Abstract
A 72-year-old case diagnosed as esophageal cancer was admitted because of non-productive cough and exertional dyspnea after receiving a total dose of 150mg of Bleomycin. He had a history of asbestos exposure for seven months nineteen years previously. The physical examination showed fine crackles at the base of the chest and clubbed fingers. A chest X-ray film revealed irregular opacities and honeycombing in the lower lung fields and bilateral pleural thickening. A diagnosis of Bleomycin pneumonitis was made and Predonisolone, 30mg daily, was begun, with some improvement. However, he suffered from influenza A and died of progressive respiratory insufficiency.
The autopsy revealed squamous cell carcinoma of the esophagus, fibrosis of the lung, which was thought to be mainly due to asbestosis, and remarkable bilateral pleural plaques. The inhaled asbestos fibers were demonstrated to be amosite by X-ray analysis. The histological examination of the pleural plaques revealed a developmental process from the early to mature stage; i.e. each step of fibrinous exudation, organization and hyalinization. These steps suggest a mechanical irritation of the parietal pleura by asbestos fibers within the lung. This theory of mechanical irritation was also supported by another result of our own study that the number of asbestos fibers found in the pleural plaques obtained at autopsy from the subjects with asbestos exposure is quite small.
