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Vol. 12. Issue 5.
Pages 539-544 (September - October 2006)
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Vol. 12. Issue 5.
Pages 539-544 (September - October 2006)
Artigo Original / Original Article
Open Access
Carcinomas epidermóides do pulmão na doença vibroacústica
Respiratory squamous cell carcinomas in vibroacoustic disease
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José Reis Ferreira1, Carla P. Mendes2, Mariana Alves-Pereira3, Nuno A.A. Castelo Branco4
1 Médico pneumologista, Serviço de Pneumologia, Hospital da Força Aérea, Lisboa / Pulmonologist, Pulmonology Unit, Hospital da Força Aérea, Lisboa
2 Médica pneumologista, Serviço de Pneumologia, Hospital da Força Aérea, Lisboa / Pulmonologist, Pulmonology Unit, Hospital da Força Aérea, Lisboa
3 Engenheira biomédica, ERISA, Universidade Lusófona, Lisboa / Biomedical engineer, ERISA, Universidade Lusófona, Lisboa
4 Médico anatomopatologista, Presidente do Conselho Científico, Centro da Performance Humana, Alverca / Anatomopathologist, President, Scientific Council, Centro da Performance Humana, Alverca
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Enquadramento: Em 1987, observou-se durante a autópsia de um doente com doença vibroacústica (VAD) dois tumores: Um carcinoma de células renais e um glioma maligno cerebral. Desde 1987, temse vigiado o aparecimento de tumores em doentes com a VAD. Até à data, num universo de 945 indivíduos, há 46 casos de tumores malignos, dos quais 11 são múltiplos. Dos 11 casos de tumores do aparelho respiratório, todos eram carcinomas epidermóides (CE). O presente estudo aborda as características morfológicas destes tumores. Métodos: Foram recolhidos fragmentos destes tumores (biópsia endoscópica ou cirúrgica) de 11 doentes do sexo masculino (idade média: 58±9 anos, 3 não fumadores): 2 na glote e 9 no pulmão. Dos 3 não fumadores, 2 tinham tumores do pulmão e 1 tinha tumor da glote. Todos eram trabalhadores ou reformados da indústria aeronáutica, pilotos militares ou de linhas comerciais. Foram fixados fragmentos para microscopia óptica e electrónica. Para os estudos imuno-histoquímicos usouse coloração com cromagranina e sinaptofisina. Resultados: Todos os tumores pulmonares se localizaram no brônquio do lobo superior direito, e a sua histologia era de tumores epidermóides pouco diferenciados. A pesquisa com marcadores neuroendócrinos foi negativa. Nove doentes faleceram. Os 2 sobreviventes são grandes fumadores (> 2 maços/dia). A média de idade de aparecimento do tumor em pilotos de helicóptero estava abaixo dos 50 anos, enquanto para os outros dois grupos profissionais era superior a 50. Os hábitos tabágicos não tiveram influência na progressão e desfecho dos casos. Conclusões: O CE constitui aproximadamente 40% dos tumores pulmonares na população em geral. Face aos actuais resultados, torna-se muito importante especificar o tipo histológico exacto do tumor em todos os estudos estatísticos. Não surpreende a idade mais jovem de início dos tumores em pilotos de helicóptero, atendendo aos resultados dos estudos de mutagénese em modelos animais e em trabalhadores expostos a RBF: a frequência de trocas de cromátides irmãs em pilotos de helicóptero está aumentada, bem como em modelos animais expostos a ruído e vibrações simultâneos, simulando o ambiente no cockpit de helicópteros.

Rev Port Pneumol 2006; XII (5): 539-544

Palavras-chave:
Ruído de baixa frequência
infra-sons
pilotos de helicóptero
cancro do pulmão
carcinoma epidermóide
trocas de cromátides irmãs
Abstract

Background: In 1987, the autopsy of a vibroa-coustic disease (VAD) patient disclosed two tumours: a renal cell carcinoma and a malignant glioma in the brain. Since 1987, malignancy in VAD patients has been under close surveillance. To date, in a universe of 945 individuals, there are 46 cases of malignancies, of which 11 are multiple. Of the 11 cases of respiratory tract tumours, all were squamous cell carcinomas (SqCC). This report focuses on the morphological features of these tumours.

Methods: Tumour fragments were collected (endoscopic biopsy or surgery) from 11 male VAD patients (ave. age: 58±9 years, 3 non-smokers): 2 in glottis and 9 in the lung. In the 3 non-smokers, 2 had lung tumours and 1 had a glottis tumour. All were employed as or retired aircraft technicians, military or commercial pilots. Fragments were fixed either for light and electron microscopy. Immunohistochemistry studies used chromagranine and synaptophysine staining. Results: All lung tumours were located in the upper right lobe bron-chi and were histologically poorly differentiated SqCC (Figs. 1, 2). The search with neuroendocrine markers was negative. The average age of tumour onset in helicopter pilots was below 50 years old while for the other professional groups it was above 50. Nine patients are deceased. The 2 surviving patients are heavy smokers (> 2 packs/day). Smoking habits had no influence on tumour outcome and progression. Discussion: Epidemiological studies indicate that squamous cell carcinomas account for approximately 40% of all lung tumours in men. It seems to be highly relevant that all VAD patient respiratory tract tumours are squamous cell carcinomas. It is not surprising that helicopter pilots are the ones who are affected the earliest because previous studies have shown that helicopter pilots exhibited the highest values for the frequency of sister chromatid exchanges. Generally, epidemiological tumor studies do not take histological tumor type into account, but given the results herein, it would seem of the utmost importance to begin specifiying the exact histological type of tumor in all statistical studies.

Rev Port Pneumol 2006; XII (5): 539-544

Key-words:
Low frequency noise
infrasound
helicopter pilots
lung cancer
squamous cell carcinoma
sister chromatid exchanges
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Copyright © 2006. Sociedade Portuguesa de Pneumologia/SPP
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