Thorotrast-induced ruptured hepatic angiosarcoma

Abstract

The use of Thorotrast as a contrast medium is now of historical interest. Thorotrast-induced angiosarcoma, though rare, still generates considerable clinical interest because of the characteristic opacification of the liver, spleen, and lymph nodes, and the long latency period between exposure and the onset of the tumor. We present a case of hepatic angiosarcoma which developed 37 years after the administration of Thorotrast.

Hepatic angiosarcoma occurring 65 years after thorium dioxide (Thorostrast) exposure: imaging, surgical and histopathologic findings of a historical case

“…During the hepatic parenchymal phase or delayed post-contrast scans, the entire mass or at least some of its areas become isodense with normal liver (11). When typical central necrosis or hemorrhage is present substantial and prolongated peripheral enhancement may appears and may mimic a very large benign angioma in which incomplete contrast filling is a rule (2,7).…”

“…With time, the carcinogenic effects of Th²³² became increasingly clear and numerous cases of Th²³²-related malignancies were reported, especially malignant hepatic tumours, such as hepatocellular carcinoma, cholangio carcinoma and hemangiosarcoma (HAS) (2-7). Th²³² was abandoned following a report by MacMahon et al (8) of HAS attributed to Thorotrast exposure in 1947 (6)(7)(8).…”

“…Peripheral cholangiocarcinoma classically manifests as a large, well-defined hepatic mass with lobulated margins and peripheral rim enhancement (15). Moreover cholangiocarcinoma frequently demonstrates intrahepatic ductal dilatation (2,7).…”

“…The diagnosis was prompt for several reasons: the patient presented with spontaneous hemoperitoneum -a classical complication of HAS precipitating emergency imaging and surgery -, the MDCT findings were rather typical of a vascular tumor and finally pathognomonic CT signs related to previous Thorotrast (Th²³²) exposureknown as the most known iatrogenic cause of HAS -were associated. The history of the problems associated to the use of Thorotrast (TH²³²) and the imaging features of HAS are briefly remembered (4)(5)(6)(7). With a delay of 65 years after Thorotrast exposure, this "historical" case probably represents, to our knowledge, the most delayed presentation of Th²³² related HAS ever published.…”

Current Imaging Strategies of Primary and Secondary Neoplasms of the Liver

“…In adults, angiosarcoma has an association with industrial exposure to vinyl chloride and has also been associated with thorotrast exposure. 32,33 On imaging studies, they usually present as solitary masses with abnormal vascularity and have been reported to cause high-output heart failure. Sarcomas may be difficult to distinguish from fibrolamellar tumors but usually lack a central stellate scar on cross-sectional imaging studies.…”