Document p2knBja9BZVOJxGnoD6OZ7zJw

FILE NAME: RT Vanderbilt (RTV) DATE: 1974 June 30 DOC#: RTV045 DOCUMENT DESCRIPTION: Autopsy of Ralph J. Brown Noting Death Related to His Work with Asbestos 9 M - 227 A 9 Name: Date and Time of Death: Date and Time of Autopsy: ROSW ELL PA RK MEMORIAL IN STITU TE AUTOPSY REPORT RALPH J . BROWN 66//3290//7744 @@ 59*;3300 AP,MM*. Chart Number: 131343 PAruotosepestyoiN?u*mber^AP"k1id1a3n5a4nd,MI 1 BRAIN The dura mater and the leptomeninges are smooth and unremarkable. The sagittal sinus and the cerebral arteries are patent. Serial coronal sections of the cerebrum show no evidence of softening, hemorrhage or any tumor. The ventricular system is patent and shows no dilatation. The cerebellum, pons and medulla are unremarkable. Representative, sections are taken and the rest is saved. 9 JOHN W. PICKREN, M.D. 9 Y7S/ 1/e8t/ 7 4 PER: t.patchidanand, M.D. 9 9 M - 227 A I Name: Date and Time of Death: Date and Time of Autopsy: ROSW ELL PARK MEMORIAL IN STITU TE AUTOPSY REPORT RALPH J. BROWN .....' 6/29/74 <? 5:30 P.M. 6/30/74 @ 9i30A.M. c A m ^t ` Chart Number: 13X343 = Autopsy Number: 11354 Prosector: Y. Satchidanand, MICROSCOPIC DESCRIPTION CARDIOVASCULAR SYSTEM . Section of the heart shows mild focal fibrosis. RESPIRATORY SYSTEM The lungs show thickening and edema of the pleura. There is infiltration by malignant lymphoma, composed of well-differentiated small lymphocytes. These cells are diffusely infiltrating the lung parenchyma. The adjacent lung shows thickening and fibrosis of the alveolar walls. The alveolar septae show large atypical cells. Several of the alveoli have asteroid bodies and ferunginous bodies. Elsewhere, the alveoli are filled with dense proteinaceous material. In addition, large areas of emphysema are noted. Considerable thickening of the smaller arterioles is seen. Large emphysematous I areas are seen. The main bronchus shows ulceration and infiltration by malignant lymphoma. DIGESTIVE SYSTEM Section of the esophagus shows mild dysplasia. There is submucosal edema and squamous metaplasia of the ducts. There are a few dilated vessels. These probably represent radiation changes. The stomach has a well-preserved mucosa. There is no lymphomatous infiltration. The small intestine is unremarkable. The liver shows mild fat-metamorphosis and mild lymphocytic infiltration of the portal areas. There is moderate degree of autolysis of pancreas. RETICULO-ENDOTHELIAL SYSTEM The section of the spleen shows chronic passive congestion. A single small lymph node shows infiltration by poorly differentiated lymphocytic lymphosarcoma. The vertebral marrow shows focal hypocellularity and multifocal infiltration by malignant lymphoma. The femoral marrow is hypercellular and shows erythroid hyperplasia. Mild degree of megakaryocytic hyperplasia is seen. 3MD0CRIHB SYSTEM The pituitary gland is unremarkable. The thyroid gland is composed of small and large follicles filled with colloid. The parathyroid gland is unremarkable. The adrenal glands have well preserved cortex and medulla. PRIMARY SYSTEM . Section of the right kidney shows metastatic malignant lymphoma infiltrating the parenchyma. The glomeruli are fairly well preserved. The tubules show autolytic changes. REPRODUCTIVE SYSTBt . The testicles have atrophia seminiferous tubules, and a few are hyalinized. The section of the prostate gland shows extensive autolysis. CECTRAL NERVOUS SYSTEM Sections of the hippocampus and cerebellum are unremarkable. RALPH J. BROWN 6/29/74 @ 5;30 P.M. 6/30/74 <? 9:30 A.M. Chart Number: 131343 A-11354 ' y. Satchidanand, M. D. FINAL SUMMARY ---- -- - -- At autopsy the lungs were found to be very heavy (right lung 1400 gms. and It. lung 1100 guts). Microscopic examination revealed very interesting features. Extensive fibrosis was noted, this could be attributed to the radiation this patii received for the malignant lymphoma. However9 thin patient is said to have worked' for many years in a talc factory. This explains the "ferunginous bodies'* and the 1 "asteroid bodies" seen in large numbers in the lungs. The "ferunginous body" also! known as the asbestos body is not specific for asbestosis. It is formed by a ! deposition of iron1 salts and protein on particles of asbestos. However, similar deposition is seen in cosmetic talc, aluminum silicate and glass fibers. Animal experiments have confirmed the above finding. Therefore, the fibrosis can be attributed to both radiation and lung exposure to talc. A fibrogenic impurity accompanying talc (hydrated magnesium silicate, is tremolite A mineral form of asbestos. Troolite is known to form asbestos like bodies and induce interstitial fibrosis. 3 3 3 3 1 3 3 9 9 9 9 9 9 9 9 9 9 9 RALPH J. BROWN 6/29/74 @ 5:30 P.M. 6/30/74 @ 9:30 A.M. Chare Number: 131343 A-11354 Y. Satchidanand, M. 0. FINAL ANATOMICAL DIAGNOSIS 1. Lymphocytic lymphosarcoma involving right lung, right hilar lymph nodes, and right kidney following lymphosarcoma of left cervical lymph nodes* TO8 M9623 2* Bilateral pulmonary congestion and extensive radiation fibrosis (right lung 1400 gms and left lung 1100 gms). T28 9320 3. Bilateral pulmonary talcosis, T28 M5602 4. Focal acute bronchopneumonia. T28 M4101 5. Bilateral pleural effusion, 300 cc each side. 6. Atherosclerosis of coronary arteries and aorta, moderate* 7. Arteriolar nephrosclerosis, mild. 8. Status post: a) Radiotheripy 3600 rads to left neck, 11/16/71 - 12/22/71* b) Chemotherapy - Vincristine and Cytoxan, April - September 1971. B8803, 8829, E8813 c) Chemotherapy with BCNU and Prednisone, September 1972. 8536 d) Chemotherapy with Adriamycin, March 1973* 8838 e) Chemotherapy - Methotrexate, (July 1973) Leukovoria, Ara-C, Cytoxan, and Vincristine. E8830, E8822 f) Radiation to whole chest (2100 rads, February 1974). MECHANISM OF DEATH RESPIRATORY INSUFFICIENCY DUE TO BILATERAL PULMONARY CONGESTION, EDEMA AND RADIATION FIBROSIS. JOHN W. FICKREN, M. D. YS:kb 4/3/75 9 9 9 9 9 9 ! i RALPH J. BROWN 6/29/74 <? 5:30 ?.M, 6/30/74 @ s9:30 A JL Chart Number: 131343 A - 11354 Y. Satchidanand, M. D. FINAL ANATOMICAL DIAGNOSIS 1. Lymphocytic lymphosarcoma involving right lung, right hilar lymph nodes, and right kidney following lymphosarcoma of left cervical lymph nodes. T08 M9623 2. Bilateral pulmonary congestion, and extensive radiation fibrosis (right lung 1400 gms and left lung 1100 gms). 128 E9320 3. Bilateral pulmonary talcosis. T28 M5602 4. Focal acute bronchopneumoaia. T28 M4101 5. Bilateral pleural effusion, 300 cc each side. 6. Atherosclerosis of coronary arteries and aorta, moderate. 7. Arteriolar nephrosclerosis, mild. 8. Status post: a) Radiotherapy 3600 rads to left neck, 11/16/71 - 12/22/71. b) Chemotherapy - Vincristine and Cytoxan, April - September 1971. E8803, E8829, E8813 c) Chemotherapy with BCNU and Prednisone, September 1972. E8536 d) Chemotherapy with Adriamycin, March 1973. E8838 e) Chemotherapy - Methotrexate, (July 1973) Leukovorin, Ara-C, Cytoxan, and Vincristine. E8830, E8822 ) Radiation to whole chest (2100 rads, February 1974). MECHANISM OF DEATH RESPIRATORY INSUFFICIENCY DOE TO BILATERAL FUIM0NARY CONGESTION, EDEMA AND RADIATION FIBROSIS. JOHN W. PICKREN, M. D. CHIHF OF.P$fH0L0GY YS:kb 4/3/75 PER: Yr?Stchidanandr M. D. Q --' \ J/. F. feta, M. D. RALPH J. BROWN 6/29/74 5:30 p .m . 6/30/74 <? 9:30 A.M. Chare Number: 131343 A-11354 ' 7. Satchidanand, M , D . FINAL SUMMARY At autopsy the lungs were found to be very heavy (right lung 1400 gms. and It. lung 1100 gms). Microscopic examination revealed very interesting features. Extensive fibrosis was noted. This could be attributed to the radiation this patient received for the malignant lymphoma. However; this patient is said to have worked for many years in a talc factory. This explains the "ferunginous bodies" and the "asteroid bodies" seen in large numbers in the lungs. The "ferunginous body" also known as the asbestos body is not specific for asbestosis. It is formed by a deposition of iron^salts and protein on particles of asbestos. However, similar deposition is seen in cosmetic talc, .aluminum silicate and glass fibers. Animal experiments have confirmed the above finding. Therefore, the fibrosis can be attributed to both radiation and lung exposure to talc. A fibrogenic impurity accompanying talc (hydrated magnesium silicate, is tremolite, A mineral form of asbestos. Tremolite is known to form asbestos like bodies and induce interstitial fibrosis. M 22 7 A Name: Date and Time of Death: Date and Time of Autopsy: RO SW ELL PARK MEMORIAL IN STITU TE AUTOPSY REPORT RALPH J. BROUN 6 / 2 9 / 7 4 <? 5 :3 0 P.M. 6 / 3 0 / 7 4 @ 9 :3 0 A.M. Chart Number: 131343 Autopsy Number: 11354 Prosector: Y . Satchidanand MICROSCOPIC DESCRIPTION CARDIOVASCULAR SYSTEM Section of the heart shows mild focal fibrosis. RESPIRATORY SYSTEM The lungs show thickening and edema of the pleura. There is infiltration by malignant lymphoma, composed of well-differentiated small lymphocytes* These cells are diffusely infiltrating the lung parenchyma. The adjacent lung shows thickening and fibrosis of the alveolar walls. The alveolar septae show large atypical cells. Several of the alveoli have asteroid bodies and ferunginous bodies. Elsewhere, the alveoli are filled with dense proteinaceous material, in addition, large areas of emphysema are noted. Considerable thickening of the smaller arterioles is seen. Large emphysematous areas are seen. The main bronchus shows ulceration and infiltration by malignant lymphoma. DIGESTIVE SYSTEM Section of the esophagus shows mild dysplasia. There is submucosal edema and squamous metaplasia of the ducts. There are a few dilated vessels. These probably represent radiation changes* The stomach has a well-preserved mucosa. There is no lymphomatous infiltration. The small intestine is unremarkable. The liver shows mild fat-metamorphosis and mild lymphocytic infiltration of the portal areas. There is moderate degree of autolysis of pancreas. REIICULO-ENDOTHELIAL SYSTEM The section of the spleen shows chronic passive congestion. A single small lymph node shows infiltration by poorly differentiated lymphocytic lymphosarcoma. The vertebral marrow shows focal hypocellularity and multifocal infiltration by malignant lymphoma. The femoral marrow is hypereellular and shows erythroid hyperplasia. Mild degree of megakaryocytic hyperplasia is seen. ENDOCRINE SYSTEM The pituitary gland ia unremarkable. The thyroid gland is composed of small and large follicles filled with colloid. The parathyroid gland is unremarkable. The adrenal glands have well preserved cortex and medulla. URINARY SYSTEM . Section of the right kidney shows metastatic malignant lymphoma infiltrating the parenchyma. The glomeruli are fairly well preserved. The tubules show auto lytic changes. REPRODUCTIVE SYSTEM . The testicles have atrophie seminiferous tubules, and a few are hyalinized. The section of the prostate gland shows extensive autolysis. CENTRAL NERVOUS SYSTEM Sections of the hippocampus and cerebellum are unremarkable.