Hepatic angiosarcoma occurring 65 years after thorium dioxide (Thorotrast) exposure: imaging, surgical and histo- pathologic findings of a historical case.

We report the CT, surgical and histopathologic findings of a rare case of Hepatic Angiosarcoma (HAS) diagnosed in a 85-year old women 65 years afterThorotrast (Th232) exposure for angiography. At the early arterial phase of dynamic MDCT, peripheral curvilinear and central nodular puddling of contrast produced in the 8 cm tumor.Then progressive contrast filling of the tumor was observed on the delayed scans. Associated pathognomonic signs related to previous Th232 exposure were also found comprising diffuse intrahepatic reticular bands of calcifications, numerous calcified epigastric lymph nodes and a calcified shrunken spleen. Emergency laparotomy was performed because of associated hemoperitoneum. With a delay of 65 years afterThorotrast exposure, this historical case probably represents, to our knowledge, the most delayed presentation of Th232 related HAS ever published.

Biokinetics and assessment of intake of thorium dioxide.

The aim of this work was to investigate the biokinetics of thorium dioxide in animals for the purpose of assessing intakes of the compound by workers and the resulting doses. The results imply that measurements of the decay products in the chest or extrapolations from urine analysis data are unlikely to be of value for doses below 20 mSv. Even higher doses should be interpreted with caution as a consequence of uncertainties in particle size distribution and variations in dietary excretion.

Microanalytical study of thorium 232 deposits in bone marrow and liver.

Analytical microscopy was used to study the distribution and chemical composition of thorium deposits in bone marrow and liver after injection of thorium dioxide and thorium nitrate. Thorotrast (thorium dioxide) was identified as being localized in bone marrow macrophages of a patient who had undergone cerebral arteriography forty two years ago. Large thorotrast deposits were also present in liver cells. We show that non-colloidal thorium (thorium nitrate) injected in rats concentrates in a non soluble form in bone marrow macrophages, hepatocytes and Kupffer cells. These deposits of thorium associated with phosphorus can be explained by the formation of thorium phosphate in lysosomes and we demonstrate that they remain in tissue for a long time. Microanalysis was performed with ion microscopy, and electron probe microanalysis by X ray spectrometry, which can identify and localize thorium and associated elements at cellular or intracellular level.

Ultrastructural localization of Thorotrast (thorium dioxide) in human liver by analytical scanning electron microscope.

The distribution of thorium dioxide (Thorotrast) in the liver from a Thorotrast-administered autopsy case was examined stereographically by analytical scanning electron microscopy. Thorium particles were detected in the macrophages of the portal triad and hepatic sinusoid. These macrophages were irregularly shaped and tended to be aggregated. In the sinusoid, accumulation of the macrophages formed a thrombus-like structure. Furthermore, observed in the sinusoid were free Thorotrast particles that appeared to have been released into the sinusoid as a result of breakdown of the macrophages (Kupffer cells).

[Use of computed tomography for quantifying Thorotrast and detecting Thorotrast-induced liver tumors]. / Der Beitrag der Computertomographie zur Quantifizierung der Thorotrastose und zur Erkennung thorotrastinduzierter Lebertumoren.

242 Thorotrast patients were examined by CT. The mean CT-density-values of the whole liver correlate well (0.72) with the measurements of the radioactivity by total-body-counting. Twenty-one of 24 primary liver tumors were correctly diagnosed by CT. The smallest tumor measured 3 cm in diameter. In 8 patients surgical treatment was possible. The sensitivity of CT for the detection of liver tumors, is higher than the sensitivity of echography.

Lung cancer in a Thorotrast administered patient.

A 79-year-old man developed small cell carcinoma in the lung 43 years after Thorotrast-injection. The tumor with interstitial fibrosis arose in the periphery of the lung. Thorotrast particles were observed in the liver, spleen, bone marrow, and lymph nodes but not in the lungs. Four other Japanese cases of lung cancer after Thorotrast injection were reviewed.

Discrimination between thorotrast and iodine contrast medium by means of dual-energy CT scanning.

A dual-energy CT scanning method is proposed to discriminate between thorotrast and iodine contrast medium in patients suspected of having thorotrast deposits in the spinal canal as a consequence of myelography injections. The ratio of CT numbers at two X-ray tube voltages was used to distinguish the two materials in the analysis of dual-energy CT scanning. The K-edge of thorium was used to enhance the discrimination sensitivity. Theoretical analysis predicted the feasibility of the method and this was verified by experiment. The sensitivity for the discrimination between thorium and iodine is much higher than that achieved by the gamma-ray counting technique using a whole-body counter. This method, the ratio of CT numbers at two kV values, may be useful in other clinical applications.

Veno-occlusive disease and peliosis of the liver after thorotrast administration.

A case of veno-occlusive disease and peliosis of the liver without coexisting liver malignancy 35 years after thorotrast administration is presented. In the liver four main widely distributed lesions were found: Veno-occlusive disease (VOD), peliosis, fibrosis and thorotrast deposits. Whether the VOD and the peliotic lesions are pathogenetically related or totally independent cannot be determined in the present case. However, the VOD and the peliosis are possibly related to the protracted alpha-emitting effect of thorotrast deposited in the liver parenchyma.

Latency of thorotrast-induced renal tumours. Survey of the literature and a case report.

A case of thorotrast-induced renal tumour is reported. The relevant literature is briefly surveyed. The latency periods to tumour detection in the published cases were analyzed. Latency was longer in transitional cell carcinoma than in the other histological tumour types. The difference was statistically significant. It is concluded that discovery of more cases of thorotrast-induced renal tumour is to be expected. The importance of bearing this possibility in mind when confronted with roentgenograms showing 'calcifications' in or near the kidney is pointed out.

Thorotrast-associated cholangiocarcinoma: an epidemiologic and clinicopathologic study.

Six cases of Thorotrast-associated cholangiocarcinoma (TACC) are studied and compared with eight previously reported cases as well as with cases of non-TACC. TACC shares some epidemiologic features both with non-TACC as well as Thorotrast-associated angiosarcoma (TAAS) but appears to occur in younger patients than non-TACC. There is an apparent increased prevalence of both benign and malignant thyroid disease in the current group of patients with TACC; previous epidemiologic studies have not identified this phenomenon. Thorotrast-associated hepatic fibrosis was present in all 14 TACC cases; otherwise, both non-TACC and TACC are clinically and morphologically similar. Bile duct dysplasia and/or transition to adenocarcinoma, which occurred in all the AFIP cases, are seldom described in case reports of either TACC or non-TACC; in the current study they served to validate the intrahepatic origin of the tumors.

Energy dispersive x-ray detection of thorium dioxide.

Since the recognition of the development of certain malignant neoplasms in association with thorium dioxide (Thorotrast), its presence has been documented by light microscopic appearance and time-consuming autoradiography. Energy dispersive x-ray microanalysis can be used in the rapid documentation of thorium in paraffin-embedded tissues and it is confirmed that thorium is the principal component of the granular deposits described by light microscopy.

Identification of thorium dioxide in human liver cells by electron microscopic x-ray microanalysis.

Thirty-two years after injection of thorium dioxide (Thorotrast) for diagnostic x-ray studies in a female patient deposits were found by light microscopy in the liver macrophages (Kupffer cells). They were shown by electron microscopy to be located inside secondary lysosomes, and by autoradiography and x-ray microanalysis they were identified as thorium.