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Vázquez A, Simó M, Persiva O, Sánchez L, Sansano I, Alemán C. Diagnosis and outcome of patients with idiopathic pleural effusions. Rev Clin Esp 2023; 223:320-324. [PMID: 36990383 DOI: 10.1016/j.rceng.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Long-term follow-up course for patients with idiopathic pleural effusions has not been established. METHODS From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1, 3, 6 and every 6 months for a minimum of 1 year. RESULTS Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. CONCLUSION Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up.
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Affiliation(s)
- A Vázquez
- Departments of Internal Medicine, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - M Simó
- Departments of Nuclear Imaging, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - O Persiva
- Departments of Radiology, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - L Sánchez
- Departments of Thoracic Surgery, University Autonomous of Barcelona, Universitat Autònoma de Barcelona. University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - I Sansano
- Departments of Pathology, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
| | - C Alemán
- Departments of Internal Medicine, University Autonomous of Barcelona, Universitat Autònoma de Barcelona, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain.
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Kishimoto T, Kojima Y, Fujimoto N. Significance of secretory leukocyte peptidase inhibitor in pleural fluid for the diagnosis of benign asbestos pleural effusion. Sci Rep 2021; 11:12965. [PMID: 34155270 PMCID: PMC8217519 DOI: 10.1038/s41598-021-92289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Secretory leukocyte peptidase inhibitor (SLPI) is a biomarker present in the respiratory tract that protects against tissue destruction and aids in wound healing. We examined whether SLPI in pleural effusion can be used to distinguish benign asbestos pleural effusion (BAPE) from early-stage malignant pleural mesothelioma (MPM) and other diseases. We measured the levels of SLPI, hyaluronic acid (HA), soluble mesothelin-related peptides (SMRP), CCL2, galectin-3, and CYFRA21-1 in 51 patients with BAPE, 37 patients with early-stage MPM, 77 patients with pleural effusions due to non-small-cell lung cancer (LCa), and 74 patients with other pleural effusions. SLPI levels in the pleural fluid of patients with BAPE were significantly lower than those in patients with MPM, LCa, and other pleural effusions (p < 0.0001). The area under the curve (AUC) for SLPI’s ability to distinguish BAPE from MPM was 0.902, with a sensitivity of 82.4% and a specificity of 86.5%. This AUC was not only favourable but was better than the AUC for the ability of CYFRA21-1 to distinguish BAPE (0.853). The combination of SLPI and CYFRA21-1 achieved an AUC of 0.965 for the differentiation between BAPE and MPM. Pleural fluid SLPI as well as CYFRA21-1 and HA is useful as a biomarker to diagnose BAPE, which needs to be distinguished from early-stage MPM.
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Affiliation(s)
- Takumi Kishimoto
- Department of Medicine, Okayama Rosai Hospital, 1-10-25 Chikko Midorimachi, Minami-ku, Okayama, 702-8055, Japan.
| | - Yoko Kojima
- Department of Medicine, Okayama Rosai Hospital, 1-10-25 Chikko Midorimachi, Minami-ku, Okayama, 702-8055, Japan
| | - Nobukazu Fujimoto
- Department of Medicine, Okayama Rosai Hospital, 1-10-25 Chikko Midorimachi, Minami-ku, Okayama, 702-8055, Japan
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3
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Gillett D, Mitchell MA, Dhaliwal I. Avoid the Trap: Nonexpanding Lung. Chest 2021; 160:1131-1136. [PMID: 33895128 DOI: 10.1016/j.chest.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022] Open
Abstract
Nonexpanding lung is a mechanical complication in which part of the lung is unable to expand to the chest wall, preventing apposition of the visceral and parietal pleura. This can result from various visceral pleural disease processes, including malignant pleural effusion and empyema. Nonexpanding lung can be referred to as trapped lung or lung entrapment, both with distinct clinical features and management strategies. Early evaluation of pleural effusions is important to address underlying causes of pleural inflammation and to prevent the progression from lung entrapment to trapped lung. Some patients with trapped lung will not experience symptomatic relief with pleural fluid removal. Therefore, misrecognition of trapped lung can result in patients undergoing unnecessary procedures with significant cost and morbidity. We reviewed the current understanding of nonexpanding lung, which included causes, common presentations, preventative strategies, and recommendations for clinical care.
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Affiliation(s)
- Dan Gillett
- Division of Respirology, Western University, London, ON, Canada.
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Hara R, Yano Y, Okabe F, Kuge T, Mori M, Urasaki K. Radiographic change over 11 years in a patient with asbestos-related pleural disease. Respirol Case Rep 2020; 8:e00642. [PMID: 32832086 PMCID: PMC7438685 DOI: 10.1002/rcr2.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/12/2022] Open
Abstract
Asbestos-related pulmonary conditions such as benign asbestos pleural effusion (BAPE) and diffuse pleural thickening (DPT) can develop after many years of asbestos exposure. These conditions cause progressing constrictive deficit in pulmonary function which may lead to respiratory failure and death. We report the case of a 72-year-old man with asbestos-related BAPE and DPT which developed approximately 40 years after occupational asbestos exposure, leading to chronic respiratory failure and death. We were able to observe his clinical course including computed tomography (CT) scan evaluation over 11 years. In addition to this observation, moderate asbestos body concentration was confirmed in autopsy-derived lung tissue. There are few case reports that showed radiographic course of asbestos-related pulmonary disorder initiated as BAPE, followed by unilateral DPT and later bilateral DPT that was histologically proven with asbestos body. We consider his clinical course is important in managing this disease, especially in early phase.
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Affiliation(s)
- Reina Hara
- Department of Thoracic OncologyOsaka Toneyama Medical CenterOsakaJapan
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Yukihiro Yano
- Department of Thoracic OncologyOsaka Toneyama Medical CenterOsakaJapan
| | - Fukuko Okabe
- Department of Thoracic OncologyOsaka Toneyama Medical CenterOsakaJapan
| | - Tomoki Kuge
- Department of Thoracic OncologyOsaka Toneyama Medical CenterOsakaJapan
| | - Masahide Mori
- Department of Thoracic OncologyOsaka Toneyama Medical CenterOsakaJapan
| | - Koji Urasaki
- Department of PathologyOsaka Toneyama Medical CenterOsakaJapan
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Tada Y, Tagawa M, Yusa T, Yatomi M, Shimomura I, Suzuki T, Takeshita Y, Sato T, Shimada H, Hiroshima K. Diffuse pleural thickening and thoracic contraction: An indistinguishable case from malignant pleural mesothelioma. SAGE Open Med Case Rep 2020; 8:2050313X20948716. [PMID: 32922794 PMCID: PMC7446552 DOI: 10.1177/2050313x20948716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
The differential diagnosis of reactive mesothelial hyperplasia and mesothelioma is difficult. We present a rare case of diffuse pleural thickening with thoracic contraction that was indistinguishable from mesothelioma. A 66-year-old woman with no history of asbestos exposure visited our hospital with a complaint of dyspnea. The clinical findings included circumferential pleural thickening on chest computed tomography image and a high concentration of hyaluronic acid in the pleural fluid. Pleural biopsies obtained by thoracoscopy under local anesthesia were pathologically consistent with mesothelioma, but the patient refused to take any kind of mesothelioma treatments. Four months later, she consented to a surgical pleural biopsy under general anesthesia to obtain larger tissue samples, which included typical proliferating polygonal cells positive for CAM5.2, calretinin, WT-1, D2-40, CK5/6, epithelial membrane antigen, and glucose transporter-1 and negative for carcinoembryonic antigen, BerEP4, and MOC31. The analysis was consistent with diagnosis of epithelioid mesothelioma. Fluorescence in situ hybridization, however, showed the presence of p16 gene, and the expression of BRCA1-associated protein-1 was detected by immunohistochemistry. Our final diagnosis was diffuse pleural thickening unrelated to asbestos exposure. Differential diagnosis of diffuse pleural thickening and malignant mesothelioma is thus difficult and routine immunohistochemical examinations are often insufficient for accurate diagnosis. Multiple diagnostic methods are required for correct diagnosis in a clinically marginal case.
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Affiliation(s)
- Yuji Tada
- Department of Pulmonary Medicine, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Masatoshi Tagawa
- Division of Pathology and Cell Therapy, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Toshikazu Yusa
- Department of General Thoracic Surgery and Asbestos Disease Center, Chiba Rosai Hospital, Chiba, Japan
| | - Mari Yatomi
- Department of Internal Medicine, Chiba Rosai Hospital, Chiba, Japan
| | - Iwao Shimomura
- Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Toshio Suzuki
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichiro Takeshita
- Department of Pulmonary Medicine, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Tetsuo Sato
- Department of Pulmonary Medicine, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Kenzo Hiroshima
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
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6
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Luo W, Zeng Y, Shen P, Wu X, Wang J, Zhang X. A multidisciplinary approach for the diagnosis of benign asbestos pleural effusion: a single-center experience. J Thorac Dis 2020; 12:4338-4346. [PMID: 32944346 PMCID: PMC7475600 DOI: 10.21037/jtd-20-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is little detailed information regarding benign asbestos pleural effusion (BAPE). It is frequently misdiagnosed because of lack of a standardized diagnostic approach and criteria. The present study aimed to better characterize BAPE and outline a diagnostic approach for this disease. Methods Complete clinical data of 11 consecutive patients with BAPE were prospectively collected and analysed. A multidisciplinary team (MDT) was involved in discussing the suspected cases of BAPE. The team was comprised of thoracic physicians, radiologists and pathologists. A multidisciplinary practical diagnostic approach for BAPE was introduced. Results Six patients had respiratory symptoms, but another 5 were asymptomatic. All the patients had an asbestos exposure and the median duration was 23.9 years (rang, 12–36 years). The median level of lactate dehydrogenase (LDH), adenosine deaminase (ADA), proteins and carcinoembryonic antigen (CEA) in the pleural fluid (PF) were 221.4 U/L (range, 189.8–11,325 U/L), 21 U/L (rang, 14–247 U/L), 48.3 g/dL (range, 35.2–53.2 g/dL) and 3.46 mg/mL (range, 0.84–4.54 mg/mL), respectively. Five patients had pleural plaques, 2 had diffuse pleural thickening (DPT), 1 had asbestosis, and 1 had round atelectasis. The pleural biopsy specimens showed a benign fibrotic pleura in all case. The symptoms and pleural pulmonary radiologic findings remained stable during the follow-up. Conclusions BAPE is diagnosed by exclusion. A suspected diagnosis of BAPE with an asbestos exposure should be considered, especially with the presence of pleural plaques, and/or DPT, and rounded atelectasis. The MDT-based diagnostic approach may reduce misdiagnosis.
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Affiliation(s)
- Weizhan Luo
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunxiang Zeng
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Panxiao Shen
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaobing Wu
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jinlin Wang
- Department of Respiratory Disease, The State Key Laboratory of Respiratory Disease, China Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ximing Zhang
- School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
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Shibata R, Ozaki T, Tada K, Aoyama T, Watanabe M, Himuro N, Takahashi K, Ito K, Yasuno T, Miyake K, Masutani K, Uesugi N, Nabeshima K, Nakashima H. Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases. CEN Case Rep 2020; 9:385-391. [PMID: 32535843 DOI: 10.1007/s13730-020-00493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022] Open
Abstract
Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.
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Affiliation(s)
- Ryoko Shibata
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tomomi Ozaki
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazuhiro Tada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Aoyama
- Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Maho Watanabe
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoko Himuro
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Koji Takahashi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Katsuhisa Miyake
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Noriko Uesugi
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hitoshi Nakashima
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
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Cox CW, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Occupational Lung Diseases. J Am Coll Radiol 2020; 17:S188-S197. [PMID: 32370962 DOI: 10.1016/j.jacr.2020.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Churg A, Dacic S, Galateau-Salle F, Attanoos R, de Perrot M. Malignant Mesothelioma In Situ: Clinical and Pathologic Implications. J Thorac Oncol 2020; 15:899-901. [PMID: 32307274 DOI: 10.1016/j.jtho.2020.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Andrew Churg
- Department of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Richard Attanoos
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Marc de Perrot
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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10
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Kishimoto T, Fujimoto N, Mizuhashi K, Kozawa S, Miura M. Retrospective investigation on diagnostic process for benign asbestos pleural effusion (BAPE) using checklist. J Occup Health 2020; 62:e12182. [PMID: 33314519 PMCID: PMC7733549 DOI: 10.1002/1348-9585.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES In Japan, benign asbestos pleural effusion (BAPE) has been eligible for industrial accident compensation since 2003 as an asbestos-related disease despite the lack of good criteria. We compiled a criteria into a checklist of essential items and for excluding other diseases inducing pleural effusion as a diagnosis process. METHOD Thoracentesis was performed in order to confirm the presence of pleural effusion at the initial diagnosis, and 105 suspected BAPE patients were retrospectively examined. We complied a checklist comprising the following diagnostic items: (a) occupational asbestos exposure; (b) confirmation of exudate of pleural effusion; (c) exclusion of pleural effusion with malignant tumors based on negative results of CEA and hyaluronic acid, and cytology of pleural effusion; (d) exclusion of rheumatic, bacterial, and tuberculous pleuritis; (d) radiological findings for exclusion of malignancies; and (e) histopathological findings based on thoracoscopy that exclude malignancies (when thoracoscopy was not performed, there was confirmation that no malignancies were present during 3-month follow-up observation). Cases that satisfied all items were defined as BAPE. RESULTS Among the 105 suspected cases, there were five cases that had no occupational asbestos exposure; six cases in which transudate of on pleural effusion; one case each of rheumatoid pleuritis and tuberculous pleuritis; and five cases of pleural mesothelioma based on chest radiography and histopathological findings within 3 months after initial diagnosis. Therefore, we excluded 18 cases from the 105 candidates and determined 87 cases of BAPE. CONCLUSION We consider that six items described above are suitable for diagnosing BAPE.
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Affiliation(s)
- Takumi Kishimoto
- Research & Training Center for asbestos‐related diseasesOkayamaJapan
| | - Nobukazu Fujimoto
- Research & Training Center for asbestos‐related diseasesOkayamaJapan
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11
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Jany B. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:615. [PMID: 32048592 PMCID: PMC6819701 DOI: 10.3238/arztebl.2019.0615b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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12
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Porcel J. Persistent benign pleural effusion. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Porcel J. Derrames pleurales benignos persistentes. Rev Clin Esp 2017; 217:336-341. [DOI: 10.1016/j.rce.2017.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
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14
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Ledda C, Costa C, Matera S, Puglisi B, Costanzo V, Bracci M, Fenga C, Rapisarda V, Loreto C. Immunomodulatory effects in workers exposed to naturally occurring asbestos fibers. Mol Med Rep 2017; 15:3372-3378. [PMID: 28339042 DOI: 10.3892/mmr.2017.6384] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 11/06/2022] Open
Abstract
Natural asbestiform fibers are defined 'naturally occurring asbestos' (NOA) and refer to the mineral as a natural component of soils or rocks. The release of NOA fibers into the air from rocks or soils by routine human activities or natural weathering processes represents a risk for human beings. Fluoro-edenite (FE) is a NOA fiber detected in the benmoreitic lava in the area of Biancavilla, South-west slope of Mt. Etna. The aim of the present study was to investigate FE immunotoxicity pathways in a group of 38 occupationally exposed construction workers, in order to find any biological markers of its effect. Subjects underwent respiratory function tests and HRCT total chest scanning. Serum IL-1β, IL-6, IL-8 and TNF-α were measured. The presence of PPs was significantly greater in subjects exposed than in the control (25 vs. 2). In subjects exposed to FE, IL-1β and TNF-α values were significantly higher than the controls. The previously observed increase of IL-1β and IL-18 showed a probable involvement of the proteic complex defined inflammosome by FE fibers.
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Affiliation(s)
- Caterina Ledda
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Chiara Costa
- Section of Occupational Medicine, Department of Biomedical, Odontoiatric, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Serena Matera
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Beatrice Puglisi
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Valentina Costanzo
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Massimo Bracci
- Section of Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Concettina Fenga
- Section of Occupational Medicine, Department of Biomedical, Odontoiatric, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Venerando Rapisarda
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carla Loreto
- Section of Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, Catania, Italy
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Ledda C, Pomara C, Bracci M, Mangano D, Ricceri V, Musumeci A, Ferrante M, Musumeci G, Loreto C, Fenga C, Santarelli L, Rapisarda V. Natural carcinogenic fiber and pleural plaques assessment in a general population: A cross-sectional study. ENVIRONMENTAL RESEARCH 2016; 150:23-29. [PMID: 27236568 DOI: 10.1016/j.envres.2016.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/09/2016] [Accepted: 05/17/2016] [Indexed: 06/05/2023]
Abstract
Natural carcinogenic fibers are asbestos and asbestiform fibers present as a natural component of soils or rocks. These fibers are released into the environment resulting in exposure of the general population. Environmental contamination by fibers are those cases occurred in: rural regions of Turkey, in Mediterranean countries and in other sites of the world, including northern Europe, USA and China. Fluoro-edenite(FE) is a natural mineral species first isolated in Biancavilla, Sicily. The fibers are similar in size and morphology to some amphibolic asbestos fibers, whose inhalation can cause chronic inflammation and cancer. The aim of the current study is to assess the presence and features of pleural plaques (PPs) in Biancavilla's general population exposed to FE through a retrospective cross-sectional study. All High-Resolution Computed Tomography (HRCT) chest scans carried out between June 2009 and June 2015 in Biancavilla municipality hospital site (exposed subjects) were reviewed. The exposed groups were 1:1 subjects, matched according to age and sex distributions, with unexposed subjects (n.1.240) randomly selected among HRCT chest scans carried out in a Hospital 30km away from Biancavilla. Subjects from Biancavilla with PPs were significantly more numerous than the control group ones (218 vs 38). Average age of either group was >60 years; the age of exposed subjects was significantly (p=0.0312) lesser than the unexposed group. In exposed subjects, in most PPs thickness ranged between 2 and 4.9cm(38%, n=83); while in unexposed ones PPs thickness was less than 2cm (55%, n=21). As to the size of PPs in exposed subjects, in most cases it ranged between 1cm and 24% of chest wall (53%, n=116); while in unexposed ones the size of PPs was lesser than 1cm (23%, n=58). Among exposed subjects, 36 cases (17%) PPs were detected with calcification, whereas in unexposed ones only three (8%) presented calcification. 137 lung parenchymal abnormalities were observed in exposed group; whereas, 12 lung parenchymal involvement were registered in unexposed subjects. The RR for PPs is 6,74 CI 95% (4,47-9,58) p<0,0001 in the exposed population. These findings, suggested the urge to extend the screening on the possible involvement of the respiratory tract to all Biancavilla's population, particularly in those aged more than 30. Besides, it seems essential to start indoor monitoring Biancavilla's municipality.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Hygiene and Public Health, Department Medical Sciences, Surgical and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.
| | - Cristoforo Pomara
- Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Department of Anatomy, School of Medicine, University of Malta, Msida, Malta
| | - Massimo Bracci
- Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Dario Mangano
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Vincenzo Ricceri
- Division of Radiology - Hospital of Biancavilla "Maria SS. Addolorata", ASP Catania, Biancavilla, Italy
| | - Andrea Musumeci
- Division of Radiology - University Hospital "Policlinico - Vittorio Emanuele", University of Catania, Catania, Italy
| | - Margherita Ferrante
- Hygiene and Public Health, Department Medical Sciences, Surgical and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Giuseppe Musumeci
- Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, Catania, Italy
| | - Carla Loreto
- Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, Catania, Italy
| | - Concettina Fenga
- Occupational Medicine, Department of the Environment, Safety, Territory, Food and Health Sciences, University of Messina, Messina, Italy
| | - Lory Santarelli
- Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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