Researchers from Romania have presented a case study in which they have argued on the importance of correct diagnosis of asbestos related cancers and also on the importance of lung biopsy as the key diagnostic procedure to distinguish asbestos related cancers.

"Distinction between mesothelioma and lung adenocarcinoma based on immunohistochemistry in a patient with asbestos bodies in bronchoalveolar fluid – case report" has been published by the researchers of the University of Medicine and Pharmacy, Bucharest, Romania on 29th November, 2016 in the Romanian Journal of Morphology and Embryology.

Importance of Correct Diagnosis

Asbestos related cancers are often misdiagnosed because of their similar symptoms, while the causes and treatments of all cancers are different. For example epithelioid mesothelioma is often misdiagnosed with adenocarcinoma, which renders in the correct treatment of the disease.

Key Statistics of Lung Cancer

World Health Organization (WHO) has reported that every year over 100,000 people all around the world die with asbestos related diseases. Among these, lung cancer is the most common cause of deaths.

American Society has estimated that in 2017, 222,5000 new cases of lung cancer will be reported, and approximately 155,500 deaths. And these statistics are only for United States. Lung cancer has been proved to be the leading cause of cancerous deaths. For that reason assessment of correct diagnosis is crucially important to apply the correct medicinal procedures, and thus for the recovery and better health of the patients.

Discussion on Patient’s Case History

Asbestos-related cancers include lung cancer, mesothelioma, asbestosis, asbestos-related gastrointestinal and many other fatal diseases. In this case study, the researchers have studied a case of 61 years old man, who was suffering from chronic lung disease, which was complicated by the accumulation of fluid around the right lung.

He was treated for tuberculosis two years ago. After a year of treatment, a 3 cm long nodule was detected through X-rays in his right lung.

According to his occupational history, it was find out that for over 29 years, he was working at asbestos-cement industry. Through Bronchoalveolar lavage (BAL- in which bronchoscope, containing salt water, is injected inside a small portion of lung and immediately sucked out, immersed with the cells of these air sacs) presence of asbestos bodies was revealed in his lungs.

Early Diagnosis results in confused results

On the basis of 36 years retention time of these asbestos bodies in the patient's lungs, he was diagnosed with asbestosis. But the retention of fluid in the outer space of lungs is a common manifestation of pleural tuberculosis, mesothelioma or lung cancer. In this case specifically, it was discovered that the asbestos related cancer was adenocarcinoma, a cancer that flourish in the inner epithelial lining of the organs.

Application of Immunohistochemical Analysis  and Lung Biopsy

Through analysis of histopathological and IHC (Immunohistochemical) pattern, the researchers concluded that in patients with excessive asbestos exposure, the retention of fluid in the outer space of the lung is not the valid sign of mesothelioma occurrence.

As pleural mesothelioma and adenocarcinoma, both occur at epithelial lining of the organs, but give different results through immunohistochemical and histopathological studies, so careful evaluation of the exact cause of fluid retention through lung biopsy is crucially important for correct diagnosis.


It was concluded by the researchers that initially development of malignant mesothelioma was diagnosed, but with the results of immunohistochemistry analysis of the BAL samples, the condition of lung adenocarcinoma was diagnosed.

Key Points for Correct Diagnosis

In a nutshell, in all cases of occupational cancers resulted with the asbestos exposure, all tests must be performed including BALF, immunohistochemical analysis and lung biopsy. Thus to correctly infer the actual state of asbestos related cancer.

Accurate diagnosis of cancer will lead to the right treatment, as many cancers seems similar with respect to symptoms and affected location, but their treatment varies.

Taking the mesothelioma and adenocarcinoma example again, these are very similar in their point of occurrence, but mesothelioma is a very rare, difficult to treat and uncommon disease. On the other hand, adenocarcinoma is less aggressive type of cancer, with high outcome of positively treated patients.