnosis of IgA myeloma Case 2. The patient was a 61 year old white man who pre- sented in July 1975 for assessment of asbestos pulmo- nary disability He had worked in the mining industry in Southern Africa almost continually since the age of 20. After x abbas approximately 13 years as a gold miner the patient was sub- sequently employed for 28 years as an asbestos milling su- pervisor at a chrysotile asbestos mine in Swaziland He al exposed mainly to chrysotile fibers although he also was HI vised the mixing of chrysotile and crocidolite asbestos fsourpetrh-e a manufacture of insulation materials For five years during this ABS period he also sustained heavy intermittent exposure to cro- cidolite and amoiteasbestos while assisting in the dismantling gt and reconstruction of asbestos mills in South Africa The pa- tient smoked about 20 cigarettes daily for 40 years and had a cough productive of mucoid sputum and dyspnea on mild exertion Figure 2 Case 2. Chest roentgenogram right anterior oblique view demonstrating pleural thickening and plaque formation Physical examination revealed no cyanosis or clubbing Cardiovascular examination was within normal limits The chest was shaped and on auscultation diminished air entry and bilateral basilar crepitant rales were heard There was no hepatosplenomegaly or lymphadenopathy 326 August 1979 The American Journal of Medicine Volume 67 eee ASSOCIATED NEOPLASMS ET AL Chest films revealed bilateral fine linear opacities in the lower lobes of the lungs Bilateral pleural thickening was also noted with pleural plaques evident along the lateral costal margins Figure 2 These findings were consistent with asrelated pleural thickening and parenchymal asbes- tosis The hemoglobin level was 16.1 dl the hematocrit value 45.2 per cent the white cell count 30,400 79 per cent lymphocytes 19 per cent segmented neutrophils and 2 per cent monocytes and the platelet count 235,000 As aspirate of bone marrow showed replacement by small lymphocytes The serum total protein was 6.9 dl with 4.3 dl of albumin The serum IgA measured 58 ml IgG 98 IU IgM 39 ml and IgE 100 IU No ferruginous bodies or malignant cells were detected in the sputum The morphologic features of the peripheral blood and bone marrow were consistent with a diagnosis of chronic lymphocytic leukemia The B cell nature of the leukemia was illustrated by the large proportion 76 per cent of surface IgMpositive lymphocytes in the peripheral blood as shown by immunofluorescence 11 The percentage of circulating T cells as determined by spontaneous rosetting with sheep erythrocytes 12 was correspondingly reduced 12 per cent Case 3. The patient was a 71 year old white man who was hospitalized in Washington D.C. in March 1977 because of severe low back pain He had experienced heavy exposure to chrysotile asbestos for 25 years through the daily installation of brake lining in automobiles Physical examination disclosed mild pallor and bone tenderness over the upper lumbar ver- tebral area Roentgenograms of the spinal column demon- i strated generalized osteoporosis and collapse of the eighth & t s thoracic and the first and second lumbar vertebral bodies 4 fe Chest roentgenograms revealed normal lung parenchyma and 7 pleura Osteolytic lesions were present in multiple ribs in the oe left scapula and in the right humerus Figure 3A The hemoglobin level was 8.6 dl the hematocrit value 26.8 per cent the white cell count 5,100 the platelet count 230,000 and the reticulocyte count 1.1 per cent A. differ- ential leukocyte count 5 showed per cent band forms 34 per cent segmented neutrophils 42 per cent lymphocytes 3 per cent basophils and 16 per cent monocytes The peripheral formation blood smear showed prominent red cell rouleaux The blood urea nitrogen was 25 mg serum creatinine 1.3 mg uric acid 11.0 mg calcium 9.3 mg and serum total protein 11.2 dl with 3.4 dl of albumin Serum protein electrophoresis showed a monoclonal spike in the gamma fraction with an M component of 6.0 dl The serum IgG measured 893 ml IgA 27 ml and IgM 22 ml Serum Figure 3. Case 3. Chest roentgenogram A film obtained in November 1977 demonstrates pleural thickening on the right An osteolytic lesion is evident in the upper right hu- merus B film obtained on admission in February 1978 a demonstrates pleural effusion on the right side immunoelectrophoresis showed an abnormal heavy arc of IgG kappa type No Bence Jones proteinuria was demonstrated A bone marrow aspirate and biopsy revealed sheets of plasma cells with numerous immature forms A diagnosis of IgG myeloma was made Treatment was begun with intermittent melphalan and prednisone where- upon symptoms of bone pain subsided Serum protein electrophoresis four months later showed the monoclonal spike had decreased to 3.1 dl The patient was readmitted in February 1978 because of increasing sided chest pain and progressive dyspnea Examination revealed tachypnea and absence of breath sounds in the lower half of the right lung A repeat chest roentgenogram Figure 3B revealed a moderate pleural effusion on the right side Computerized thoracic tomography confirmed the right pleural effusion together with multiple subpleural masses and a nodule on the right pericardial sur- face An exploratory thoracotomy revealed 300 ml of sangui- neous pleural fluid and multiple tumor implants of various sizes were found on the diaphragm as well as the parietal and visceral pleura Histopathologic examination of the tumors showed the features of an epithelial variety of malignant mesothelioma Figure 4 Ferruginous bodies were not ob- August 1979 The American Journal of Medicine Volume 67 327 7 ~ - - a . - ae . ~ ~ ~ _* . 7 7 ~ ON toe - v 7 7 - . he a . . - : Figure 4 Case 3 Bio specimen of a thoracic tumor nodule demonstrating demonstrating chal type of malignant mesothelioma Acinar spaces lined by flattened Solumnar Solumnar or cuboidal epithelium are surrounded by fibrocellular strom Hera- toxvin and cosin stain magnification magnification X 250 reduced by 35 per cent ee ee ee Hhese twa homhap tangas v7 {{ ' , oe HOW categ UPYT " dune fae qoenen par ie, , THe Mas ys Porn Te a oo ter 4 Sati pap Se Pp 114 hos ; Pe ore Cahesange sn tne ue pope Seah hppa pre ores alta ~>000 tae bron bron mop boaest ) CAE EL bona tespre up tipo plus vel 3) 10 29 bod abzzed pat osis6 Lichen detected Canny ate loquinu jo ase PROSSp PROSSp AL fy susppdood oa : mali SOD que'nt. fyeren Shas Do pas eae boa ay fe peer ut 13.1 autopsies "| die tastapers POICAC TQ sape negra tan et atop , af BEG H ISOIX 10. Syste sup ATO OST Jo Cases ashestosds Cheunedde tye 0 t phe Stocup 1 a. mon ali Pere ' BARS fl , " op pue Mery oe heteds sasor pup associated nem tologic neoplastS 1 pano O j HE REPORT Total bays gn. per over of Hancrience such tumors in in the OTE Aadae Pose Used foe thber apsosite ! 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