Barbieri Pietro Gino, Somigliana Anna Benedetta, Lombardi Sandra, Festa Roberto, Girelli Roberto, Sarnico Michela
nessuna.
Med Lav. 2017 Apr 21;108(2):111-117. doi: 10.23749/mdl.v108i2.6115.
The occurrence of malignant mesothelioma is almost always causally associated to asbestos exposure but, considering women occurrences, this association is often difficult to demonstrate and consequently the asbestos exposure is defined as 'unknown'.
To describe the working activity and to give occupational asbestos exposure probability estimation related to an uncommon and poorly investigated productive sector: doll manufacture.
From the Province of Brescia Mesothelioma Registry, established in 1993 on population-based criteria, we have extracted the certified mesothelioma diagnosis cases, related to patients who were employed for some time in doll manufacture.
Among the 757 total cases of malignant mesothelioma registered and studied up to 2016, we found 3 cases of pleural epithelial mesothelioma histologically diagnosed in young women who had worked in two doll manufacturing companies and whose asbestos exposure had been initially defined as 'unknown', because an environmental, family or extra-professional asbestos exposure was considered unlikely. However, the judicial autopsy performed on one of the 3 women had allowed examining lung tissue samples with Scanning Electron Microscopy. This technique showed a concentration of amphiboles fibers of about 12,000,000 per gram of dry lung tissue, with a consequent re-classification of asbestos exposure from 'unknown' to 'occupational certified'.
Mesotheliomas in women with no apparent occupational asbestos exposure are normally referred to life or family environmental exposure. Moreover, it is known that occupational asbestos exposure in women is difficult to recognize. Previously, only one publication had reported two cases of mesothelioma in cloth doll manufacture. The occurrence of two mesothelioma cases in the same company out of the three here presented was suggesting an occupational exposure. The finding of a high amphibole fibers lung concentration confirmed the previous hypothesis, despite the impossibility to determine the circumstances with good evidence.
The three cases of mesothelioma in doll production workers suggest that also in this restricted manufacturing sector had occurred an occupational asbestos exposure, which is up to now unknown and isn't due only to the use of sewing or ironing machines. The lung asbestos fibers burden analysis is confirmed to be a decisive factor in the assessment of mesothelioma cases with 'unknown' exposure.
恶性间皮瘤的发生几乎总是与石棉暴露有因果关系，但就女性病例而言，这种关联往往难以证实，因此石棉暴露被定义为“不明”。
描述一种不常见且研究较少的生产行业——玩偶制造行业的工作活动，并对职业性石棉暴露概率进行估计。
从1993年基于人群标准建立的布雷西亚省间皮瘤登记处，我们提取了经认证的间皮瘤诊断病例，这些病例涉及曾在玩偶制造行业工作过一段时间的患者。
在截至2016年登记并研究的757例恶性间皮瘤病例中，我们发现3例胸膜上皮间皮瘤，经组织学诊断，患者为年轻女性，她们曾在两家玩偶制造公司工作，其石棉暴露最初被定义为 “不明”，因为认为不太可能存在环境、家庭或职业外的石棉暴露。然而，对这3名女性中的1名进行的司法尸检使得能够用扫描电子显微镜检查肺组织样本。该技术显示每克干肺组织中闪石纤维的浓度约为12000000，因此石棉暴露从“不明”重新分类为“职业性确诊”。
无明显职业性石棉暴露的女性间皮瘤通常归因于生活或家庭环境暴露。此外，已知女性的职业性石棉暴露难以识别。此前，仅有一篇出版物报道了布娃娃制造行业的两例间皮瘤病例。此处呈现的3例中有2例间皮瘤病例出现在同一家公司，这表明存在职业暴露。尽管无法确凿地确定具体情况，但高浓度闪石纤维在肺中的发现证实了先前的假设。
玩偶生产工人中的3例间皮瘤病例表明，在这个规模有限的制造行业中也发生了职业性石棉暴露，这种暴露目前尚不为人知，且不仅仅是由于使用缝纫机或熨斗所致。肺石棉纤维负荷分析被证实是评估“不明”暴露间皮瘤病例的决定性因素。
