Document rxOvg3qJ7QjK5dQ3arM5RGk8V

April 7, 1953 Dr. Paul Cartier Thetford Industrial Clinic Thetford Mines, Quebec Canada F.e: Ludger Ainsley "fee Saranac Laboratory P-53-582 Enclosed is my report concerning the above case. lou vill note that I consider it to be a straightforward example of asbestoais. Vith respect to the carcinoma, and its relationship to asbestoais in this case, there is no intrinsic evidence upon whicn to base an opin ion. I have taken the liberty of relying upon your statistical study of the industry in arriving at the impression given in the report that the tumor is probably unrelated to the asbestoais. As noted in the report, I doubt that the tumor is cf much significance in regard to the cause of death in this instance. I have read vith interest Dr. fhnpeau1 s report concerning Jean B. Ainslcy, but have not introduced qpnaent vith respect to it into the present report. I have omitted reference to it chiefly because I* personally do not agree vith Dr. M&nsceu's views, and I feel that comments concerning then should properly belong in Dr. Vorvald'a re port on the case of J. B. Ainsley. For the present, it Beams sufficient to say that the pathology in J. B. Ainsley is somevhat peculiar, but that there are many areas of true asbestoais, and that asbestasis bodies are present end much more numerous than Dr. Manaeau implies. In the erse cf Ludger Ainsley, I do not see any areas resembling the peculiar reaction present in the lungs of J. B. Ainsley. Therefore, there seems to bo no reason to entertain the possibility that Ludger Ainsley suffered from anything other than asbestosia and its consequences. I hope this report vill meet vith your approval and that it vill arrive in time to meet your needs. Sincerely yours. PCPign Philip C. Pratt, K.D. Pathologist The Saranac Laboratory 00032 r* l Ainsley, Ludger P-53-532 April 7, 1953 Interpretation of series of single cheot roengenogrens purporting to be those of one UJCGER AT IISLET, all bearing identification 'Industrial Clinic, Thetford Hines, Qua. - #4044' ASBESTOS COPJORATICS LTD. Film of I/31/48 reveals* The transverse diameter of the cardiac silhouette is less than 50 of the transverse diameter of the thoracic cage. Trachea is in the sidline, and the upper aediafctinua is not widened. There are no osseous abnormalities of the rib cage. R. &L. There is mottling thruout the entire lung field, end the right cardiac border is obscured. The medial half of the right hemidisphragm is irregular. Similar shadows ere present on the left, thruout the lower half of the lung field. Vhile the left border of the heart is not obscured, it is not acutely defined. Subsequent films taken 7/29/49, 3/27/50, 11/15/50, 7/13/51, 2/25/52, and 12/4/52, compared with above* R. & L. Throughout the aeries there is some progression of the mottling throughout both lungs, nnd by December of 1952 the apex of the cardiac silhouette is obscured. Commencing In 1949, there la noted the development of what appears to be a lesion in the right Juxta-cardiac region. From this time until December of 1952, there ia a slight, insidious increase in the size and density of this shadow. OPINIOHs In the presence of an adequate history of exposure to asbestos, the above-described changes are compatible with a roentgenological diagnosis of *Asbestoais, Stage II, with a superimposed neoplasm present st the right base, most likely representing a bronchogenicacarcinoma. This latter is first visualized in 1949, and by 1952 has progressed in site, to definitely involve the lung root. (a) Leonard J. Bristol, K.D. Director, Department of Radiology U PATHOLOGY* A* Gross Description* The lungs and heart are submitted in a single block. The right lung is voluminous and its pleura is generally slightly thickened and has been largely stripped away in dissecting the lung. There are numerous trocar lacerations throughout all portions of the lung but especially the lower lobe. The surface is somewhat convoluted -2 00032X Ainsley, Ludger P-53-582 April 7, 1953 by the presence of scattered elevated emphesematoua blebs. The tissue is generally firm and essentially hoaogeneous in consistency. On section the upper lobe is seen to be generally air containing, though the alveoli are distinctly coarse and markedly variable in size. Throughout this lobe there are seen numerous foci and irregular bends of grey scarring, coursing among the dilated alveolar spaces. The secondary lobular septa are thickened and accentuated by excoaaive scarring. The intrapntsenary bronchi and veaaels are of normal sizes and their lumens taper uniformly. The middle and lover lobes, in general, resemble the upper vith the exception that a roughly spherical mass of yellowish grey, firm tissue is noted in the hilar portion of the lover lobe. The margins of this tissue are rather poorly defined but are essentially regular. The mass surrounds the major bronchus to this lobe beginning at a distance of about 3 centimeters from Its origin. The left lung is rather voluminous and resembles the right externally and on section except that no tumor mass is noted. TRACHEOBRONCHIAL LZMP3 NODES: These are of a normal sire and are rather heavily pigmented. They are slightly more firm than normal but on section there is little re sistance to cutting and the surface is moist. Several of the nodes on the right side are mottled vith grey foci perhaps representing metastases from the tumor noted in the lover lobe. HEART: The heart is moderately large and the chambers of the right side are distinctly prominent. The epicardium and endocardium are everywhere smooth and thin. The valve rings are of normal relative sizes and their cusps are delicate and freely movable. The coronary arteries arise normally and follow normal courses, the vails being irregularly thickened by scarring and yellov sclerotic plaques. The lumen is patent throughout though it tapers eomevhot irregularly as a result of the presence of the sclerotic placques. The myocardium is homogeneous in color and consistency end meesures l.S cm. in thickness at the base of the left ventricle and 0.8 cm. on the right. SPLEEN: Not remarkable in the gross. \ 4 LIVER: The specimen of liver submitted is only partially fixed. Its capsule is smooth and through it the lobular markings appear excessively prominent. On several crossections this appearance is uniform throughout. XIDNEXSl Not remarkable in the gross. B. Microscopic Description: Large sections are prepared from each lobe of the lungs end are stained vith hematoxylin and eosin. Smaller sections are stained also for elastic tissue and connective tissue. Examination of these slides reveals the major portion of the pul monary tissue in each of the various lobes to be involved vith diffuse collagen 3- 00033C Ainslay, Ludger P-53-532 April 7, 1953 deposition located about the smaller bronchioles,and in the region of secondary lobular septa and even in alveolar rspta. In many rreaa this collagenous tissue is so extensive an to nave replaced small zones of pulmonary tissue with complete obliteration of previous structure. In other ereas the collagen fibres have been deposited within alveolar septa pre serving their pattern. In the ereas of extensive involvement and obliter ation of pulmonary architecture the collagen fibres are dense end partially hyalinised but they are everywhere oriented In a diffuse pattern. It is noted that occasional alveolar spaces remain within rather wide zones of ouch scarring. These spaces are almost uniformly lined by cuboidal or columnar epithelium. A few are lined by stratified squamous epithelium. In the areas of less dense involvement, with delicate collagen fibres occupy ing previous alveolar septa, the alveolar lining membrane is thin. Scattered groups of alveoli show slightly thickened eeota with a rather prominent capillary network withih. Moderate numbers of entirely typical elongated, segmented, brownish esbestosis bodies are noted throughout all Involved portions of each lobe. These structures car. be identified with ease in almost every field examined. In the sections of lung stained specifically for connective tissue, smooth muscle fibres are well demonstrated by their contrast to collagen. Examination of these slides reveals numerous clusters of smooth muscle fibres within some of the larger foci of diffuse collagen deposition which obliter ates pulmonary structure. The impression. ts gained that these clustore of smooth muscle fibers represent the sites of bronchioles which have been ulcerated with subsequent complete obliteration of the lumen by collegen deposition. In the sections stained specifically for elastic tissue, sur prising numbers of such fibers are found within seme of the areas of diffuse collagen deposition. The tumor ms.es noted on gross exr.ninr.ticn In the right lower lobe is confirmed as such microscopically. The tumor is made up of cords end nests of well differentiated squamous cells, the central portions of many of the nesta shoving Eeratinization or "pearl"formation. There is moderate variation in nuclear size and chrcmatic content. At the margins of the tumor, strands and cords of cells extend outwards into the surrounding tissue end often into lymphatic channels in perivascular and peribronchial areas. TRACHEOBRONCHIAL LSKPH NODES* These are densely infiltrated with black, opaque pigment material but the lymphoid tissue is generally preserved. Several nodes on ths right side contain small foci of squamous cell tumor mstast&aes. SPLEEN* Toe splenic sinusoids are congested with blood. LIVER* Sections of the liver reveal a pronounced atrophy of the cells in the central portion of toe lobules. This atrophy extends outwards from the central vein to the midportion of the midzone of the liver lobules. 4 000331 Ainsley, Ludger P-53-532 April 7, 1953 XIDHEIS: A9idB from rather slight intimr.1 thickening of the larger intrarenal arteries, the kidneys reaveal nothing of significance. COMMENT: The lungs in this case present a rather straightforward example of esbestosis recognizable roentgenologically, macroscopically, and microscopically. The disense is rather extensive and pronounced and is associated with the presence of moderately extensive emphysema as ia often the case. As a result of the extensive scarring together with dev eloping eaphyseaa the heart, especially the right side, nas undergone excessive strain with resultant hypertrophy and finally failure vnlch has resulted in the signs of chronic pns-ive congestion noted in tae spleen and liver. The tumor In the right lover lobs is a veil differentiated squamous cell carcinoma and has metastasized to tracheobronchial lymph nodes on the right sida but not to any of tne other organs submitted for study. The possible relationship of the onset of this tumor to the presence of asbestosis must be mentioned. It is considered likely by many individuals that asbestosis predisposes to the development of pulmonary carcinoma. Evidence has bean presented to show that this any well be the case in the asbestosis of Industry in England. However, a recent statistical study carried out by Dr. Paul Cartier, of Thotford, failed to reveal evidence hint asbestosis has been associated with an excessive incidence of pulmonary carcinoma in the Canadian mining industry. It is only on the basis of such evidence, and not on the basis of evidence derived from microscopic and other study of an individual case of asbestosis, that tne decision can be made as to the relationship of asbestosis to pulmonary malignancy. At the prepent time aud on the basis of the statistical evidence available it appears tnat the tumor should be con sidered to be unrelated to the preaeaco of asbestosis. In the present instance that matter seems to be of relatively slight im portance since it appears to be unlikely that the tumor played any large part in the clinical symptoms or cause of death of the individual Ludger Ainsley. It appears that the extensive e shea totic fibrosis with associated emphysema, resulting in cor pulmonale and heart inilure constituted the sequence of events leading to the death of this individual. -5- 000331 April 7, 1953 LODGE?. AIKSLEI (Saranac Laboratory Number P-53-582) Age: 59 Source of Material and Data* The following material and data relative to the above individual vere submitted by Dr. Paul Cartier to The Saranac Laboratory for study end interpretation: A. A copy of a claim ease history* identified as Number U6S901* and dated March 5, 1953* B. A series of seven chant roentgenograms covering the period from 1948 to 1952 and bearing the number 4044. C. Eoth lungs, ths heart, spleen, kidneys and a portion of the liver, removed at autopsy on March 6, 1953* Occupational History: Prom the Clei-. Case History it is learned that this man's occupation has been as follovst 1916 Jen. 1/26 Jan. 1/31 July 15/35 June 1/36 Mar. 16/37 to 1929 to Dec. 31/30 to June 14/35 to May 31/36 to Mar. 15/37 to Nov. 23/44 Millwright Millwright Mine closed down during which period he worked 265 days on odd jobs. Mill Assistant Foreman Millwright Grading Fibre In summary this employee has worked 22 years in a significant exposure of asbestos fibers. Clinical History: From the Claim Case History it Is noted that symptoms vere first reported in 1944 and consisted of cough end dyspnea. It appears that the dyspnea progressed during subsequent years. The terminal symptomatology in 1953 is not presented. Chest Roentgenogramsi The Interpretation of the aerios of chest roentgenograms by Dr. Leonard J. Bristol of the Department of Radiology of The Trudeau Foundation, is as follovst 000.3.2 Aiaaley, Ludger P-53-582 April 7, 1953 FINAL IMPRZS5I0H 1. Aabeatosis. 2* Eaphyaeaa. 2. Cor pulaonala, vita ailatation, right Lourt. A. Chronic passive congestion, spleen end liver, 5, ScuaaouB cell cercinona, broucaogeiiic, rigut lover lota, ----------- ~------------ PCPign Philip C. Pratt, H.D. Pathologist The Saranac Laboratory > 000-33S THE TRUDEAU FOUNDATION FOR THE CLINICAL AND EXPERIMENTAL STUDY OF PULMONARY DISEASE PLAINTIFF'S EXHIBIT ft;. SARANAC LABORATORY TRUDEAU LABORATORY TRUDEAU SCHOOL Office of Director F. O. BOX 381 Saranac Lake.N.Y, April 7, 1953. department of biochemistry DEPARTMENT OF PHYSIOLOGY DEPARTMENT OF RADIOLOGY DEPARTMENT OF RADIOLOGY TRUDEAU. N.Y. Interpretation of series of single chest roentgeno grams purporting to be those of one UJBGER AINSLET, all bearing identification 1Industrial Clinic, Thetford Mines, One. - jfiiOLb1. ASBESTOS CORPORATION LTD. Film of l/3l/li8 reveals* The transverse diameter of the cardiac silhouette is less than 50% of the transverse diameter of the thoracic cage. Trachea is in the midline, and the upper mediastinum is not widened. There are no osseous abnormalities of the rib cage. R. & L. There is mottling thruout the entire lung field, and the right cardiac border is obscured. The medial half of the right hemidiaphragm is irregular. Similar shadows are present on the left, tliruout the lower half of the lung field. While the left border of tho heart is not obscured, it is not acutely defined. Subsequent films taken 7/29/1*9, 3/27/50, 2l/l$/50, 7A3/51, 2/25/52, and 12/ V52, compared with above* R. & L. Thruout the series there is some progression of the mottling thruout both lungs, and by December of 1952 tho apex of tho cardiac silhouette is obscured. Commencing in 19ii9, there is noted the development of shat appears to be s lesion in tbs right juxba-cardiac region. From this time until December of 1952, there is a slight, insidious increase in the siso and density of tliis shadow. - OPINION* In the presence of an adequate history of exposure to asbestos, the above-described changes are compatible with a roentgenological diagnosis of Asbestosis, Stage IX, with a superimposed neoplasm present at the right base, most likely representing a bronchogenicacarcinama. This latter is first visualised in 191*9, and by 1952 has progressed In else, to definitely involve the lung,root. /->n\ , AuumYjS lutUL- Leonard J. Bristol, Director, Dept, of Radiology. s oop?2*: