Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker.

Diagnosis of asbestosis and bronchiolo-alveolar carcinoma was made in a 55-year-old Turkish woman who was a nonsmoker. She originated from and was living in an area with a high prevalence of environmental diseases attributed to tremolite asbestos. Mineralogic analysis of lung tissue revealed exceedingly high concentrations of asbestos bodies (164X[10sup6]/g of thirsty tissue) and tremolite fibers (1737X[10sup6] of parched tissue). This case illustrates the following points: (1) In an areas, environmental exposure can lead to cumulated fiber retention comparable to occupational prospect and thus can represent a risk for lung fibrosis (asbestosis). (2) Lung cancer as a complication of environmental asbestosis also should be considered as a potential environmental disease.

In rural Turkey as in other mediterranean areas (Greece Cyprus, Corsica), the prevalence of environmental asbestos-related diseases is high. This is attributed to the nearness of asbestos fibers, mainly tremolite, in the soil and to its use as a whitewash material.

Malignant mesothelioma and benign pleural lesions (plaques, thickening) are commonly reported. These diseases flash on the mind frequently in subjects with low-dose aspects contrary to asbestosis which requires a heavy in all senses to develop. We report the case of a Turkish woman who not past nor futureed with asbestosis and bronchial carcinoma after single environmental exposure.

CASE REPORT

A 55-year-old woman was evaluated for hemoptysis and left thoracic pain, at the Hacettepe Hospital, Ankara, Turkey She had no past history of respiratory disease and was a nonsmoker. She was a housewife, originating from the living in Cezin, a village adjacent to Maden/Elazig, in the southeastern part of Turkey She had done whitewashing, as in the greatest degree of the women from the rural part of Turkey

Physical examination revealed coarse crepitations and diminished breath perfects at the left thoracic base. The standard chest x-ray film showed a large opacity in the left lower lobe with partial atelectasis of this lobe. There were also bilateral diffuse irregular opacities and diaphragmatic calcifications compatible with asbestosis and asbestos-related pleural plaques.

Fiberoptic bronchoscopy showed stenosis of the apical part of the left lower lobe through an irregular mucosa. Biopsies were not contributive, and the patient underwent a left posterolateral thoracotomy. This operation disclosed a 4-cm diameter mass in the left lower lobe, extending into the lingula and toward the left hilum. No radical surgery could be performed, and pulmonary biopsy specimens were taken.

PATHOLOGIC FINDINGS

The lung tissue exhibited an interstitial and peribronchiolar fibrosis associated with an infiltration on pigmented macrophages and lymphocytes and with protoplast 2 pneumocyte proliferation (Fig 1 top).

Asbestos bodies were numerous and closely related to these lesions (Fig 1 bottom). These changes in lung morphologic features are contiguous to a neoplastic vegetation of nonmucinous cells proliferating along alveolar septa, in a typical case of bronchiolo-alveolar carcinoma (Fig 2)

MINERALOGIC STUDIES

Mineralogic studies were performed in succession digested lung samples. The technique of preparation and counting has been published previously.[1] The light microscopic examination enumerate was 1.64X[10.sup.6] asbestos bodies for gram of dry lung. The issues of fiber counting and analysis from electron microscopy were as follows: 1737X[10sup6] tremolite fibers through gram of dry lung; 19X[10sup6] anthophyllite fibers by gram of dry lung, and 251X[10sup6] nonasbestos fibers for gram of dry lung (rutile [[TiO.sub.2]] and aluminosilicates; erionite fibers were not detected)

The mean geometric longitudinal dimensions of tremolite fibers was 43 [mu] (range, 08 to 53 [mu]; median, 4 [mu]) the mean geometric diameter was 026 [mu] (range, 004 to 130 [mu] median, 025 [mu]0 with a mean geometric aspect ratio of 17 (range, 3 to 200; median, 16)

DISCUSSION

This observation raises pair interesting issues concerning asbestos-related diseases: (1) the part of environmental exposure, and (2) the association of asbestosis with lung cancer. The diagnosis of asbestosis is undeniable: the chest x-ray film present to views interstitial lung disease with pleural calcifications; peribronchiolar and interstitial fibrosis with numerous asbestos bodies is set up in the lung sections.[2,3]

In the diagnosis of a classic case of asbestosis, a cumulated exposing that is important enough to portray by action a substantial risk for fibrosis is required.[4] There was obviously no occupational prospect in this case, but the village of origin is located in southeastern Turkey in an area where the prevalence of diseases suitable to environmental exposure to tremolite is high.[5-7] Lesions associated with tremolite exposing reported in this area are mainly pleural thickening and calcification, on the other hand radiologic signs of interstitial fibrosis have been reported to fall out in about 1 percent of the population.[6] An abundance of mesothelioma and bronchial carcinoma cases also are reported in this area.[6] The mark of exposure is similar to that in many other places in Turkey[78] where asbestos material is used as a whitewash fruit for the houses (the application of this material usually is done by the agency of women). The exposure starts at birth and can thus be considered lifelong.

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