Kobayashi Kazuhiro, Watanabe Naoki, Oka Teruaki, Tomita Hiroyuki, Suzui Natsuko, Oumi Yasunori, Hara Akira, Miyazaki Tatsuhiko
Department of Pathology, Gifu University Hospital, Gifu-City, Japan.
Division of Pathology, Gifu Municipal Hospital, Gifu-City, Japan.
Pathol Int. 2019 Apr;69(4):229-234. doi: 10.1111/pin.12772. Epub 2019 Feb 18.
A 73-year-old Japanese man, who worked at a confectionery company for more than 20 years, was diagnosed with a 28 mm nodular lesion in the superior lobe of the right lung by whole-body computed tomography examination. A biopsy revealed the presence of adenocarcinoma. With a diagnosis of a primary lung cancer, a right upper lobectomy was performed. A nodular lesion, 25 × 23 mm in size, was observed in the upper right lobe lung field, and was diagnosed histopathologically as a papillary adenocarcinoma. In addition, fibrous scars in the central part of the tumor showed numerous Langhans and/or foreign body giant cells, and histiocytic cells that had phagocytized numerous small transparent crystals, together with coal powder deposition. The extracted crystals were observed with a scanning electron microscope, and although plate-like structures were observed, ferruginous bodies suggestive of asbestos were not found. The crystals were demonstrated to be talc by powder X-ray diffraction. Herein, we investigated a case of lung adenocarcinoma in a patient with talcosis, with discussions based on a literature search. This collision of talcosis and lung adenocarcinoma adds to an increasing body of knowledge on an apparent association between talc and cancer cases.
一名73岁的日本男性，在一家糖果公司工作了20多年，通过全身计算机断层扫描检查发现右肺上叶有一个28毫米的结节性病变。活检显示存在腺癌。诊断为原发性肺癌后，进行了右上叶切除术。在右上叶肺野观察到一个大小为25×23毫米的结节性病变，组织病理学诊断为乳头状腺癌。此外，肿瘤中央部分的纤维瘢痕显示有大量朗汉斯巨细胞和/或异物巨细胞，以及吞噬了大量小透明晶体的组织细胞，同时伴有煤尘沉积。用扫描电子显微镜观察提取的晶体，虽然观察到板状结构，但未发现提示石棉的含铁小体。通过粉末X射线衍射证明晶体为滑石粉。在此，我们调查了一例滑石肺患者的肺腺癌病例，并基于文献检索进行了讨论。滑石肺与肺腺癌的这种碰撞增加了关于滑石与癌症病例之间明显关联的知识体系。
