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  Table of Contents 
CASE REPORT
Year : 2020  |  Volume : 24  |  Issue : 3  |  Page : 203-205
 

The medical concrete cancer of the lung: A unique case report


1 Azienda per l' Assistenza Sanitaria n. 5 “Friuli Occidentale”, Struttura Complessa di Pneumologia, Pordenone, Italy
2 Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Date of Submission24-Apr-2019
Date of Decision12-Jan-2020
Date of Acceptance04-Apr-2020
Date of Web Publication14-Dec-2020

Correspondence Address:
Dr. Unnati Desai
Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai - 400 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.IJOEM_94_19

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  Abstract 


A 53-year-old 10 pack year smoker and concrete worker for 12 years presented to us with a lung mass proven to be small cell lung cancer on lung biopsy. An industrial terminology of concrete cancer already exists defining the wear and tear in concrete due to various interactions. The interactions of concrete and smoke on lung, predisposed and increased the risk of lung cancer probably as an additive effect which we label as the medical concrete cancer of the lung.


Keywords: Building industry, cement, concrete, lung cancer, small cell cancer


How to cite this article:
Tamburrini M, Desai U, Zuccon U, Barbetta C. The medical concrete cancer of the lung: A unique case report. Indian J Occup Environ Med 2020;24:203-5

How to cite this URL:
Tamburrini M, Desai U, Zuccon U, Barbetta C. The medical concrete cancer of the lung: A unique case report. Indian J Occup Environ Med [serial online] 2020 [cited 2021 Jan 27];24:203-5. Available from: https://www.ijoem.com/text.asp?2020/24/3/203/302828





  Introduction Top


Occupational exposures and respiratory morbidity has been known for decades.[1],[2] However, literature is sparse on the understanding of why and what causes the respiratory dysfunction. Occupations like the building/construction industry have exposure to inorganic dusts of various kinds with smoke fumes. Respiratory system is involved in these workers causing respiratory diseases like COPD to lung cancers and mesotheliomas.[3],[4] We report a case of small cell cancer of the lung in a concrete cement worker who was also a smoker (10 pack years). Concrete cancer or concrete spalling is an terminology used in the industrial field which signifies dangerous cracking or breaking of concrete due to various additive reasons.[5] Similarly, the occupational exposures in building industry to cement, concrete, mortar, and others with concurrent exposure to cigarette smoke resulted in an additive effect causing the small cell cancer which we label as the medical concrete cancer of the lungs in our patient.


  Case Summary Top


A 53-year-old man presented to the out-patient department with complaints of a febrile illness and cough for 2 weeks. The view of a chest X Ray (CXR) opacity and possibility of community acquired pneumonia; he was treated with doxycycline (100 mg) twice daily for 5 days. He responded to antibiotic therapy. However in view of persistent CXR opacity and a left hilar lesion on 1 month follow-up, a non-resolving Chest X -ray opacity at one month duration prompted the treating doctor to do CECT of the thorax [Figure 1]. The past and family history was not relevant for any major medical illness. The patient was a resident of Italy since 2003 and hailing from Ukraine. He worked as a construction industry worker since last 12 years in Italy. His role was of a concrete mixer while making buildings. Previously in Ukraine, he worked in various similar occupations like the construction industry majorly and glass industry for few years. He is a current smoker of 10 pack years. The CECT thorax revealed a 31 × 21 × 50 mm mass lesion surrounding the left lower lobe bronchus and its proximal branches with vascular involvement. The mass partially enveloped the lingular bronchus. A 14 mm nodule was also seen at the apical segment of the left lower lobe adherent to the fissure [Figure 2]. The conventional bronchoscopy showed abnormal bronchial mucosa however no endobronchial lesion [Figure 3]. An endobronchial ultrasound (EBUS) guided biopsy was performed [Figure 4]. The biopsy on histopathological examination confirmed small cell lung cancer.
Figure 1: Chest radiograph showing a left hilar opacity

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Figure 2: Computed tomography of the thorax showing a 31 × 21 × 50 mm mass lesion surrounding the left lower lobe bronchus

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Figure 3: Bronchoscopy image showing the abnormal mucosa in the left lower lobe bronchus

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Figure 4: EBUS image of the EBUS guided biopsy of the left lower lobe lesion

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The patient was referred to the medical oncology services for further palliative care.


  Discussion Top


The construction industry involves a heterogenous work profile including construction, demolition, stone masonry, stone cutting, paving, pottery, ceramics and glass manufacturing, mining, quarrying, and sand blasting.[6] These workers are exposed to mixture of hazardous materials like limestone, granite, crystalline silica, and cement by inhalation and direct contact. Some studies also indicate a link between crystalline silica exposure and lung cancer.[7]

In construction, concrete is an important composite building material, comprising of aggregate (typically a rocky material) and a binder (typically Portland cement or asphalt). Aggregate consists of coarse gravel or crushed rocks such as limestone, or granite, along with finer materials such as sand in a concrete mix. Binder consists of a cement, with most commonly Portland cement being used. Portland cement is a type of cement used in construction industry for concreting and plastering. The other types of cements are used in oil, gas industry, water pipes and sewage system. Other mineral and chemical admixtures may be added in the process.[8] Industrial concrete cancer is caused when the aggregate within a concrete slab begins to degrade.Cigarette smoking or other forms of smoking have been observed in people working in these occupations. While the additive risk of smoking and asbestos exposure has been documented in literature, the same is not true for other commoner occupational exposures.[9] Concrete has been associated with multiple health problems including predisposition to lung and skin cancers. The interaction that concrete has in addition to smoking in these workers has not documented. The type of a worker’s job may influence smoking rates. This was proven in a US-based study in on-site engineers. It concluded that worker’s exposed to factors like lead/lead-based paint, asbestos, silica, solvents, benzene were less likely to smoke, whereas those exposed to asphalt fumes, heat stress, concrete, and welding fumes were more likely to smoke.[10]

Our case patient was a field worker exposed to various environmental agents like concrete over many years in addition to being a smoker of 10 pack years. The interaction that concrete has in addition to smoking in these workers has not been documented in the past literature. In addition these workers are often involved in associated industry jobs exposing them to multitude risk factors. In our case our patient had worked in both the construction as well as glass industry. The dual exposure of concrete from occupational exposures and cigarette smoke, increased the risk and may be hypothesised to have an additive effect in the predisposition to small cell lung cancer in our patient. These lung cancers presenting due to the probable additive effect of exposures to concrete, other construction work and cigarette smoke are labelled uniquely by us as the medical concrete cancer.


  Conclusions Top


Medical concrete cancer of the lung is the lung cancer caused due to various interactions of concrete with other occupational exposures and smoke.

Please mention if you have obtained a patient (or relatives) consent for publication-Yes

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hoy RF. Respiratory problems- occupational and environmental exposures. AustFam Physician 2012;41:856-60.  Back to cited text no. 1
    
2.
ATS. Occupational lung diseases. Available from: https://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/chapter-13-occupational-lung-diseases.pdf. [Last accessed on 2019 Apr22].  Back to cited text no. 2
    
3.
Occupational Disease among Construction Worker. Available from: https://www.cpwr.com/sites/default/files/research/OccupationalDisease AmongWorkers.pdf. [Last accessed on 2019 Apr 22].  Back to cited text no. 3
    
4.
Sullivan PA, Bang KM, Hearl FJ, Wagner GR. Respiratory disease risks in the construction industry.Occup Med 1995;10:313-34.  Back to cited text no. 4
    
5.
Concrete cancer. Available from: https://en.wikipedia.org/wiki/Alkali–silica_reaction. [Last accessed on 2019 Apr22].  Back to cited text no. 5
    
6.
Occupational disease in construction. Available from: https://www.sheilds.org/occupational-disease-construction/. [Last accessed on 2019 Apr 22].  Back to cited text no. 6
    
7.
Knutsson A, Damber L, Jarvholm B. Cancers in concrete workers: Results of a cohort study of 33668 workers. Occup Environ Med 2000;57:264-7.  Back to cited text no. 7
    
8.
Concrete. Wikipedia. Available from: https://en.wikipedia.org/wiki/Concrete. [Last accessed on 2019 Apr 22].  Back to cited text no. 8
    
9.
Case BW. Asbestos, smoking and lung cancer: Interaction and attribution. Occup Environ Med 2006;63:507-8.  Back to cited text no. 9
    
10.
Hong O, Duffy SA, Choi SH, Chin DL. The association between occupational exposure and cigarette smoking among operating engineers. Arch Environ Occup Health 2014;69:172-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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