[Relevance of pathological examinations and lung dust analyses in the context of asbestos-associated lung cancer-No. 4104 of the list of occupational diseases in Germany].

This report discusses the relevance of pathological-anatomical examinations and lung dust analyses in the context of asbestos-related lung cancer on the basis of three case reports. The cases one and two demonstrate a limited performance of conventional computed tomography scanning with a resolution of 3 mm for the detection of asbestos-related pleural diseases. In these cases, only the autopsy was able to confirm the diagnosis of pleural plaques and, therefore, the German criteria for occupational disease No. 4104 of the list of the occupational diseases were fulfilled. Case three clearly shows that routine pathological examinations, especially without the consideration of an occupational disease, could not always successfully obtain the diagnosis of a grade I asbestosis. Only intense histological examinations (iron-staining, 400 x magnification) in combination with lung dust analysis were able to provide such a diagnosis. As shown here, pathological-anatomic examinations including lung dust analysis are highly valuable for the estimation of asbestos-related lung diseases. A merely partial consideration of all possible evidence forms can be responsible for the rejection of a reasonable compensation claim for an occupational disease. Therefore pathological-anatomic examinations are indispensable today and in the future. A definite rejection of occupational disease No. 4104 without an analysis of lung parenchyma is not justified.