Pathology of asbestosis- An update of the diagnostic criteria: Report of the asbestosis committee of the college of american pathologists and pulmonary pathology society.

Asbestosis is defined as diffuse pulmonary fibrosis caused by the inhalation of excessive amounts of asbestos fibers. Pathologically, both pulmonary fibrosis of a particular pattern and evidence of excess asbestos in the lungs must be present. Clinically, the disease usually progresses slowly, with a typical latent period of more than 20 years from first exposure to onset of symptoms. DIFFERENTIAL DIAGNOSIS: IDIOPATHIC PULMONARY FIBROSIS: The pulmonary fibrosis of asbestosis is interstitial and has a basal subpleural distribution, similar to that seen in idiopathic pulmonary fibrosis, which is the principal differential diagnosis. However, there are differences between the 2 diseases apart from the presence or absence of asbestos. First, the interstitial fibrosis of asbestosis is accompanied by very little inflammation, which, although not marked, is better developed in idiopathic pulmonary fibrosis. Second, in keeping with the slow tempo of the disease, the fibroblastic foci that characterize idiopathic pulmonary fibrosis are infrequent in asbestosis. Third, asbestosis is almost always accompanied by mild fibrosis of the visceral pleura, a feature that is rare in idiopathic pulmonary fibrosis. DIFFERENTIAL DIAGNOSIS: RESPIRATORY BRONCHIOLITIS: Asbestosis is believed to start in the region of the respiratory bronchiole and gradually extends outward to involve more and more of the lung acinus, until the separate foci of fibrosis link, resulting in the characteristically diffuse pattern of the disease. These early stages of the disease are diagnostically problematic because similar centriacinar fibrosis is often seen in cigarette smokers and is characteristic of mixed-dust pneumoconiosis. Fibrosis limited to the walls of the bronchioles does not represent asbestosis. ROLE OF ASBESTOS BODIES: Histologic evidence of asbestos inhalation is provided by the identification of asbestos bodies either lying freely in the air spaces or embedded in the interstitial fibrosis. Asbestos bodies are distinguished from other ferruginous bodies by their thin, transparent core. Two or more asbestos bodies per square centimeter of a 5- mu m-thick lung section, in combination with interstitial fibrosis of the appropriate pattern, are indicative of asbestosis. Fewer asbestos bodies do not necessarily exclude a diagnosis of asbestosis, but evidence of excess asbestos would then require quantitative studies performed on lung digests. ROLE OF FIBER ANALYSIS: Quantification of asbestos load may be performed on lung digests or bronchoalveolar lavage material, employing either light microscopy, scanning electron microscopy, or transmission electron microscopy. Whichever technique is employed, the results are only dependable if the laboratory is well practiced in the method chosen, frequently performs such analyses, and the results are compared with those obtained by the same laboratory applying the same technique to a control population.

An evaluation of the risks of lung cancer and mesothelioma from exposure to amphibole cleavage fragments.

Amphiboles are hydrated mineral silicates five of which occur in asbestiform habits as asbestos grunerite (amosite) asbestos, riebeckite (crocidolite) asbestos, anthophyllite asbestos, tremolite asbestos and actinolite asbestos] and non-asbestiform habits (grunerite, riebeckite, anthophyllite, tremolite and actinolite). The asbestiform varieties are characterized by long, thin fibers while non-asbestiform varieties such as cleavage fragments form short fibers with larger widths. The U.S. regulatory method for counting asbestos fibers (aspect ratio > or = 3:1, length > or = 5 microm) does not distinguish between asbestos and cleavage fragments. The method biases toward increased counts of non-asbestiform cleavage fragments compared to long, thin asbestos fibers. One consequence of this regulatory approach is that workers can be erroneously classified as exposed to concentrations of asbestos (asbestiform amphiboles) above the U.S. 0.1 f/mL exposure standard when in fact they are not exposed to asbestos at all but non-asbestiform amphibole cleavage fragments. Another consequence is that the known carcinogenic effects of asbestos may be falsely attributed to non-asbestiform amphibole cleavage fragments of the same mineral. The purpose of this review is to assess whether amphibole cleavage fragments pose the same risk of lung cancer and mesothelioma characteristic of amphibole asbestos fibers. We identified three groups of workers exposed to non-asbestiform amphiboles: two groups exposed to grunerite (Homestake gold miners and taconite miners) and one group exposed to industrial talc containing non-asbestiform tremolite and anthophyllite in St. Lawrence County, NY. In addition to assessing strength of association and exposure-response trends in the non-asbestiform amphibole cohorts, comparisons were also made with cohorts exposed to the asbestiform counterpart (positive control) and cohorts exposed to the mineral (e.g. talc) that does not contain amphiboles (negative controls). The cohorts exposed to non-asbestiform amphiboles had no excesses of lung cancer or mesothelioma. Similar results were observed in the negative control groups, in stark contrast to the excess risks of asbestos-related disease found in the asbestos cohorts. The only possible exception is the twofold increased risk of lung cancer where exposure was to industrial talc containing cleavage fragments of tremolite and anthophyllite. However, this risk is not considered attributable to the talc or amphibole cleavage fragments for several reasons. A similar increased risk of lung cancer was found in Vermont talc workers, studied in the same time period. Their exposure was to relatively pure talc. There was no relationship between lung cancer mortality and exposure measured as mg/m(3)years and years worked. A case-control study reported that all the lung cancer cases were smokers (or former smokers) and attributed the excess to smoking. There were two mesothelioma cases among the NY State talc workers exposed to cleavage fragments of tremolite and anthophyllite, but talc is not a plausible cause because of too short latency and potential for previous asbestos exposure. The positive controls of tremolite asbestos and anthophyllite asbestos exposed workers showed excess risks of both lung cancer and mesothelioma and positive exposure-response trends. St. Lawrence, NY talc does not produce mesotheliomas in animals while amphibole asbestos does. In sum, the weight of evidence fully supports a conclusion that non-asbestiform amphiboles do not increase the risk of lung cancer or mesothelioma.

Exposure to airborne amphibole structures and health risks: Libby, Montana.

Libby, Montana is the site of a large vermiculite deposit that was mined between 1920 and 1990 to extract vermiculite for commercial applications such as insulation, gardening products, and construction materials. The Libby vermiculite deposit also contains amphibole minerals including tremolite, actinolite, richterite, and winchite. Historically, Libby mine workers experienced high exposures to amphibole structures, and, as a group, have experienced the health consequences of those occupational exposures. It has been suggested that Libby residents also have been and continue to be exposed to amphibole structures released during the vermiculite mining operations and therefore are at increased risk for disease. The Agency for Toxic Substance and Disease Registry (ATSDR) conducted two epidemiological-type studies of residents living in Libby and the surrounding areas to assess these risks. The Environmental Protection Agency (EPA) collected and analyzed exposure data in Libby and used those data to project risks of asbestos-associated disease for Libby residents. The EPA has placed the Libby Asbestos Site, which includes the mine and the town of Libby, on its National Priority List of hazardous waste sites in need of clean up. This article presents a review of the exposure studies conducted in Libby and an analysis of health risks based on the data collected in those studies. Libby mine workers have experienced elevated levels of asbestos-associated disease as a consequence of their occupational exposures to amphibole structures. Libby residents' exposures typically are substantially lower than mine workers' historical exposures, and the health risk projections for residents are, accordingly, substantially lower.

Características, propiedades, patogenia y fuentes de exposición del asbesto / Asbestos: characteristics, properties, pathogenesis and sources of exposure

El asbesto es un mineral fibroso conocido desdeantiguo, utilizado ampliamente en la industria debido asus propiedades físicas y químicas que lo hacen muyadecuado para dicho fin. Los tipos de asbesto se clasificanen grupo serpentina y en anfiboles según la configuracióncurvada o recta de sus fibras. En cuanto a suspropiedades destacan la resistencia al calor, al desgaste,a los álcalis y ácidos y su flexibilidad entre otrascaracterísticas que lo hacen un material adecuadopara ser utilizado como aislante, en la industria textil yen otros muchos campos. Es conocido desde haceaños el riesgo patogénico del amianto al permanecertiempo en el tejido pulmonar, atribuyéndole según losestudios la alteración de la actividad mucociliar delhuésped, la activación macrofágica y la liberación demediadores inflamatorios así como un aumento de supoder oncogénico al asociarse al humo del tabaco eincluso a ciertos virus

Asbestos is a fibrous mineral that has been knownsince ancient times. It is widely used in industry due toits physical and chemical properties which make ithighly suitable for this end. Asbestos is classified intwo groups - serpentine and amphibole - depending onthe curved or straight configuration of their fibres.Outstanding amongst its properties are its resistanceto heat, wear, alkalis and acids, and its flexibility,amongst other characteristics, which make it a suitablematerial for use as insulation, in industrial textiles andin many other fields. The pathogenic risk of asbestosremaining for a long time in the pulmonary tissue hasbeen known for many years; studies attribute it withalteration of the mucociliary activity of the host,macrophage activation and the freeing of inflammatorymediators as well as an increase in their oncogenicstrength on association with tobacco and even someviruses

Lung mineral fibers of former miners and millers from Thetford-Mines and asbestos regions: a comparative study of fiber concentration and dimension.

Fiber dimension and concentration may vary substantially between two necropsy populations of former chrysotile miners and millers of Thetford-Mines and Asbestos regions. This possibility could explain, at least in part, the higher incidence of respiratory diseases among workers from Thetford-Mines than among workers from the Asbestos region. The authors used a transmission electron microscope, equipped with an x-ray energy-dispersive spectrometer, to analyze lung mineral fibers of 86 subjects from the two mining regions and to classify fiber sizes into three categories. The most consistent difference was the higher concentration of tremolite in lung tissues of workers from Thetford-Mines, compared with workers from the Asbestos region. Amosite and crocidolite were also detected in lung tissues of several workers from the Asbestos region. No consistent and biologically important difference was found for fiber dimension; therefore, fiber dimension does not seem to be a factor that accounts for the difference in incidence of respiratory diseases between the two groups. The greater incidence of respiratory diseases among workers of Thetford-Mines can be explained by the fact that they had greater exposure to fibers than did workers at the Asbestos region. Among the mineral fibers studied, retention of tremolite fibers was most apparent.