OCCUPATIONALLY RELATED ANGIOSARCOMA OF THE LIVER IN THE UNITED-KINGDOM 1972-1994

Background-Angiosarcoma of the liver (ASL) has been described in vinyl chloride workers worldwide. Aim-To describe the UK experience of occu pationally related ASL. Patients-Twenty patients who died from ASL aft er exposure to vinyl chloride. Methods-The case records and pathologic al findings of these 20 patients were reviewed. Results-Twenty men in the United Kingdom aged 37 to 71 years have developed ASL in associati on with occupational exposure to vinyl chloride monomer VCM in two fac tories. All had been exposed to VCM for three to 29 years, the tumour developing nine to 35 years after first exposure. Presenting clinical features included abdominal pain, malaise, jaundice, ascites, and mass ive hepatomegaly. In most cases the disease progressed rapidly, death occurring within a few weeks from hepatic coma. In 17 cases there was no spread outside the liver. In four cases there had been haemorrhage from oesophageal varices due to noncirrhotic portal fibrosis diagnosed six to 18 years previously. At necropsy the livers of these men showe d considerable, often massive, replacement by tumour, apparently multi focal, with necrosis and haemorrhage. Conclusions-In view of the long latency between exposure and development of the tumour the full extent of ASL occurrence may not be known until 35 years after the introduct ion of the Code of Practice in 1975.