Document Q8Z50roJgQQx294XzRgpNRkk

!.,J I >! *.*''[ MtflT '.r I lf.AL.TU. I lli NATION I'uim.ic nr.Ai. in .1 mvicl r.A m:j. .\L i:. .n i o ; i , or klai i H III. llir.UA. M.-.'l r 1 / Ml 4TOI4 31 July 1974 '.VELF-'AFCI* NAWONAl. CANCtR ir.STITUTE tfirju+ R&S 115595 Dr. Philip bandrigan Cu.-muaicab Ic Disease Center 1600 Clifton Road, W.E. Atlanta, Georgia 30322 Dear Dr. Landrigan: u>& .. HiM/bi/ On Inly 19th we none you MM^H^tcports for six of the eight Conn- t icur i.ncl i rc-.i are reports for the other two patients; After completing the individual reports, Dr. Popper, Dr. Lingeman and I reviewed the eight cases once more, in order to r.:aice some evaluation about their possible similarity or dissimilarity to .lesions seen in VC-PVC workers. Our comments about this are listed below: (1) believe the angiosarcoma of the liver of this patirnt is different iron; most of the angiosarcomas seen in VC-PVC workers. Sinusoidal dilatation and/or megalucytosis of hopntocytes were not seen. Also there was no hepatic fibrosis similar to that seen in the VC-PVC workers. (2) Carcinoma involving pancreas and liver, possibly primary in the pancreas. We do not have a carcinoma of this type among Che known VC-PVC workers whose lesions we have reviewed. (3) carcinoid type bronchial adenoma seen in the lung o- i his patient almost surely has no relationship to the hepatic lesions (.? hemangiomas) in the liver. We have not. seen any bronchial adenomas in the VC-PVC worker sections we have examined. (4) angiosarcoma in this paLicnt forms capillary, slit--j.ii . j.pne.es and replaces hepatic tissues. Wc only occasionally found this type of histological pattern in the angiosarcomas of the VC-l'VC workers and, in those patients, always also found w.ulLioontric areas of angiosarcoma with a sinusoidal, and/or papillary pattern. We did not see these types of pattern in Mr. Mullov's section. Thus wo do not think his hepatic angiosarcoma is characteristic of tho ___ angios.ii comas seen in the Yl'.-WC workers.. Also R&S 115596 i\jj;c 2 - Dr. Philip I.omlrigan liver is definitely cirrhotic with large deposits of' iron. These features also were not scon in Lho VC-PVC workers with hepatic fibrosis and with or without hepatic angiosarcomas. (5) cannot bo certain, one way or another, about Tli is r.- e. ~~ v . histologic fcaLure, i.e. the cells of the angiosarcoma are somewhat "i ibrohlar.tic," is dissimilar to angiosarcoma;; seen in most of the VC-PVC workers. However several other histologies 1 feature:; are similar to the VC-PVC workers hepatic lesions; namely, sinusoidal dilatation, tectorial and enveloping features of*the sinusoidal lining cells, portal tract fibrosis, and variability in size of hepatocytes. In summary, there are sufficient histological similarityes that we cannot exclude this as a so-called "VC-I'VC type case." (6) MHCMSSBSBBBfrPI ease refer to the note on our surgical pathology re,.-art S74-130G. In brief, oe are not completely certain that this is an angiosarcoma of the liver or even a pric.ary sarcoma of the liver. It is not like any of the other tumors we've seen in the, livers of VC-PVC workers. (7) ^Q^U^S^^Tha histological features of the hepatic angiosarcoma and portal tract fibrosis seen in this case are similar in nearly all respects to the lesions we have seen in most of the VC-I'VC workers' livers. (8) have reviewed needle biopsies only from this paLicat's angiosarcoma. The amount of material is I insufficient for a definite comparative statement, but we do not see the histologic features which we believe are most characteristic of the angiosarcomas in VC-PVC workers. In conclusion x.'c interpret five of these car--?: os having definite hepatic angiosarcomas and an additional case <0iBBB&E333E53QN& as possibly having a hepatic angiosarcoma, In one patient the overall histologic tea turns are the woii.l: as or very sirvi i.-u- u; the hepatic Hi'.cn in most of the VC-PVC workers. In another case :re are several similar features and one or two I dissimilar features. We wjtnt to emphasize that we do not think there is any single, histological feature either of the angiosarcomas or of the hepatic fibrosis which is pathognomonic of vinyl chloride exposure. For example, all the changes we've seen in the livers of the VC-l'VC workers can apparently be produced by exposure to arsonicals. However, certain types of hepatic fibrosis. J \ I J ' Page 3 - Dr. Philip J.andrigan sinusoidal di location, wuj ticentric angiosarcomas with sinusoidal, papillary and cavernous patterns together with mcgalocytcmis of hepatocytos collectively form a spectrum of hepatic lesions which are "characteristic" of the VC-J'VC workers* lesions- It is with these facts in mind that we have attempted to evaluate the Connecticut cases and compare their similarities and dissimilarities with the VC-PVC workers. Thank you for getting this material for our review. We would like to keep the submitted sections awhile longer in order to take photo micrographs of the various lesions. Also our conclusions about some of these cnr...*s night be more definite if we examined additional licriu cl r ndd'l -"L cp--ci3l will write you later about individual cases which might, be. studied further. Sincerely, Louis B. Thomas, 11.P. Chief, Laboratory of Pathology R&S 115597 ** R&S 115598 TABLE 1 V. '** CONFIRMED CASES OF LIVER ANGIOSARCOMA AMON(i WORKERS EXPOSED TO VINYL CHLORIDE OR POLYVINYL CHLORIDE COUNTRY Sweden CASE **, BIRTH DATE 02 11-27-11 Un 11 cd States 01 Uni ted States 02 United States 03 United States 04 United States 05 United States 06 United States 0? United States 08 United States 09 United States 10 United States 11 United States 12 . United States 13 W. Germany 01 W. Germany 02 Great Britain 01 Norway 01 . Sweden 01 00-00-22 00-00-34 00-00-15 00-00-24 00-00-12 00-00-29 05-03-22 05-06-20 00-00-31 08-16-13 05-27-09 11-17-18 12-01-21 07-26-31 06-04-30 00-00-01 12-23-15 06-23-27 United States 14 United States 15 00-00-13 00-00-25 1st VC or PVC EXPOSURE. DX ANGIO SARCOMA AGE AT DX YRS 1st EXP TO DX VC MONOMER PRODUCTION WORKERS 00-00-45 05-15-72 61 27 POLYMERIZATION WORKERS 12-09-48 11-15-55 11-28-45 07-06-52 06-19-44 01-17-62 08-00-44 10-07-46 05-28-45 06-00-51 10-14-46 09-13-49 08-19-44 10-14-57 10-01-57 00-00-46 03-00-50 08-14-51 03-00-71 05-00-70 12-00-73 08-00-67 . 04-00-64 02-00-74 00-00-68 08-00-61 03-01-74 05-00-68 03-00-70 05-00-69 05-00-74 00-00-71 00-00-69 12-00-72 12-20-71 02-00-70 49 36 58 43 52 45 45 41 43 55 61 50 53 40 39 71 56 43 SECONDARY MANUFACTURING 08-18-38 06-00-73 60 00-00-00 07-00-72 47 ' 22 14 . 28 15 20 12 24 15 29 17 23 20 30 14 11 26 22 x) 36 00 TOT YRS EXP 23 16 13 28 15 18 12 18 15 17 17 23 15 30 14 11 20 21 18 00 00 Jun^ 25, 19/4 DATE OF DEATH * 08-16-7? 03-03-73 09-28-71 12-19-73 01-07-68 04-05-64 Alive 03-23-68 08-29-61 ALIVE 05-10-68 03-16-70 05-02-69 ALIVE 12-14-71 01-25-69 12-00-72 01-04-72 . 10-20-70 - . j V< * L*. , 1, 07-03-73 f 02-15-73 Note *00* Indicates unknown date