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The natural occurrence of asbestos (NOA) in rural areas is a serious concern for human health and the dispersion route of asbestos in the proximity of natural asbestos-rich settings has been marginally evaluated so far. NOA may affect air, but also water and soil quality. In rural areas population may be exposed to asbestos with a largely unknown impact on human health. This work investigates the potential exposure of a farmer cultivating a field nearby the largest former asbestos mine of Western Europe (Balangero, Italy). The concentration of waterborne asbestos in the stream used to water the field was measured (ca. 2×10(5) fibers per liter, ff/L) and the cultivated ultramafic topsoil characterized, evidencing a remarkable occurrence of chrysotile. The worker's personal exposure and the environmental fiber dispersion during a simulated agricultural activity (tillage) were quantified in two independent trials. During the trials, the worker was exposed to average concentrations of 16 and 26 ff/L, with a peak of 40 ff/L. These data inform about the possible exposure of an agricultural worker to asbestos concentration higher than the accepted threshold of 2 ff/L. The release of asbestos fibers into the environment was negligible (0-2 ff/L)., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Congenital 21-alpha hydroxylase deficiency is a syndrome characterized by a cortisol synthesis deficiency and, rarely, by testicular masses. We present a case of bilateral nodular hyperplasia of the testis without adrenal hyperplasia in a patient affected by 21-alpha hydroxylase deficiency. This mass mimicked a testicular tumor and made differential diagnosis with a Leydig cell tumor extremely difficult. Multiple hard nodules (1 cm in diameter) could be palpated in both testes but were more prominent on the right. After an unsuccessful 30-day trial of an adrenocorticotropic hormone suppression regimen with dexamethasone (0.5 mg/qid), a right total orchifunicolectomy was performed. The final histological diagnosis was that of multiple, well-circumscribed nodules consisting of cord-like and microalveolar-like gonadal stroma, typical of an adrenogenital syndrome, and fibrosis. Differential diagnosis between testicular nodules in patients with congenital adrenal hyperplasia and Leydig cell tumors is a major clinical challenge. In cases of cortisol suppression resistant testicular masses, a serum adrenal hormone profile obtained from the gonadal vein and histology of the testicular nodule (with parenchyma sparing surgery) are recommended to obtain a correct diagnosis.