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Pere Sanz-Gallén, Santiago Nogué, Eva Muñoz and Francisco Sabater*
Clinical Toxicology Unit and *Otorhinolaryngology Service. Hospital Clínic. Barcelona
The case-control study by D' Errico et al (1) on occupational risk factors for sinonasal cancer concludes that exposure to arsenic is one such factor and suggests more cases should be reported, as there...
The case-control study by D' Errico et al (1) on occupational risk factors for sinonasal cancer concludes that exposure to arsenic is one such factor and suggests more cases should be reported, as there are only two studies at present (2,3). We contribute a new case of a worker in the glassware industry, in order to reinforce the relationship between sinonasal cancer and occupational exposure to arsenic.
A middle-aged, non-smoking patient was diagnosed more than a decade previously with squamous cell carcinoma affecting the left maxilla. The initial computed tomography (CT) scan had shown a lesion occupying the space of the left maxillary sinus that had destroyed the bone structure of the left maxilla and invaded the soft facial tissue and the pterygopalatine fossa. A CT scan more than a decade later after surgery and radiotherapy shows changes in the nasal fossa and left maxillary sinus, with a fibrotic mass of scar tissue.
The patient worked in the glassware industry for over twenty years. The main materials forming the mix introduced in the glass furnace were silica, sodium carbonate, potassium carbonate, zinc oxide and lead oxide. The dyes, which represented 0.1% of the mixture, included cadmium sulphide and oxides of cobalt, copper, chromium, manganese and nickel. One per cent of arsenic trioxide was added to the mixture to increase the transparency of the glass. An onsite workplace study showed environmental levels of chromium and nickel <3 µg/m3, but levels of arsenic of 85 µg/m3 (Threshold Limit Value: 10 µg/m3).
Although chromium and nickel oxides, known sinonasal carcinogens, are used in the glassware industry, the environmental levels found were very low. However, the levels of arsenic were very high, in agreement with the study by Battista et al in various glassware companies (3). Therefore, arsenic trioxide should be replaced by other metals and preventive measures should be introduced to minimize the health risks of workers exposed to these substances in the workplace.
1. d'Errico A, Pasian S, Baratti A, Zanelli R, Alfonzo S, Gilardi L et al. A case-control study on occupational risk factors for sino-nasal cancer. Occup Environ Med. Publish Ahead of Print, January 19, 2009
2. Roth F. Uber den bronchialkrebs arsengeschadigter winzer. Virchows Arch Pathol Anat 1958;331: 119-137.
3. Battista G, Bartoli D, Iaia TE, Dini F, Fiumalbi C, Ciglioli S et al. Art glassware and sinonasal cancer: report of three cases. Am J Ind Med 1996; 30: 31-35.