Annals of Occupational and Environmental Medicine

Case Report

Glioblastoma in a paper industry worker exposed to high concentrations of formaldehyde: a case report: Youngshin Lee, Jiwoon Kwon, Miyeon Jang, Seongwon Ma, Kyo Yeon Jun, Minjoo Yoon, Shinhee Ye; Ann Occup Environ Med 2024;36:e17. Published online July 5, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e17

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub: Background
Formaldehyde was classified as a Group I Carcinogen by the International Agency for Research on Cancer (IARC) in 2006. While the IARC has stated that there is a lack of evidence that formaldehyde causes brain cancer, three meta-analyses have consistently reported a significantly higher risk of brain cancer in workers exposed to high levels of formaldehyde. Therefore, we report a case of a worker who was diagnosed with glioblastoma after being exposed to high concentrations of formaldehyde while working with formaldehyde resin in the paper industry.
Case presentation
A 40-year-old male patient joined an impregnated paper manufacturer and performed impregnation work using formaldehyde resin for 10 years and 2 months. In 2017, the patient experienced a severe headache and visited the hospital for brain magnetic resonance imaging, which revealed a mass. In the same year, the patient underwent a craniotomy for brain tumor resection and was diagnosed with glioblastoma of the temporal lobe. In 2019, a craniotomy was performed owing to the recurrence of the brain tumor, but he died in 2020. An exposure assessment of the work environment determined that the patient was exposed to formaldehyde above the exposure threshold of 0.3 ppm continuously for more than 10 years and that he had high respiratory and dermal exposure through performing work without wearing a respirator or protective gloves.
Conclusions
This case report represents the first instance where the epidemiological investigation and evaluation committee of the Occupational Safety and Health Research Institute in Korea recognized the scientific evidence of work-related brain tumors due to long-term exposure to high concentrations of formaldehyde during impregnated paperwork. This case highlights the importance of proper workplace management, informing workers that prolonged exposure to formaldehyde in impregnation work can cause brain tumors and minimizing exposure in similar processes.; 고농도 포름알데히드에 노출된 제지 산업 근로자에서 발생한 교모세포종: 사례보고
배경
포름알데히드는 2006년 국제암연구소(IARC)에서 1군 발암 물질로 분류되었다. IARC는 포름알데히드가 뇌종양을 유발한다는 증거가 부족하다고 밝혔지만, 세 건의 메타 분석에서 고농도의 포름알데히드에 노출된 근로자의 뇌종양 위험도가 상당히 높다고 일관되게 보고했다. 이에 포름알데히드 수지를 사용하는 제지 산업에서 근무하던 중 고농도의 포름알데히드에 노출되어 교모세포종 진단을 받은 근로자의 사례를 보고하고자 한다.
증례
40세 남성 환자는 함침지 제조업체에 입사하여 10년 2개월 동안 포름알데히드 수지를 사용한 함침 작업을 수행했다. 2017년 9월, 환자는 심한 두통을 느껴 병원을 방문하여 촬영한 뇌 자기공명영상(MRI)의 결과에서 종양이 발견되었다. 같은 해에 환자는 뇌종양 절제를 위해 개두술을 시행하였고 측두엽의 교모세포종을 진단받았다. 2019년 뇌종양 재발로 개두술을 시행하였지만 치료에도 불구하고 2020년 사망하였다. 환자의 작업환경 노출 평가 결과, 10년 이상 지속적으로 노출 기준치인 0.3ppm 이상의 포름알데히드에 노출되었고, 호흡기나 보호 장갑을 착용하지 않고 작업을 수행해 호흡기 및 피부 노출이 높았던 것으로 확인되었다.
고찰
본 사례는 국내 산업안전보건연구원 역학조사평가위원회가 함침 작업 중 고농도 포름알데히드에 장기간 노출되어 업무상 뇌종양이 발생하였다는 과학적 근거를 인정한 첫 사례이다. 이 사례를 통해 함침 작업에서 포름알데히드에 장기간 노출되면 뇌종양이 발생할 수 있음을 근로자에게 알리고 유사한 공정에서 노출을 최소화하는 등 적절한 작업환경관리의 필요성을 강조한다.

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Research Article

Does formaldehyde have a causal association with nasopharyngeal cancer and leukaemia?: Soon-Chan Kwon, Inah Kim, Jaechul Song, Jungsun Park; Ann Occup Environ Med 2018;30:5. Published online January 31, 2018; DOI: https://doi.org/10.1186/s40557-018-0218-z

Abstract PDF PubReader ePub

Background

The South Korean criteria for occupational diseases were amended in July 2013. These criteria included formaldehyde as a newly defined occupational carcinogen, based on cases of “leukemia or nasopharyngeal cancer caused by formaldehyde exposure”. This inclusion was based on the Internal Agency for Research on Cancer classification, which classified formaldehyde as definite human carcinogen for nasopharyngeal cancer in 2004 and leukemia in 2012.

Methods

We reviewed reports regarding the causal relationship between occupational exposure to formaldehyde in Korea and the development of these cancers, in order to determine whether these cases were work-related.

Results

Previous reports regarding excess mortality from nasopharyngeal cancer caused by formaldehyde exposure seemed to be influenced by excess mortality from a single plant. The recent meta-risk for nasopharyngeal cancer was significantly increased in case-control studies, but was null for cohort studies (excluding unexplained clusters of nasopharyngeal cancers). A recent analysis of the largest industrial cohort revealed elevated risks of both leukemia and Hodgkin lymphoma at the peak formaldehyde exposure, and both cancers exhibited significant dose-response relationships. A nested case-control study of embalmers revealed that mortality from myeloid leukemia increased significantly with increasing numbers of embalms and with increasing formaldehyde exposure. The recent meta-risks for all leukemia and myeloid leukemia increased significantly. In South Korea, a few cases were considered occupational cancers as a result of mixed exposures to various chemicals (e.g., benzene), although no cases were compensated for formaldehyde exposure. The peak formaldehyde exposure levels in Korea were 2.70–14.8 ppm in a small number of specialized studies, which considered anatomy students, endoscopy employees who handled biopsy specimens, and manufacturing workers who were exposed to high temperatures.

Conclusion

Additional evidence is needed to confirm the relationship between formaldehyde exposure and nasopharyngeal cancer. All lymphohematopoietic malignancies, including leukemia, should be considered in cases with occupational formaldehyde exposure.

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Glioblastoma in a paper industry worker exposed to high concentrations of formaldehyde: a case report
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Case Reports

A case of multiple myeloma in a poultry worker: Pil Kyun Jung, Inah Kim, Inhyo Park, Chinyon Kim, Eun-A Kim, Jaehoon Roh; Ann Occup Environ Med 2014;26:35. Published online November 1, 2014; DOI: https://doi.org/10.1186/s40557-014-0035-y

Abstract PDF Supplementary Material PubReader ePub

Background

Livestock breeders including poultry workers are exposed to various agricultural chemicals including pesticides and/or organic solvents. Multiple myeloma is a rare disease in Korea, and few reports have investigated the influence of occupational exposures on multiple myeloma occurrence.

Case presentation

A 61-year-old male poultry farm worker presented with bone pain and generalized weakness. A bone marrow biopsy was performed, and he was diagnosed with multiple myeloma. The patient had worked in a poultry farm for 16 years and was exposed to various pesticides and organic solvents such as formaldehyde without any proper personal protective equipment. Results of the work reenactment revealed that the concentration of formaldehyde (17.53 ppm) greatly exceeded the time-weighted average (0.5 ppm) and short-term exposure limit (1.0 ppm) suggested in the Korean Industrial Safety and Health Act.

Conclusions

This case report suggests that poultry workers may be exposed to high levels of various hazardous chemicals including pesticides and/or organic solvents. Numerous previous studies have suggested an association between multiple myeloma and exposure to agricultural chemicals; thus, multiple myeloma in this patient might have resulted from the prolonged, high exposure to these chemicals.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-014-0035-y) contains supplementary material, which is available to authorized users.

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Occupational risk factors in health of broiler-farm workers: A systematic review
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Malignant Fibrous Histiocytoma of the Maxillary Sinus in a Spray Painter from an Automobile Repair Shop: Seok-Hwan Choi, Se-Yeong Kim, Man-Ki Son, Hui-Seok Yang, Sun-Woo Lee, Jung-Il Kim, Kap-Yeol Jung; Ann Occup Environ Med 2013;25:30-30. Published online November 1, 2013; DOI: https://doi.org/10.1186/2052-4374-25-30

Abstract PDF PubReader ePub

Background

We report a case of a spray painter who developed malignant fibrous histiocytoma (MFH) of the maxillary sinus following long-term exposure to chromium, nickel, and formaldehyde, implying that these agents are probable causal agents of MFH.

Case report

The patient developed right-sided prosopalgia that began twenty months ago. The symptom persisted despite medical treatment. After two months, he was diagnosed with MFH through imaging studies, surgery, and pathological microscopic findings at a university hospital in Seoul. His social, medical, and family history was unremarkable.

The patient had worked for about 18 years at an automobile repair shop as a spray painter. During this period, he had been exposed to various occupational agents, such as hexavalent chromium, nickel, and formaldehyde, without appropriate personal protective equipment. He painted 6 days a week and worked for about 8 hours a day.

Investigation of the patient’s work environment detected hexavalent chromium, chromate, nickel, and formaldehyde.

Conclusions

The study revealed that the patient had been exposed to hexavalent chromium, formaldehyde, and nickel compounds through sanding and spray painting. The association between paranasal cancer and exposure to the aforementioned occupational human carcinogens has been established. We suggest, in this case, the possibility that the paint spraying acted as a causal agent for paranasal cancer.

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Original Articles

The Health Effects of Formaldehyde during an Anatomy Dissection Course: Si Young Park, Chang Yoon Kim, Joo Young Kim, Joon Sakong; Korean Journal of Occupational and Environmental Medicine 2006;18(3):171-178. Published online September 30, 2006; DOI: https://doi.org/10.35371/kjoem.2006.18.3.171

Abstract PDF

OBJECTIVES
This study evaluated the acute health effect of formaldehyde during an anatomy dissection course.
METHODS
The formaldehyde concentrations in a gross anatomy laboratory were measured and analyzed during an anatomy dissection course attended by eighty medical students. The Pulmonary Function Test and three tests of the Korean Computerized Neurobehavioral Test (digit classification, digit addition and symbol digit) were given to thirty of the eighty medical students at the pre- and post-exposure. A questionnaire survey was administered to the eighty medical students at the pre- and post-exposure.
RESULTS
The differences in the mean FVC and FEV(1) were statistically significant (p<0.01) at the preand post-exposure. In the low exposed group (<2 ppm), only the decreases in FEV(1) on post-exposure were statistically significant (p<0.05) compared with FEV(1) on pre-exposure. In the high exposed group (> or = 2 ppm), decreases in both FVC and FEV(1) on post-exposure were statistically significant (p<0.05). The overall performance on the digit classification, digit addition and symbol digit of the Korean Computerized Neurobehavioral Test on post-exposure was lower than that on pre-exposure. In the low exposed group, the performances on the digit classification and symbol digit were lower than those on pre-exposure. In the high exposed group, the performances on digit classification, digit addition and symbol digit were lower than those on pre-exposure. Complaints involving the eyes, nose and throat increased substantially on post-practice compared with pre-practice in both groups. There were statistically significant differences in the complaints involving the eyes, nose and throat between the pre-practice and post-practice in both groups (p<0.05). There were more complaints in the high exposed group than in the low exposed group.
CONCLUSIONS
Formaldehyde exposure during a dissection can decrease the pulmonary function and neurobehavioral performance, and can increase the complaints involving the eyes, nose and throat. The effect on the symptoms, pulmonary function and neurobehavioral performance is positively correlated with the formaldehyde level.

Citations

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Safety and Management Status of Anatomical Labs in Medical Schools
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Soon-Chan Kwon, Inah Kim, Jaechul Song, Jungsun Park
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The effect of formaldehyde on neurobehavioral performance of student during cadaver dissection
Yong Sakong, Hee-Yoon Jo, In-Gook Lee, Kyeong-Soo Lee, Man-Joong Jun
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Sister-Chromatid Exchanges in Lymphocytes of Medical Students Exposed to Formaldehyde: Soo Jin Lee, Jeong Il Son, Sang Hyo Sim, Kee Young Kim, Jaecheol Song, Suo Ja Chu, Sung Han Shim, Youl Hee Cho, Doo Jin Park; Korean Journal of Occupational and Environmental Medicine 1998;10(2):282-289. Published online May 31, 1998; DOI: https://doi.org/10.35371/kjoem.1998.10.2.282

Abstract PDF

Sister-chromatic exchanges measured in the peripheral lymphocytes of 15 non-smoking medical students after exposure to formaldehyde during a 24-week anatomy class showed a small but significant (p=0.0468) increase when compared with samples obtained from the same individuals immediately before exposure. Mean frequencies of sister-chromatic exchange of cultured peripheral lymphocytes were 5.40+/-0.24 from the samples before exposure and 5.87+/-0.22 from the same samples after exposure. Breathing-zone air samples collected by formaldehyde monitoring kit with digital colorimeter (SKC) showed a mean concentration of 0.72+/-0.02 ppm formaldehyde.

Citations

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The effect of formaldehyde on neurobehavioral performance of student during cadaver dissection
Yong Sakong, Hee-Yoon Jo, In-Gook Lee, Kyeong-Soo Lee, Man-Joong Jun
Yeungnam University Journal of Medicine.2016; 33(2): 85. CrossRef

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