Document XzpJbZY4n7krdMZMgLJQqvVoG

rs 'R (^A Di. (O ]?c!S <rSJTj- |? 3. Angiosarcoma of the Liver Following Vinyl Chloride Exposure J. Bradford Block, MD Recently, angiosarcoma of the liver has been found in six workers ex posed to vinyl chloride. This relationship has never been recognized. (JAMA 22S:53-54, 1974) of a peripancreatic node. Inflammation, consistent with cholangitis ip the ascend ing duct, was observed. The patient died on Dec 19. Diagnosis at autopsy was angio sarcoma of the liver. THE B. F. Goodrich plant in Louis ville, Ky, has recently, voluntarily and admirably, released the informa tion that several of their employees exposed to vinyl chloride have died of angiosarcoma. This has been a unique situation. Report of Cases Case l.-The patient, a 44-year-old man who had worked in the vinyl chloride area for 15 years, was first admitted to the hos pital on Aug 20, 1967, with an enlarged spleen and liver. Roentgenography of the upper gastrointestinal tract, angiography, and a bone marrow biopsy were per formed. On Aug 25, he was transferred to another hospital for surgery. The diag nosis at that time was carcinoma of the liver. The patient had a sympathectomy on Sept 5, and a vagotomy with pyloroplasty on Sept 9. On Oct 2, he underwent splenec tomy, aspiration of a liver "hematoma," and a wedge resection of a liver tumor, which was diagnosed as angiosarcoma. Chemotherapy by intra-arterial infusion began on Oct 5, and was repeated on Nov 27, and Dec 12. The patient died on Jan 7, 1968, and diagnosis of angiosarcoma of the liver was confirmed at autopsy. Case Z-A 38-year-old male worker, who had worked with vinyl chloride for 16 From the Medical Consulting Group. Ken tucky Department of Labor, Frankfort. Reprint requests to 1228 Capital Plaza Towsr, Frankfort, KY 40601 (Dr. Block). years, was first admitted to the hospital on Jan 5, 1970. He complained of general weakness and had a history of tarry stools. The working diagnosis was bleeding gas tric ulcer. He responded well to conserva tive treatment and was released. He was readmitted in March 1970. At exploratory laparotomy on March 5, a diagnosis of can cer of the liver was made. The patient died Sept 27,1971. Gross and microscopic exam inations at autopsy confirmed the diag nosis of angiosarcoma of the liver. Case 3.--This male worker, 50 years of age, was first admitted to the hospital in 1964; he had worked in the vinyl chloride area for 17 years. The diagnosis at that time was a bleeding gastric ulcer. He re sponded well to conservative treatment and was released. He was again hospi talized on May 10, 1965, with the same diagnosis. At surgery, no ulcer was found. A portal shunt was performed, and an open liver biopsy specimen was taken. A diagnosis of toxic hepatitis resulting from "chemicals" was made. Gallbladder sur gery was performed Oct 19, 1970. The pa tient died on March 3, 1973. At autopsy, a diagnosis of angiosarcoma of the liver was made on the basis of gross and microscopic evidence. Case 4.--Another male worker, in the same plant for 28 years, was first admitted to the hospital on July 15, 1973, when he was 58 years of age. He had hepatosplenomegalv of unknown causation. On Aug 23, an exploratory laparotomy was performed. Multiple biopsy specimens of the liver were taken as well as a specimen Case 5.--The patient, a 52-year-old man, had worked in the vinyl chloride area for almost 20 years. He was first admitted to the hospital in January 1964. The diagnosis on admission was cholecystitis. He had had vague pain in the right upper quadrant for some time, but no other complaints. At surgery, a mass was discovered in the dome of the liver. It was thought to be a hematoma and an attempt was made to drain it. Further investigation showed me tastasis to both lungs. The case was complicated by intrapleural hemorrhage. Death on April 4, 1964, was attributed to cardiac tamponade. At autopsy, diagnosis of angiosarcoma of the liver with wide spread metastasis was made. Both lungs, as well as the heart and bowel, were in volved. Microscopic examination of liver tissue from outside the area of the tumor showed "minimal hepatitis." Case 6.--The patient, a 47-year-old man, was hospitalized in February 1974. He complained of vague pain in the right up per quadrant. Examination in the company laboratory showed an elevated level of lac tic dehydrogenase, type 4. On admission to the hospital, concentrations of lactic dehy drogenase and serum alkaline phosphatase were elevated. Chest roentgenogram and lung scan were normal. Results of the liver scan were questionable. On the basis of the man's work history, it was decided to per form an open biopsy of the iiver. The liver was large and widely involved with neo plasm, the main mass being in the dome of the liver. The tumor appeared to bo con fined to the liver itself. Microscopic exami nation of the biopsy specimens demon strated angiosarcoma of the liver. The JAMA. July 1. 1974 Vol 229. No 1 BFG25773 Liver Angiosarcoma--Block 53 23515001