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 occupationally related ASL. Patients-Twenty patients who died from ASL after exposure to vinyl chloride. Methods-The case records and pathological findings of these 20 patients were reviewed. Results-Twenty men in the United Kingdom aged 37 to 71 years have developed ASL in association with occupational exposure to vinyl chloride monomer VCM in two factories. 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 massive 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 showed considerable, often massive, replacement by tumour, apparently multifocal, 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 introduction of the Code of Practice in 1975.