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Old 03-17-2011
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Arrow Test your knowledge #28! (Pathology)

A 68-year-old recently retired factory worker presents with dyspnea upon exertion. The patient admits to having smoked, but claims to have quit five years ago. Physical exam reveals dry crackling rales bilaterally and moderate finger clubbing. A chest x-ray shows shaggy heart borders and diffuse infiltrates at lung bases. Ferruginous bodies (see figure below) are seen on bronchoalveolar lavage. From which of the following is this patient in particular at most risk?

Test your knowledge #28! (Pathology)-lung082.jpg
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  1. Carcinoma
  2. Mesothelioma
  3. Pneumothorax
  4. Renal failure
  5. Septic shock
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Old 03-17-2011
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That large stick like thing resembles an asbestos crystal. (I believe there were two types, one which didn't cause pathology), anyways history also reveals he was a factory worker.

I will go with B. Mesothelioma
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Old 03-17-2011
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The key here is AT MOST RISK. The answer is A. Carcinoma.
Asbesto's ferruginous bodies are seen in asbestosis. Asbestosis increases the risk of mesothelioma, but also, and more commonly of bronchogenic carcinoma. In particular, smoking has a synergistic effect with abestosis for bronchogenic carcinoma. Although the history specifically states that he quit smoking 5 years ago, we know that the risk for lung cancer does not decrease until >15-20 years after quitting.
So for asbestosis: #1 bronchogenic carcinoma, #2 mesothelioma.
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Old 03-20-2011
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Correct Answer Correct!

Quote:
Originally Posted by jorgemorales View Post
The key here is AT MOST RISK. The answer is A. Carcinoma.
Asbestos ferruginous bodies are seen in asbestosis. Asbestosis increases the risk of mesothelioma, but also, and more commonly of bronchogenic carcinoma. In particular, smoking has a synergistic effect with abestosis for bronchogenic carcinoma. Although the history specifically states that he quit smoking 5 years ago, we know that the risk for lung cancer does not decrease until >15-20 years after quitting.
So for asbestosis: #1 bronchogenic carcinoma, #2 mesothelioma.
Absolutely correct, and explained very well!

As jorgemorales wrote, the correct answer is A. Carcinoma. PatelMD correctly noted that the figure shows a ferruginous amphibolic asbestos body. Occupational exposure to asbestos is linked to:
  • localized fibrous plaques
  • pleural effusion
  • parenchymal interstitial fibrosis
  • lung carcinoma
  • mesothelioma

While the risk of both carcinoma and mesothelioma is increased by asbestos exposure, there is no additional risk of mesothelioma with smoking. The risk of carcinoma, however, is greatly increased by the combination of smoking and asbestos exposure. In addition, malignant mesothelioma takes 10-20 years longer to develop than carcinoma. Thus, carcinoma poses the greatest risk for our patient.

These lists from Medscape might help indicate possible clues we might see in a question stem about asbestosis:
Manufacturers commonly use asbestos in the following products:
  • Products containing asbestos cement - Pipes, shingles, clapboards, sheets
  • Vinyl-asbestos floor tiles
  • Asbestos paper in filtering and insulating products
  • Material in brake linings and clutch facings
  • Textile products - Yarn, felt, tape, cord, rope
  • Spray products used for acoustical, thermal, and fireproofing purposes
Examples of occupations associated with asbestosis include the following:
  • Insulation workers
  • Boilermakers
  • Pipefitters
  • Plumbers
  • Steamfitters
  • Welders
  • Janitors
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