Eisenhawer Christian, Felten Michael K, Hager Thomas, Gronostayskiy Mikhail, Bruners Philipp, Tannapfel Andrea, Kraus Thomas
Institute of Occupational and Social Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
J Occup Med Toxicol. 2017 Aug 24;12:25. doi: 10.1186/s12995-017-0171-8. eCollection 2017.
Health surveillance of formerly asbestos exposed individuals focus on early detection of asbestos related diseases, such as lung fibrosis (asbestosis), pleural plaques, mesothelioma and lung cancer in particular. One main concern is the early and clear identification of lesions with a high risk of malignant changes and their undelayed clinical work-up. False positive results may lead to unnecessary and often painful diagnostic interventions, which create high costs when applied to a large cohort and also may discredit the whole program. We describe an unusual presentation of a common lesion among asbestos exposed individuals, which has to our knowledge never been described before. Being aware of this pathological pathway may prevent inadequate clinical decisions with disadvantages for the patient. Underlying implications regarding health surveillance and the reading of CT-scans of the thorax are important for the management of formerly asbestos exposed individuals.
During follow-up of an asbestos exposed 72 year old former power plant worker with known pleural changes, a nodule located next to the left costophrenic angle was newly discovered on CT-scan. As the previous scan 1 year before did not show any changes in that area, a fast growing tumour was suspected and an immediate biopsy performed. The tissue showed the characteristics of a pleural plaque with no signs of malignancy. After carefully reviewing all previous radiographs a rounded opacity attached to the mediastinal pleura close to the oesophagus and slightly cranial to the position of the removed nodule could be discerned. That nodule had increased in size over several years and was no longer visible on the latest scan. It appeared that the originally slow growing plaque had migrated to the costophrenic angle some time before it was discovered in the latest scan thus imposing as a fast growing tumour.
We concluded that asbestos related pleural plaques can under special circumstances get separated from the pleura and migrate to another position in the pleural cavity. The case provides new insights in the development and properties of pleural lesions and may offer new options for the management of formerly asbestos exposed patients.
对既往接触石棉者的健康监测主要聚焦于早期发现与石棉相关的疾病，尤其是肺纤维化（石棉沉着病）、胸膜斑、间皮瘤和肺癌。一个主要关注点是早期且明确地识别具有恶性变化高风险的病变，并对其进行及时的临床检查。假阳性结果可能导致不必要且往往痛苦的诊断干预，应用于大量人群时会产生高昂成本，还可能使整个项目声誉受损。我们描述了一种在接触石棉者中常见病变的不寻常表现，据我们所知，此前从未有过相关描述。了解这种病理过程可能避免做出对患者不利的不恰当临床决策。对于既往接触石棉者的管理而言，健康监测及胸部CT扫描解读的潜在影响至关重要。
在对一名72岁、有胸膜改变的既往接触石棉的前电厂工人进行随访期间，CT扫描新发现左肋膈角旁有一个结节。由于一年前的前一次扫描该区域未显示任何变化，怀疑是快速生长的肿瘤并立即进行了活检。组织显示为胸膜斑特征，无恶性迹象。仔细复查所有既往X光片后，可辨认出一个附着于纵隔胸膜、靠近食管且略高于切除结节位置的圆形不透明区。该结节数年中增大，在最新扫描中已不可见。似乎原本生长缓慢的斑块在最新扫描发现前一段时间已迁移至肋膈角，故而表现为快速生长的肿瘤。
我们得出结论，石棉相关的胸膜斑在特殊情况下可与胸膜分离并迁移至胸膜腔的另一位置。该病例为胸膜病变的发展及特性提供了新见解，可能为既往接触石棉患者的管理提供新选择。
