Document 1Le6BvX6Qr2JbYxOZjBGdykK

mi Nr, DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION July 3, 1974 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA ;I0333 TELEPHONE <04i Ol llll John Creech, M.D. Plant Physician B. F. Goodrich Chemical Company Bell's Lane, Rubbertown Louisville, Kentucky. Dear Dr. Creech: Enclosed are copies of 15 pathology reports prepared by Dr. Thomas after reviewing specimens submitted to him. Included in this group are: Parks, The report or is particularly intriguing and I have also enclose d a copy of a letter concerning him from In addition to all the relevant pathologists, I have also sent indi- vidual reports to Drs. Seipel and McCullough , Dr. Will Ward (Parka), Dr. Ciliberti , and Dr. Kerfees and I am also sending a copy of report to his physician. If there is anybody else that you think should receive copies of any of these reports, please let me know and I will forward copies to them. I am truly sorry for the delay in sending these along to you; I will certainly send you any further reports as soon as I receive them. Dr. Thomas and Dr. Popper were deeply appreciative of the opportunity to review all of these specimens and of your referring all of the biopsy material to them; we all would sincerely like to thank you onjse again for allowing us to work with you on this investigation. Please let me know if I can be of any further help at any time. Sincerely, Hemfjr Falk, M.D. EIS Officer 1 Cancer and Birth Defects Division Center for Disease Control HF/ar Enclosures . p. S'. i JuJu\. CU -MAU C&u >Oi24 BFG67663 r r. DEPARTMENT OP HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #1 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPHONE (4041 433.JJM age at diagnosis - 52 y.o. work duration - 19 years date of dx. - 4/64 Onset of illness - 8/63 - tiredness, swelling of feet and "bloating of stomach." adm. #1 - l/64 - c.c. - RUQ pain, severe P.E. - abd-RUQ splinting and tenderness Lab. - Gall Bladder series: non-visualization O.R. - Exploratory lap. and cholecystectomy 1) Blood and clots on opening, from hemangioma on dame of liver. 2) Thickened gall bladder with multiple adhesions. Path.* 1) Chronic cholecystitis, minimal 2) Liver bx - focal non-specific hepatitis, slight. Post-Op. - Wound Dehiscence, slow healing adm. #2 - l/64 - c.c. - icterus, fever, wound dehiscence LFT on adm. - T.B.-4.9 (d-2.2), SGOT-115 A.P.-nl. 2/64 - To O.R. for drainage of subphrenic hematoma (and possible abscess) 3/64 - Needle biopsy of liver - no change from previous - possibly nl. Course - l) Continued febrile, with inability to control bleeding through open wound (received 27 units of blood over 2-month span). 2) Increasing lung densities, dyspnea, and pleural, fluid. 4/9/64 - Expired. Autopsy Report - 1) Massive replacement of liver by angiosarcoma with metastases to epicardium, septum of heart, lungs, pleura, serosa of small bowel and mesentery, periadrenal adipose tissue, diaphragm, an d in sections of L kidney. 2) Liver - 5>200 grams - all of R lobe replaced by tumor mass, with many sma.l.1 lesions in L lobe. 1,000 cc of trapped fluid over dame. 3) Bloody fluid in pleural cavity and pericardial sac. j BFG67664 DEPARTMENT OF HEALTH EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #2 CENTER FOR OISEASE CONTROL ATLANTA, GEORGIA 30333 TCICPMONE <4041 age at diagnosis - 43 y.o. work duration - 17 years date of dx. - 8/67 Onset of illness - fall of '66 - tired, lethargic. Also, intermittent "pleurisy" in chest and hack. 7/67 - total of "anemia" hy physician. adm. #1 - 8/67 - Complained of "knot" in epigastrium and severe pain adm. P.E. - Epigastric mass + 4FB spleen Lab. - CBC - Hg.-lO, WBC-7,400, Plat.-140,000 B.M.-nl. ----- Transfer to major hospital - initial impression: R/0 Hodgkin disease adm. #2 - 8/67 - Lab. - Plat. count - 335000 LFT - T.B. - 1 (nl 1.0) A.P. - 31 (nl. 4-17) SGOT - 65 (nl. 45) LDH - 180 (nl. 120) BA enema and lympbangiogram - nl. Liver scan - large defect in liver, and bypersplenism O.R. - laparotomy - a) splenectomy b) found large hemangiana 'n* hematoma - drained O.R. - Sudden blood loss 3 days later led to return to O.R. Liver bx. at this time revealed liver ca. Course - Treated with 5-FU and Cytoxan adm. #3-6 (10/67-12/67) - for chemo Rx and its complications. Chemotherapy brought only very transient response, the patient having a downhill course after diagnosis with increasing hepar size, ascites, jaundice, and expired on 1/7/68. Path. - Autopsy - Angiosarcoma of liver, both lobes, with extension into diaphragm and anterior abdominal wall. BFG67665 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH service HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #3 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPHONE <4041 age at diagnosis - 36 y.o. work duration - l4 years date of dx. - 5/70 adm. #1 - 1/70 - onset of illness - passed tarry stools, P.E.-abd-neg., upper G.I.-nl., Imp - bleeding duodenal ulcer. Rxdiet, meds. adm. #2 - 5/70 - Recurrence of tarry stools. Readmitted to evaluate and correct. P.E. - Enlarged liver and palpable spleen Lab. - SMA-12 - T.B. - 1.2 (nl. 1.0) Repeat: T.B. - 0.9 A.P. - 98 (nl. 85) A.P. - 112 LDH - 215 (nl. 200) LDH - 203 SGOT - 58 (nl. 50) SGOT - 68 Upper G. I. - a) suggestion of mass displacing stomach R/O - liver, pancreas, retroperitoneum b) no definite ulcer seen c) spleen Esophagram - suggestion of varices Liver scan - large lesion in L lobe, and extending into R lobe O.R. - Laparotomy - bx. of liver (with hemorrhage from site, controlled) Path.- Angiosarcoma Rx. - a) Radiotherapy-Cobalt - 5/70 b) 5-FU - several courses Course - Improved x appx. 1 year, with wt. gain, stability of liver function tests, and suggestion of increased up take on liver scan. 9/71 - Repeat biopsy - showed large areas of irregular fibrosis with islands of atypical endothelial cells. 9/27/71- Expired BFG67666 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #4 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPHONE (404) age at diagnosis (cirrhosis) - 4l y.o. age at diagnosis (angiosarcoma) - 49 y.o. duration of work (to initial dx.) - 15 years date of diagnosis (cirrhosis) - 5/65 date of diagnosis (angiosarcoma) - 3/73 adm. #1 - 12/63 - nausea, wt. loss, weakness, paller melena and hematemesis dx - ulcer Rx - diet and meds adm. #2 - 5/65 - repeat hematemesis and melena varices visualized on esophagoscopy liver bx. - showed mild portal fibrosis, with lymphocytic in filtrates, and scattered liver cell necrosis - low grade process. O.R. - portal bypez*teiiSion portacaval shunt Dx. - toxic hepatitis cirrhosis. Secondary to occupational exposure. After discharge - Work transfer, & L.F.T.'s returned to normal. adm. #3 & #4 - 11/67 & 2/68 - for hemorrhoidectomy and inguinal hernia repair. adm. #5 - 10/70 - presented with weakness, worn-out, low-grade fever, sweats, P.E. - enlargement of liver and return of abn. L.F.T.'s. Liver bx. - needle - interpreted as aggressive form of hepatitis, with progression from previously diagnosed toxic hepatitis to cirrhosis. adm. #6 - 10/70 - cholecystectomy for gallstones. open liver bx. - "very slight acute and chronic inflammation. adm. #T & #6 -- 11/70 & 12/70 - increased weakness, wt. loss, sweat, and fever. Rx with prednisone, but symptoms persisted. adm. #9 - 5/71 - Cleveland Clinic a) arteriogram - "tumor blush" b) reinterpretation of 1970 bx. - "anaplastic hepatoma," and portal fibrosis adm. #10-15 (5/71-3/73) - Far chemo Rx with 5-FU and oncovin, and for treatment of complications 2 disease and therapy. Course - slowly downhill with incipient hepatic coma. 8/72 - no change in heparin 1 year leading to doubt about dx. of hepatoma Lab. - T.B.-1.0, LDH-240, SGOT-nl., A.P.-215 Liver scan - huge, irregular defect in upper post-portion of liver Expired - 3/3/73 - - 1) Angiosarcoma 2) Cirrhosis BFG67667 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #5 CENTER POR OISEASE CONTROL ATLANTA. GEORGIA 30333 TELEPHONE (404) tSl-fSM age at diagnosis - 58 y.o, work duration - 27 years date of dx. - 12/73 adm. #1 - 7/73 - c.c. - poor appetite, weakness, and 25 lb. weight loss in prior 3 mos. P.E. - hepatosplenanegaly Lab. - SMA-12 T.B.-1.8 A.P.-350 SG0T-100 (Repeat T.B.-2.4, w^.th d. 1.4) Liver scan - neg. for neoplasm Upper G.I., Ba enema, oral cholecystogram - nl. Needle biopsy of liver - #1 - severe hepatic fibrosis with bile duct proliferation, consistent with post-necrotic cirrhosis. #2-4 days later. Poor specimen. Not interpretable. Repeat liver scan - hepatosplenanegaly consistent with diffuse disease. O.R. - Exploratory lap. - no evidence of malignancy - mult, open liver bx. Path.- Imp. - liver bx. - peripertal inflammation and fibrosis. slight bile stasis ? ascending cholangitis Discharged hone on ampicillin because of latter possibility. adm. #2 -12/73 - c.c. - Downhill course with increasing weakness, jaundice, ab dominal distention, and loss of appetite. P.E. - Far advanced liver disease - with marked jaundice, ascites spider angianata. Abd. - ter se. and grossly distended. Lab. - SMA-12 - T.B. - 35.8 (d.2l) A.P. - 350 SGOT - 95 (68 on repeat) LDH - 275 Alb - 1 Pro Time - 25*9 12/19/73 - date of expiration. Autopsy - angiosarcana, with extension into duodenum. BFG67668 r DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE health services and MENTAL health administration CASE #6 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPHONE (4041 OS-lltl age at diagnosis - 45 y.o. work duration - 12 years date of dx. - 2/74 Onset of illness - late summer '73 - l) much more tired in recent months 2) intermittent 'pleurisy' - under R rib cage 3) nl. P.E. in 8/73* SMA-12 - nl. except slight LDH. 12/73 - SMA screen - nl. except LDH - 265 2/73 - SMA screen - nl. except LDH - 305 2/74 - adm. for w/u - P.E. - abd-neg. Lab. - Hg - 15.3 - nl. BSP ~ 3lj> m retention -- nl. SMA-12 - T.B. - 0.5, SGOT - 28, A.P. - 5, -LDH 311 SGPT - 19 LDH - isozymes - IV - lung pattern T.P. - 7.0 (with G & alb.) urine, EKG, chest X-ray, lung scan - nl. Liver scan - ant. - enlarged liver with slight diminution at lower pole of R lobe post. - generalized diminution over lower half of R lobe lat. - neg. interpretation - suspicious, but not well defined enough to be diagnostic O.R. - laparotomy - a) abd - nl. feel b) ant. surface of liver - nl. c) nodular, hard, indurated feel at dame of liver, most marked posteriorty. Several biopsies done. Path. - Angiosarcoma BFG67669 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #7 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPHONE 14041 11-till age at dx. - 46 y.o. work duration - 24 years date of dx. - 12/68 onset of illness - 10/68 - c.c. - weakness and tarry stools P.E. - Pallor; Abd - neg. adm. #1 - Hg. 5.6 - mult, transfusions SMA - 12 - nl. T.B. & L.D.H. SGOT - 75 and A.P. - 310 Upper G.I. - duodenal ulcer Patient refused surgery. Discharged improved. (Work transfer) adm. #2 - 11/68 - recurrence Upper G.I. - suggested lesser curvative ulcer O.R. - Laparotomy - 1) Vagotomy and Pyloroplasty; 2) liver appeared abnormal: whitish, splotchy appearance to capsule, and firm; 3) spleen - 2-3 x nl. Lab. - BSP - 229 C.F. - 4 + at 24 hr. SMA - 12 - T.B. - 1.2 (0.8 - d), SGOT - 114, SGPT - 166, A.P. 350, Alb. - nl. Varices - Probable an esophogram. Not visible on esophagoscopy Path.: 1) Liver - portal fibrosis, proliferation of bile ducts, subcapsular fibrosis. 2) Spleen - 560 grams O.R. - Laparotomy - Repeat - Splenoportogram with increased splanchnic pressure leading to splenectomy & splenorenal shunt. adm. #3 - 1/69 - recurrence - o palpable liver - SMA as above Upper G.I. - 2/69 - Varices present but smaller adm. #4 - 5/70 - recurrence - home after improvement BSP -8io SMA - 12 - as above After this admission the SMA - 12 returned to nl. adm. #5 - 6/72 - c.c. - fever, RUQ pain, and back pain SMA - 12 - nl. except SGOT - 220 and A.P. 350 Liver scan - nl. Clinical dac - Ca. of Pancreas. Patient refused surgery. BFG6767 .1*4* -.T"- DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #8 CENTER FOR OISEASE CONTROL ATLANTA, GEORGIA 30333 TELEPMONK: (4041 4ai-)S1t age at diagnosis - 28 y.o. work duration - 5 years date of dx. - l/72 9/7I - c;c. - chest pains, and 25 lb. recent wt. loss adm. #1 - 9/71 - ? hx. of ethanol intake x 6 years Hepatosplenamegaly T.B. - 1.9 (d-0.7) and "borderline SGOT ESR - 23, 18 Weakly positive mono test dx.: l) ? hepatic disease 2 ethanol intake; 2) R/O Inf. Mono. adm. #2 -10/71 Hx. & P.E. - Had gained 7 lb. and developed ""butterfly rash" since previous adm. Lah. - Repeat mono test - neg Repeat.ESR - 10 ANF & LE Prep - neg. SMA - 12 -TT.B. & SGOT -93 (A.P.-nl.) Liver scan - Nl. except for enlarged spleen Needle hx. of liver - attempted mult, times Inadequat e specimen. adm. #3 -I2/7I - Hx. - 8 lb. wt. loss, jaundice, debility. Admitted for de finitive hx. P.E. - icteric. 2FB liver 8s 2FB spleen Lah. - CBC - nl. Stool Cult - + salminella - Rx: Ampi. ESR - 44 T.B. - 5.6 (d. - 4.5) SMA - 12 - T.B. - 4.3, LDH-nl, SGOT - 190, A.P. - 550 serum electrophoresis - neg. AuAg - neg. O.R. - Exp. Lap. - spleen - 3 x nl. size G.B. - nl. liver - found seme soft dot-like disruption of the cortex of the liver, and toe! hx. Path.: l) moderate peripertal fibrosis; 2) chronic active cholangitis Returned to work, hut transferred. adm. #4 - 8/73 - c.c. wt. loss, melena, hematemesis. SMA - 12 - nl. except for T.B. - 1.1 Upper G.I. - equivocal peptic ulcer, dx healing peptic ulcer BFG67671 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #9 CENTER FOR DISEASE CONTROL ATLANTA. GEORGIA 30333 TELEPHONE (404) 411-9911 age at diagnosis - 56 y.o. work duration - 24 years date of dx. - 9/73 C.F. 24 hours 4-8 hours T.B. 7/17/64 3/8/65 4/12/65 0 2+ 1+ 0 1.4 a- 1.3 3*- 0.8 2/73 - Bilateral hernia repair - Noted to be icteric. (Work transfer) 3/73 - Liver scan: marked splenomegaly with somewhat small liver suggesting cirrhosis. Gall Bladder study: poorly functioning. 4/7/73 - q 1 mo. liver profiles - improved, then worsened. adm* #1 - 8/73 - for w/u SMA - 12: nl. except: T.B. - 2.8 A.P. - 168 Serunr electrophoresis - G (1.9) & Alb. (3*4) Liver-Spleen scan - Nl. size liver. Markedly enlarged spleen (24|cm) Upper G.I. - Probable Varices. Prolonged small bowel transit time. Spleen. Hepatic vein studies - Suggested nl. venous pattern. Splenic Angiogram - l) marked engorgement, dilatation, multiple aneurysms 2) possible occlusion of mid portion of 6plen|ic vein. Varices present. adm. #2 - 9/73 - SMA - 12 - nl. except - T.B. - 2.5 A.P. - 133 O.R. - exploratory L lobe of liver appeared nl. A veil of tortudus veins mixed with adhesions and momentum prevented full view R lobe. These veins could not be mobilized and prevented palpation of possible extrahepatic pertal block suggested on operative venogram. Liver bx. done. Splenectony (1,050 gram). Splenic vein could not be mobilized adequately and anastomosed an splenorenal shunt attempt had to be discontinued. Path. - Liver - slight in pertal fibrous tissue. Possibly nl. 11/20/73 - SMA - 12 - T.B.-0.7 A.P. 350 LDH - 275 SGOT - 43 T.P.-7 Aljb.2.7 BFG67672 I DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION CASE #10 CENTER FOR DISEASE CONTROL ATLANTA, GEORGIA 30333 TCLKPMONK: <4041 Ol.JSH age at diagnosis - 56 y.o. work duration - 29 years date of dx. - 9/73 c.c. - Presented in 8/73 with 2-3 wk. history of LLQ abdominal pain. 8/2l/73 - Oral cholecystogram - calculi Ba enema - diverticulosis adm. #1 - 9/3/73 - Hx. & P.E. - neg. Hepatic SMA - 12 - T.B. - 1.9 SGOT - 110 LDH - 240 A.P. - nl. 9/4/73 - exploratory laparotomy with cholecystectomy and liver biopsy. Operative findings - 1) Chronic cholecystitis and cholelithiasi 2) Liver - slightly enlarged, and stippled with small, pinhead-sized pustules scattered throughout. 3) Spleen - not enlarged 4) Palpable diverticuli Path. Report.: l) Liver Bx. - Imp. - subacute or chronic hepatitis with focal fibrosis and extensive regeneration. 2) Gan Bladder - Chronic inflammation. 9/12/73 - serum electrophoresis - nl. except albumin (3*3) " - BSP - 12$ retention 10/15/73 - returned to work in less hazardous area n/6/73 - nl. SMA - 12 BFG67673