Document Rjxpb5DgQ7Rd2ZMrpq6axgmXB
i
MEMORANDUM
70 Mr. Edward Klein Office of the Solicitor Department of Labor
DEPARTMENT OF HEALTH, EDUCATION, AND WELTARE
PUBLIC HEALTH SERVICE
CENTER FOR DISEASE CONTROL NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
DATE: August 22, 1974
FROM
Director
SUBJECT:
OSHA Public.Hearing on Vinyl Chloride
Enclosed is a review of the Connecticut cases by Dr. Louis B. Thomas, Chief, Laboratory of Pathology, National Cancer Institute, which should be Included in the record of the OSHA Public Hearing on Vinyl Chloride.
In accordance with Public Health Service policy, I have blacked out the names of.the patients. However, for your purpose it should be sufficient to note that case #5 in Dr. Thomas1 memorandum was the accountant at the vinyl cloth plant, and case #6 worked in an electee company applying PVC insulation.
Enclosure
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*
11? : I M LNT >j' Ilf.ALTH. IMITATION. ANN '.VELFAUP I
IVIH.IC HCAl (M .1 MVICL
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III. Mll"".L)A, M.-.'l , i , i'Tt14
31 July J 974
national CAficcn i'.stitutc
URL 17415
Dr. Phi] ip Lnndrigan Cur.:;iuaicabl.c Disuas-'C Center 3 f>00 Clifton hoad, H.E. . Atlanta, Georgia 30322
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Dear Dr. Landrjgan:
On July 19th v-c sent you Puna: Lcut ca-;t . Kncl.i
."-fr.
pathology reports for six of the eight c :i are reports for the other two patients;
After completing the individual reports. Dr. Popper, Dr. Lingeman and X reviewed the eight canon once more in order to make some evaluation about their possible similarity or dissimilarity to.lesions seen in-. VC-PVC workers'.. Our consents about this are listed below:
-U'e believe the angiosarcoma of the liver of this v.-tiont is different from nose of the angiosarcomas seer, in VC-PVC workers. Sinusoidal dilatation and/or megalocytosis of ho;>at.oeytes were not seen. Also there was no hepatic fibrosis similar to that seen in the VC-PVC workers.
Carcinoma involving pancreas and liver, possibly primary in the pancreas. We do not have a carcinoma of this type among the known VC-PVC workers whose lesions we have reviewed.
(3) carcinoid rype bronchial adenoma seen in the
lung in thin pal.Lont almost surely has no relationship to the hepatic lesions (? hemangiomas) in the liver. kV have not.
seen any bronchial adenomas in the VC-rVG worker sections
we have examined.
rTiie angiosarcoma in this patient forms capillary, slit-li spaces and replaces hepatic tissues. Wc only occasionally found this type of histological pattern in thd angionarcerms of the VC-PVC workers and, in those patients, always also found miltirontric areas of angiosarcoma with a sinusoidal and/or papillary 'pattern. V.V did not see these types of pattern in Mr. Mu Hoy'is section. Tims we do not thin'; his hepatic angi osnreos.ia is characteristic of the ongiosarcomas soon in the VC-PVC workers. Also
i'df-c. 2 - Dr. Philip I-oncirig-.m
liver is dufi.nileJy cirrhotic: with largo. deposits of iron. These I'cntuie:; nl.^o were not seen in the VOL'VC workers with hepatic fibrosis and villi or without hepatic angiosarcomas.
(5)
U^sc-.' . *.
eannoL he certain, one way or another, about ::lo] or.; e feature, i.c. the. cells of the
angio^arcuin art. `/omewlnt "i ibroblar.ticis dissimilar to angiusarcos.i.vs :.;oen in most of the VC-FVC workers. However several other hi:-tologic;i 1 feature;; arc similar to the
VC-PVC workers hepatic lesions; nanely, sinusoidal dilatation, tectorial and enveloping features of the sinusoidal lining cells, portal tx-ae.t f ibrosis, and variability in si2c of hepatocytes. In summary, there are sufficient histological
similarities that we cannot exclude this as a so-called
"VC-l'VC type case. *
(6)
cnBEKS&B Please refer to the note on our surgical
pathology i';;,
S7A-lbG6. In brief, we are not completely
certain that this is an angiosarcoma of the liver or even a
primary snrco.-,.n of the liver. It is not like any of the other
tumors we've seen in the. livers of VC-PVC workers.
URL 17-4/6
(7)
Tha histological features of the hepatic
i.
angioscirco.-o und portal tract fibrosis seen in this case are
similar in nearly all respects to the lesions we have seen
in most of the VC-TVC workers' livers.
(8) have reviewed needle biopsies only from this paLio:.!.: angiosarcoma. The amount of material is 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 uc interpret five of these card's as having definite hepatic
angiosarcomas and an additional case
possibly
having n hepatic angiosarcoma. In one pationi:
overall histologic features are the sai..e as or very s'r>' ar to the
hepatic losiunr. seen in most of the VC-PVC workers. In another case
^^HVBIBBBBB there arc several similar features and one or two
dissimilar feocurcs.
We Vjint to emphasixf Lhat we do not think there is any sinp3lc, histological feature either of the*angiosarcomas or of the hepatic fibrosis which is pathognomonic of vinyl chloride exposure. For example, nil the changes we've seen in the livers of the VC-PVC workers can apparently be produced by exposure to nrsonicals. however, certain types of hepatic fibrosis.
URL 17417
Page 3 - l)r. Philip l-andrigan
sinusoidal dilatation, r.:u3 ticentric angiosarcomas with sinusoidal, papillary and cavernous patterns together wi h uicgalocytosis of hcpatocytcs collectively form a spectrum of hepatic lesions which are "characteristic*' of the VC-T'VC workers* legions. It is with those facts in mind that we have attempted to evaluate the Connecticut eases 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 cas.-ft night be more definite if we examined additional sections or prepared addi,tional>sections and special stains. Wo will write ycu later about individual cases which might be studied further.
Sincerely,
Louis B. Thomas, M.T>. Chief, Laboratory of Pathology
-\
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TABLE 1
t
v. `n
CONFIRMED CASES OF LIVER ANGIOSARCOMA AMONG WORKERS EXPOSED
TO VINYL CHLORIDE OR POLYVINYL CHLORIDE
CASE COUNTRY
f. v
Sweden
02
United States OL
United States 02
United States 03
United States 04
United States 05
United States 06
United States 07
United States 08
United States 09
United States 10
United States 11
United States 12
United States 13
W. Germany
01
U. Germany
02
Great Britain 01
Norway
01
Sweden
01
United States 14 United States 15
BIRTH DATE
11-27-11
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
00-00-13 00-00-25
1st VC or PVC EXPOSURE
DX ANGIO SARCOMA
AGE AT DX
VC MONOMER PRODUCTION WORKERS
YRS 1st EXP TO DX
00-00-45
05-15-72
61
POLYMERIZATION WORKERS
27
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
00-00-00
07-00-72
60 47
' 22 14 28 15 20 12 24 15 29 17 23 20 30 14 11 26 22
xj
2s 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
June 25, 1974
DATE OF DEATH -
08-16-72
03-03-73 09-28-71 12-19-73 01-07-68 04-03-64 Alive 03-23-68 08-29-61 ALIVE 05-10-63 03-16-70 05-02-69 ALIVE 12-14-71 01-25-69 12-00-72 01-04-72 10-20-70^.
07-03-73 02-15-73
C- >
.
Note: '00' indicates unknown date
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