Academic journal article Environmental Health Perspectives

Liver Angiosarcoma and Hemangiopericytoma after Occupational Exposure to Vinyl Chloride Monomer

Academic journal article Environmental Health Perspectives

Liver Angiosarcoma and Hemangiopericytoma after Occupational Exposure to Vinyl Chloride Monomer

Article excerpt

Various malignant tumors of the liver, especially liver angiosarcoma, have been described after occupational exposure to vinyl chloride monomer. We present the case records and pathologic findings of two plastic industry workers who had been exposed to high concentrations of vinyl chloride. These workers developed hepatic neoplasms, angiosarcoma, or hemangiopericytoma. We discuss the histogenesis of these tumors; the common vascular origin and the mutual transformation of these two rumors suggest that the hemangiopericytoma may also have developed during occupational exposure to high concentrations of vinyl chloride monomer. Key words: hemangiopericytoma, liver angiosarcoma, vinyl chloride. Environ Health Perspect 108:793-795 (2000). [Online 13 July 2000]

Case Presentation

We analyzed the course of disease in workers involved in the manufacture and processing of polyvinyl chloride who had been exposed to high doses of vinyl chloride monomer (VCM) and who were treated at the Clinical Hospital in Split, Croatia, from 1987 to 1996. Out of 17 workers admitted in that period, we singled out the case histories of two patients whose focal lesions were established by ultrasonography and who received complete clinical examinations. The clinical examinations were performed at the Clinical Hospital in Split, and histologic findings were analyzed by the Clinical Hospital Department of Pathology.

We calculated average concentrations of VCM in the the working environments of the two men on the basis of measurements performed by the Chemical Technological Laboratory (Jugovinil, Kastel Sucurac, Hrvatska). The Chemical Technological Laboratory performed a retrospective investigation of the exposure to VCM in workers (autoclave cleaners) who were maximally exposed to VCM in a suspension polymerization plant. The investigation covered 1969-1987, when the factory was closed because it was the highest emitter of VCM in the country. The early measurements (before 1980) were performed with Drager tubes (Drager, Lubeck, Germany). Beginning in 1980, a Miran analyzer (Miran, Wilks, OH, USA) was used to perform measurements. Automatic sample collection occurred every 3 min from 12 positions inside the factory; VCM concentrations were qualitatively measured by infrared technology and results were printed. The majority of workers were exposed to concentrations of 300-400 ppm VCM.

One of the two patients who worked in the PVC plant was exposed to concentrations of 50-100 ppm VCM (based on periodic measurement for protection of worker's health).

Angiosarcoma of the liver (ASL). One patient, a male born in 1944, worked as an autoclave cleaner for 2 years (1969-1971) and from 1971 to 1973 as an autoclave foreman exposed to high concentrations of VCM (up to 1,000 ppm). The patient was admitted to the hospital in 1987 after ultrasonography, which was performed as part of a regular medical surveillance program.

The ultrasonograph revealed a focal lesion of the left lobe of the liver, which was solid, partly mixed, and contained a predominantly hyperechoic zone (10 cm in diameter, including some smaller hypoechoic areas and beams spreading radially into the adjacent parenchyma). Physical findings revealed hepatomegaly (4 cm). Laboratory findings included albumin/globulin inversion, gamma globulin of 24%, slightly prolonged prothrombin time (14 sec), and a prothrombin index of 43%. A computerized tomographic scan of the liver showed a focal lesion in the left lobe with a diameter of 10 cm and consisting of hypodense areas not enhanced with contrast, but with a structure whose density was enhanced after contrast. The right lobe was of normal density, with homogenous absorption values.

Hepatic angiography revealed a well-vascularized structure with malignant characteristics in the left lobe (10 cm in diameter). Laparoscopy showed that the right liver lobe was dark red with livid hues, whereas the left lobe was completely invaded with adhesions. …

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