Workers exposed to polyvinyl chloride may develop following liver malignancy

Ref Robbins 9/e p51 Angiosarcomas Angiosarcomas are malignant endothelial neoplasms (Fig. 9-31) that range from highly differentiated tumors resem- bling hemangiomas to wildly anaplastic lesions difficult to distinguish from carcinomas or melanomas. Older adults are more commonly affected. There is no gender bias, and lesions can occur at any site, but most often involve the skin, soft tissue, breast, and liver. Hepatic angiosarcomas are associated with ceain carcino- gens, including arsenical pesticides, Thorotrast (a radioac- tive contrast agent formerly used for radiologic imaging), and polyvinyl chloride (a widely used plastic, and one of the best known examples of human chemical carcinogen- esis). A latent period of years between exposure and sub- sequent tumor development is typical. Angiosarcomas also can arise in the setting of lymph- edema, classically in the ipsilateral upper extremity several years after radical mastectomy (i.e., with lymph node resection) for breast cancer. In such instances, the tumor presumably arises from lymphatic vessels (lymphangiosar- coma). Angiosarcomas also can be induced by radiation and rarely are associated with long-term (years) indwelling foreign bodies (e.g., catheters)