Occurrence of Sinonasal Intestinal-Type Adenocarcinoma and Non-Intestinal-Type Adenocarcinoma in Two Countries with Different Patterns of Wood Dust Exposure

SIMPLE SUMMARY: Wood dust exposure is a reported pathogenetic factor for sinonasal intestinal-type adenocarcinoma, particularly in occupational exposure in wood-working industries. This study characterized wood dust exposure and compared the occurrence of sinonasal intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma between France with predominantly deciduous hardwood forests and Finland with mostly coniferous softwood forests. The findings indicated that sinonasal intestinal-type adenocarcinomas occur much more frequently in France than in Finland and are distinctly more common than non-intestinal adenocarcinomas, while in Finland the reverse is true. This is the first systematic comparison of the occurrence of the two tumor types in countries with distinctly different wood usage and wood dust exposure. It is also the first systematic study on differences in wood dust exposure between sinonasal intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma. The results provide important epidemiological information on pathogenetic differences between the two tumor types, highlighting the significance of the source of the wood dust. ABSTRACT: Sinonasal intestinal-type adenocarcinoma is strongly associated with hardwood dust exposure. Non-intestinal-type adenocarcinoma is a rarer and less well-known subtype considered not to be related with wood dust exposure. We determined the relative numbers of these two tumor types in 56 sinonasal adenocarcinoma patients in France and Finland, relating them with carefully assessed wood dust exposure histories. Diagnostic workup including immunohistochemistry for the intestinal markers CDX2 and CK20 indicated that the proportions of the two tumors differed significantly between France and Finland. In Finnish samples non-intestinal adenocarcinomas were more common than intestinal-type adenocarcinomas (12 non-intestinal vs. nine intestinal), while in the French samples the reverse was true (six non-intestinal vs. 29 intestinal). Such remarkably dissimilar occurrence of these tumors in France and Finland presumably reflects different pathogenetic circumstances in the two countries, and perhaps their different patterns of wood dust exposure. In France the main source of wood dust is from hardwoods. In Finland it is derived from softwoods. This is the first systematic comparison of the occurrence of intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma in two countries with different wood usage. It appears to be the first systematic study on differences in wood dust exposure between intestinal-type adenocarcinoma and non-intestinal-type adenocarcinoma.