Clinicopathological study of hematological disorders after Thorotrast administration in Japan

Thorotrast-Induced Angiosarcoma Complicated by Disseminated Intravascular Coagulation and Microangiopathic Hemolytic Anemia: Case Report and Review

Thorium dioxide was first used for radiographic imaging studies as early as 1915. Carcinogenesis was clearly established by the 1940s, such that by 1956 worldwide usage had ceased. Malignancies were noted to appear from 15 to 45 years after injection. A case of thorotrast-induced hepatic angiosarcoma is presented, which was complicated by disseminated intravascular coagulation and microangiopathic hemolytic anemia. Since multiple medical conditions existed, it was unclear which was primarily responsible for these complications. This is the first reported association between thorotrast-induced malignancy and disseminated intravascular coagulation. The world literature is reviewed.

[Synchronous development of benign cholangiomas and a cholangiocarcinoma in the liver of a patient 43 years after thorotrast administration]

This is a report on a 59-year-old patient in whom the synchronous occurrence of benign cholangiomas and a cholangiocarcinoma was observed in the liver 43 years after single intraarterial application of thorotrast. Despite a half-life of over 130 years (alpha radiation), X-ray contrast media containing thorium (colloidal thorium dioxide) were used up to the 1950's in X-ray diagnosis, particularly for angiographies. Thorotrast is mainly stored in the liver, in the spleen and in epigastric lymph nodes and can therefore be easily detected radiologically in a survey radiograph of the abdomen. International studies have shown that thorotrast patients have an up to 100 times greater risk of contracting hepatic malignancies compared to control collectives. Among the causes of death of thorotrast carriers in the (old) Federal Republic of Germany, 15% are attributed to primary hepatic tumours (cholangiocarcinomas, malignant haemangioendotheliomas, hepatic cell carcinomas). In the patient presented here, a cystic mass approximately 2 cm in diameter was detected in the right lobe of the liver during computed tomography of the epigastric region conducted as part of the German Thorotrast Study at the German Cancer Research Centre in Heidelberg, as well as in sonography. Intraoperatively, this finding corresponded to a cystic cholangioma. By chance, a cholangiocarcinoma approximately 1 cm in size and several benign cholangiofibromas were also found in the left lobe of the liver. All of the tumours were excised in toto by atypical segment resection. As shown by this case report, thorotrast-induced hepatic tumours are still to be expected, even 40 years after thorotrast was removed from the market.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic and clinical investigations in 76 cases with therapy-related leukemia and myelodysplastic syndrome

Clinical, cytomorphologic, and cytogenetic investigations were carried out in a series of 76 secondary MDS and ANLL. Chromosome abnormalities were more frequent in patients with a history of multiple myeloma or macroglobulinemia (92%) and myeloproliferative disorders (82%) than in patients with previous breast cancer (40%). The secondary hematologic malignancies were mostly a trilineage bone marrow disorder. The most commonly found cytogenetic anomaly was monosomy 7, followed by total or partial loss of chromosome 5. In addition six other chromosomes, i.e., chromosome 3, 8, 9, 12, 17, and 21 seemed to be consistently involved in the pathogenetic mechanisms of secondary leukemia and MDS.