Document wq2y402OO03oaV96gqOeexVgD

4-4 < Ut u..uni <\ i VA I ` showed \ cry dense uibserous fibrosi* and lymphocytic infdtra'- tioat with id*deuned tubular inclusion* lined by polygonal cells ` that sh^w* *. no cytolocical evidence of malignancy (ft;. 7). The `` patient was seen once more in outpatients two month* Liter, when tit-: abdomen was said u> ls *#lid with crowd*. hl.s died shewed slight din'usc induration, with snmertd areal cfj-T~7 _ home shortly afterwards and necropsy was no; performed. . cere:!. No macroscopic cajcutuuu was found in tftr Case 9.--A 35-year-old woman was admitted to u pyn-eco logical ward with a three-month history of gradual enlargement -Of the *bdnmj3-_yn history of exposure to ashrsms wi* hilar lymph-nodes. In the mesentery of thu ilium, a r -..firm fibrous mats wa* found which separated easily f:,,= ^ PQreteiiur alsiionttnal wall. There were numerous naj--. recorded in the notes, but her sister was noted to have died ~ growth in tire lesser omentum, and around the pyicrcitf, from lung cancer secondary to asbestosis. There was dullness to otherwise normal stomach, h'urther nodule* and plicae, pettamioa at both lung bases, with diminished breath sounds growth svere found ihmuritou: the peritoneum, in tr-tav p^. and coarse crepitations. The abdomen was greatly distended indenting the mucosa of the large and small bowel, but u. with fiuid. Chest X-rays showed loss of nansluccncy over both where infiltrating tlie mucosa. . On histological umt-,.r tides of the diaphragm, and the sputum contained asbestos the tumour shown was composed of small cuboida! ceils v-- bodies. At laparotomy, hard nodular swellings were found papillary, cleft-like, and tubular formation. ITtere were a fc, along the mesenteric border of the small intestine and studded areas of larger, less well-differenhated cells, and also some over the omentum. The ovaries, liver, lddneys, appendix, and of myxomatous degeneration. This neoplasm was preset t ' uterus were normal. The patient died seven weeks after opera the serosa cf ileum, spleen, and the peritoneal surface cf vi, tion. u : . -.VS ,-v-7 diaphragm, with one solid trabecula of ceils extending throsm -- Ktcrcpsy.--A layer of soft white growth covered the visceral the diaphragm into the hyaline, fibroric pleural surface. TS- peritoneum over the intestines, stomach, and pelvic viscera. were small clumps of cells in a rariral lymph-node, which . There was similar growth over the under surface of the left lobe contained asbestos bodies. In the lungs, there was modem peribroncluolar and pleural fibrosis with numerous nV- t- w . .. ^ 'JiiT bodies. A little broochiolar epithelialhyperplasia was seen is ut right lower lobe. . :,r- AiSnudt - Di*curioi . V The fitst recorded case of pulmonary asbestosis was tie of a patient who died in Charing Cross Hospital, Louder. in 1900. Details were given to the Departmental Geo mittee on Compensation for Industrial Diseases (190<X k Dr. Montague Murray. It was nut until 1930, whet: further inquiry was held (Merewethcr 1930a and l Merewether and Price 1930), that asbestosis was rear nised as an industrial disease in this country* and measure were taken to prevent it. By the nature of the w involved, these measures were unlikely to be whcC . successful, arid it is of interest that of tlie 42 cases t this scries, ten (8 men and 2 women) were first expos. after 1930. Tiff* S--C*>* S, Mainly utid ltrev p**lyron)-tU nrapUifn with , ime pbpiltkry <uid iftmt imtll-ceH hroit with cicft J`ormtiotu A . AAtttom and Lxaty Cancer : * .* .. ,, *- few (hovf * tnmuiMtl pndrrtt. (XX10*) .4 * * *, of the diaphragm and over the posterior adbotsinal wall. The ovarira were normal, but their surfaces were covered with growth. In the chest, there were, tough fibrous adhesions 'between the right dome of the diaphragm and the lung, and two plaques of hyaline fibrosis in the pleura over the left dome of Lynch and Smith (1935) reported the first case of 1m `cancer associated with asbestosis. In 1952, Hueper (1952 was able to collect 61 published examples. Of 99 ceuiit by Hueper (1955), 82 originated in England. The n statistical review was that of Merewether (1947), sen reported the finding of lung cancer in 13-2% of 21 the diaphragm. No growth was found in the hilar lymph-nodes. necropsies on patients with asbestosis. Tliis was compart There was diffuse fibrosis throughout the lower lobes cf both . with an incidence of 1*32% among 6SS4 cases of sih'ctsd lungs, with areas of confluent slaty-black aatluacosis. No Wyers (1950) reported an incidence of 14*8% among If 1 1 primary growth was found anywhere. Histologic:' examination showed n neoplasm composed of solid, large polygonal cells with some papillary-cell and small-cell areas, associated with necropsies, and Ciloyne (1951) found iung cancer i 14*1% of deaths associated sn'th asbestosis. Doll (19ti cleft formation. Occasional ureas showed a transiiiond-cdl provided further cotiliminrion of a causal relatlonslup -r.: pancm (fig. 8). . his investigation of necropsy reports on 105 persons vt C*s< 24.--Admitted nt the see of 50. Three years earlier, a diagnosis of asbestosi* had been made. One year before admis sion, he attended outpatient* with en eight-month history of Itatl been employed at one asbestos works. Lung r*~~ was found in 15 of 75 ca-es with asbowosis, and in 3 of c 30 cases without asbestosis. lie concluded that the tis!t; epigastric discomfort, unrelated to meals hut worse si nirht. There were no abnormal signs and a barium-meal examination showed no abnormality, lie had some jelief from alkalis; hut s-ague abdominal dircoir,(bit persisted, and for two months beiore admission there had been loss of appetite with increasing girth. He was ill and wasted. The percussion nnte was im paired ct both hint; bases and there were biljtcr.il fca---! crepi tation*. Hie r.bjorn-n was tense with tluiJ, but, r.fter paracentrsit, a l-n-e cpi -ntrie m.tss w.i; f, It. C.Iif.l X-tv, showed <f::,i:*c tenculatron, tn isimal in i'o l.-swer rone*-. *1 i.e sputum lung roncer among men employed fer tss-cr.ty vears ` mote was ten times that of the general population. Such a direct association is not universally accepte Jacob and Hohlig (W55), in Dresden, studied 34 J casts asbestosis and found only 4 cases of lung c.tncer, but 1: associated active tuberculosis. They state that, during u pa,t twenty years, the avei.n c rur.tl'er of asbestos worN lhr>'u.*,Iiot.*t Ciemrmy In*, varied brtv.een 3UvO ami 4*\ but tis.it only 17 e.**c* s'f lutr.*. cuntar Ir.vo been repom contained atbrstui bodies. JJe died after three months in rtn.'n;; them. Jlunn anti Tnun (l5f.) criticise stett;^ *^*N0TEjTH!S DOCUMENT DID. bated o:t necropsy firsoiniys without reference to the pcf NOT ..1 Vi- iVI n*r> *' . J;-: i_ BB_ 00 0 73 4 0~71 " 4 4*4# 4i>h^U.4 ^ , 10 * * ' /* ' cist* In an cpulcmi<^pical siuOy of over 6000 '* in the asbestos mines of Quebec, they found only TArU IV--CAUSES OF. DEATH OF 15 MEM AHO 15 WOMCM WtIK . ASBESTOSIS ' ; lung cancers--an incidence of *25-3 per 100,000 -- pv'pwlJtinn studied. Comparing this incidence with * ~ ",-f 22-5 per lflrt,iv*0 for tl:c rest of the province of OuiMti or imiiwKil canter t. tcm- ni) si lung .. .. C .-..Ss.', they conclude that the absestos workers do not Fnrwfihitnt Other Cauici _ . a significantly higher death-rate from lung cancer ,* .. Aten t 10 (err.) 3 2 . Vmm 9C-'.l 4(-U,,) ^ r -* # 2 a do comparable sections of the general population. . Tee present series is too small forswrislicaT'analysis, --In-the piescnt series^9 'on5~cfcat!Ts'Tn women sverc jj it will be seen that the incidence of lum: cancer at associated with ovarian or peritoneal cancer, an incidence rwtopsy is very much higher than any previously reported of 00%. In one case (no. 5) the diagnosis was only clinical, --ltticularly among the men, where it is 67%. This is and there was nothing in the history or examination to : *r.*ly explained by selection, since 6 of the 10 men were incriminate any particular organ as the site of the primary si.-ircd directly to the medical and surgical thoracic units lesion. In the remaining 8 eases, either laparotomy or &ai other hospitals with the diagnosis, either provisional postmortem examination was performed. Only 1 (case 1) * .jtstabhshcd, of lung cancer. The same explanation docs had a definite ovarian neoplasm without peritoneal t held for tiie females, who all attendee! at general involvement. In every other ease there was diffuse peri filial outpatients, thus giving a lung cancer incidence toneal growth with ascites. In 4, the pelvis contained of all deaths associated with asbestosis. It will be a mass of growth and the ovaries were not identified. In J from table m that the average duration of exposure 2 other eases, the ovaries were said , to be studded with growth but were not, apparently, the site of the primary , nm m--ration since rhut zxronau and duration or rxrojtntx tr JJ cases or asbestosis, asbestosis with lung cancer, and lesion; in 1 case the ovaries were cystic but not involved by nsESioiii with rtrtTONiAt. cancer - . growth. " . < Xumber Of OKI My Years time fun exposure MF pyratfo* of exposure (years) MP Case 24 was the only man to show a similar picture f diffuse peritoneal cancer. An intensive examination revealed no macroscopic evidence of a primary growth, but subsequent microscopy showed bronchial epithelial* .Vtattwis >nd iikj! cinicc per*t_* iitaoti* and lung iSftKnWufifu alone * X-tint) .. * I 10 4 8 36 30*7* 23 3t-S3t 5-8 hyperplasia in the right lower lobe, and tumour-cells in a l-2tt 4 34-6* 35* 14-3* 9*7* hilar lymph-node. In addition, there was a solid rrabccuJa 9 S-V5t 30 0* 1S-3ST 33 5* 2--I5t 19-f V..-30f 7 2* of growth extending through the diaphragm, which may 14-t2f 18-33f */,-21 3-I7 have arisen on cither the pleural or the peritoneal aspects. 0 I# AveMge. f Range. In this case, and in case 9 where plaques of growth were -s y if the 4 women with lung cancer was only about nine and also found on both aspects of the diaphragm, the possibility of a missed bronchial primary is more difficult to refute. Cj a .4 1 three-quarters years whereas the average period from first MSure to death was twenty-five years, suggesting that It is possible that these cases do not represent a new pathological entity bur arc all cases of secondary carcinoma ce of exposure is'not the most important factor in the from bronchial primaries. The occurrence of sec6ndary j J sited Jtrhealotptmheenat veorfagluenaggecoanf cdeer.athMweritehweasthbeesrto(s1i9s-1a7n)dalsodeposits from bronchial carcinoma, many months before ' there is clinical or radiological evidence of the primary ardnoma of lung was about fifty-two years against about lesion, is familiar to all. Even at necropsy, a small primary itty-four years for those with asbestosis alone, though growth in the wall of a peripheral bronchus is easily missed *j\ there was little difference in the duration of exposure. unless specifically sought. The absence of clinical or -d Keeper (1951) draws the conclusion that many of these radiological evidence of lung cancer in the 10 cases of s* r-'aems die from asbestosis before their lung cancers have peritoneal cancer described docs not eliminate this :0 ane to develop. ' possibility, nor will the negative record of such a primary 55 As in other reported series, there is no great pre- entirely convince the sceptical. Yet the findings differ -d .vaderancc of any one cell type. Of 15 lung cancers, 5 from those usually associated with carcinomatosis from s. rrr squamous, S anaplastic, and in 2 others the type was lung cancer in which it is common to find deposits in liver, 15 sot stated. It is worth noting that the 4 wpmen with lung in cacer were all nonsmokers. 4 adrenals, and kidneys, buc most unusual to see diffuse peritoneal involvement without Mich deposits. However, 5) | A&aitut end Peritoneal Cancer .\ Bonser et al. (1955) and.llonscr (1059) attach imporrar.ee :h I Leieher (195-0 reported the case of a 53-ycar-old to the plaques of hyaloserositis tethering the base of the iO j iiViitos worker who lud suffered from asbestosis com- lung to the upper surface of the diaphragm in many cases cr J rotated by pulmonary tuberculosis for several years, and of asbestosis, as in ease 9 and ease 21 of this scries. They ( *bo died in 1952 from tuberculous meningitis. At consider that the consequent alteration of lymphatic j -erepsy, the peritoneum was found to be studded with or j rxiulcs of growth and there were plaques of growth over drainage of the region offers a means of spread to the abdomen of cancer arising in sequestrated bronchial J Su peritoneal aspect of the diaphragm. This was thought epithelium. On the other hand, this explanation is difficult d. of 1 liha " primary cortical cell tumour of tile pernom-mn ", i .>J typical asbestos bodies of tibres Were seen in the of '-rtucs of the tumour, but asbestos was demonstrated ac j Are by X-ray-di.Traction techniques. Bonser ct al. (1955) is j Vpfar to have made the only previous reference to a high V i I ociJcncc of abdominal neoplasms associated with to relate to the predominance of women in the present scries, since lung cancer is commoner among the men, 2 of Bonscr's 3 patients with asbestosis and peritoneal cancer were thought to have primaiy ovarian growths. Case 1 of this series was undoubtedly ovarian, and, in 4 others, the ovaries were involved in a m.v.s of growth '.'.osis. Out of their series of 72 eases, <1(1 man and filling the pelvis and may well have been the site of the C rnen) haJ peritoneal cancers. Of the 3 women, ?. had primary lesion. In all eases, the histological findings have * thought to have ovarian primaries (Bonser 1959).been compatible with ovarian carcinoma and this has been I _ ------ 1 22 ^3 * /<- A . GG. f-535(l 7 bb 0007341 P> . 1 * 1 ' .- * - .