Document pMO9K1Kb9oY6oNmEZeGYn63d

D* Zotti, LartUfi linojoM M, Motwo 1,1 tex lurjicil gtovM, . irt A. ct: c. .eportiuid Lw Clin Ext AlUrty It W Buth RK. Aitocic I ted iniphyUori*. A/ler rlo S, Dolovich rgic to J grttish Journal of Industrial Median* 1992^49:599 599 ]Vialignant pleural mesothelioma caused by nonoccupational childhood exposure to asbestos ^ ( azzadori, F Malesani, L Romeo yhe association between malignant pleural meso- fication of seven asbestos bodies in bronchoalveolar ;;,una and exposure to asbestos is well docu lavage (0'3 asbestos bodies/ml) by light microscopy. merited.12 Roughly 85% of patients with the neoplasm have a history of occupational or environ Discussion mental exposure to asbestos (with a higher percen This case is in accord with the hypothesis that nnn- tage in men than in women).3 prOfessional exposure to asbestos can be related to According to the Zielhuis classification,4 the malignant pleural mesothelioma. '' environmental exposure can be classified into the ~~ft scemytherefore useful that all these cases have to following groups: domestic exposure to asbestos be correctly and scrupulously investigated from the brought home on workers' clothing (group II), anamnestic viewpoint to verify not only occupational residence in the vicinity of asbestos processing but also non-occupational exposure even if this could factories (group III), or the asbestos in the ambient have been brief or remote. air group IV). The study of bronchoalveolar lavage has been Only a few cases of malignant pleural meso shown to be sensitive as an indicator of past exposure theliomas related to non-occupational exposure to to asbestos and its use is indicated in those patients, asbestos have been recorded.'* affected by asbestos related diseases, with doubtful or We report a further case of a young woman negative history of asbestos exposure.7"10 exposed to asbestos during childhood. The finding of asbestos bodies in recovered bron choalveolar lavage fluid (0-3 asbestos bodies/ml) Case report confirms that our case was non-occupationally A 37 year old woman was admitted to hospital because of right sided chest pain and difficulty with breathing for some months. exposed, as reported by other authors10 who indicated one asbestos body/ml as the limit value to discriminate occupationally from non-occupation- Physical and x ray film examinations were consis ally exposed persons. tent with pleural effusion on the right side. Cynological and bacteriological analysis of pleural Requests for reprints to: Dr A Cazzadori, Scrvizio di fluid collected by thoracentesis were not diagnostic. Broncoscopia, Ospedale Civile Maggiore, Piazzale No lesions were seen within the bronchial tree at Stefani, 1, 37126 Verona, Italy. fib reoptic bronchoscopy and the cytological examina tion of bronchial lavage fluid was negative for malig nancy. Computed tomography of the chest showed a wide mspissation of the parietal pleural lamina on the right, that also coated the mediastinum in the prox imity of the aortic arcus. Histological and immunocytochemical examina tion of biopsy samples obtained by thoracoscopy suggested diffuse malignant mesothelioma of mixed pattern (epithelioid and sarcomatoid (biphasic type.;. The patient's history excluded an occupational exposure U) asbcstux. hill nhAnrl rhat eh/- horl HwaH from birth until 10 years old in a house next to an asoestos processing factory. ie exposure to asbestos was confirmed by identi 1 Sclikoff IJ, Let DH. Asbestos and disease. New York: Academic tress, 1V7S. 2 Wagner JC, Sleggs CA, Marchand P. Diffuse pleural meso thelioma and asbestos exposure in the North Western Cape Province. Br J Ind Med 1960;17:260-71. 3 Rom WN, Travis WD, Brody AR. Cellular and molecular basis of the asbestos-related disease. Am Rev Respir Dis 1991;144:408-22. 4 Zielhms RL. Public health risks of exposure to asbestos. Oxford, Pergamon Press 1977. 5 Huncharek M, Smith K, Milatou R. Malignant pleural meso thelioma in a nuclear engineer. Br J Ind Med 1988;45:498-9. 6 Dooth SJ, Weaver EJM. MaJignam pleural mesothelioma five years after domestic exposure to blue asbestos. Lancet 1986^:435. 7 Sebastien P, Armstrong B, Monchaux G, Bignon J. Asbestos bodies in bronchoalveolar lavage fluid and in lung parenchyma. Am Rev Respir Dis 1988;137:75-8. 8 De Vuyst P, Jedwab J, Dumortier P, Vandermoten G, Vande Weyer R, Yemault JC. Asbestos bodies in bronchoalveolar lavage. Am Rev Respir Dis 1982;126:972-6. 9 Roggli VL, Piantadosi CA, Bell DY. A study of 20 asbestos exposed individuals and comparison to patients with other chronic interstitial lung disease. Acta cytniagxca I986:30- 470-76. 10 Dodson RF, Garcia JGN, O'Sullivan M, Com C, Levin JL, Griffith DE, Kronemberg RS. The usefulness of bron choalveolar lavage m identifying past occupational exposure to asbestos: a light and electron microscopy study. Am J Ind Med 1991;19:619-28. Accepted 25 November 1991 ..AD (o