Malignant peritoneal mesothelioma after cholangiography with thorotrast

Our plain-English summary of Malignant peritoneal mesothelioma after cholangiography with thorotrast, by R. Maurer, B. Egloff (Cancer, 1975).

The study

• Authors: R. Maurer, B. Egloff
• Journal: Cancer
• Published: 1975;36(4):1381-5
• Type of article: Case report
• Cited by: 72 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001130).

Abstract

Reported is a 59-year-old patient, who died of a peritoneal mesothelioma 36 years after contamination with thorotrast of the peritoneal cavity during cholangiography at cholecystectomy. Eleven years before death, the right kidney had to be removed for hydronephrosis due to fibrous stenosis of the pyeloureteral junction, because of thorium dioxide deposits.

In plain English

This article was a case report from the Institute of Pathology at the Kantonsspital Winterthur, Switzerland. It described one female patient, born in 1914, who had her gallbladder removed in 1937. During the operation a bile duct X-ray was taken with thorotrast, a contrast medium made of thorium dioxide, and the contrast medium spilled around the bile duct. In 1962 her right kidney, which was no longer working, was removed. Thorium dioxide was found in scar tissue that had narrowed the outlet of the kidney. She was readmitted in July 1973 and died on the 16th day in hospital. At autopsy the authors found a widespread tumor on the lining of the abdomen, which they diagnosed as peritoneal mesothelioma, and no other primary tumor. The authors gave the latency period as 36 years. The article stated that the patient had no known exposure to asbestos. The authors wrote that they believed this was a true case of radiation-induced peritoneal mesothelioma. They noted that they did not know how much thorotrast had been given and retained.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One female patient born in 1914, treated at the Kantonsspital Winterthur, Switzerland, who died at age 59 in 1973
• Exposure: Thorotrast (colloidal thorium dioxide, a radioactive X-ray contrast medium) spilled into the peritoneal cavity during cholangiography at cholecystectomy in 1937. The amount given and retained was unknown. The authors stated the patient had no known asbestos exposure.
• Main results:
  • In 1962 the patient's nonfunctioning right kidney was removed. The diagnosis was hydronephrosis due to thorotrast-induced fibrous stenosis of the pyeloureteral junction, with thorium dioxide identified in the scar tissue.
  • The patient was readmitted in July 1973 and died on the 16th day of hospitalization.
  • At autopsy the peritoneal cavity held 1750 ml of ascitic fluid and a widespread tumor. The tumor grew through the right diaphragm into the pleural cavity and onto the pericardium.
  • The autopsy showed no other primary tumor and no distant metastasis. The authors diagnosed peritoneal mesothelioma.
  • Deposits of thorium dioxide were found in close association with tumor tissue in paravertebral lymph nodes.
  • The latency period from thorotrast contamination was 36 years, which the authors considered not exceptional.
  • The authors reported that the patient had no other condition with a known carcinogenic effect, and no known exposure to asbestos.
• The authors' conclusion: The authors wrote that they believed this was a true case of radiation-induced peritoneal mesothelioma. They wrote that follow-up supervision of people with a body burden of thorium dioxide seemed essential.
• Limitations the authors state:
  • The authors did not know how much thorotrast had been administered and retained, so they could not comment on the radiation dose.
  • The authors stated that finding thorium dioxide next to tumor in the lymph nodes would not, by itself, prove contact between thorotrast and the peritoneum as the tumor's origin.
  • The authors noted that removal of the main mass of radioactive material at nephrectomy could have influenced the latency period.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneal Cavity.

Related studies

• Malignant peritoneal mesothelioma after Thorotrast exposure — C. Stey, U. Landolt-Weber, et al. (1995)
• Peritoneal mesothelioma — M. Kannerstein, J. Churg (1977)
• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Epidemiology of peritoneal mesothelioma: a review — P. Boffetta (2007)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma: a systematic review and meta-analysis — J.H. Helm, J.T. Miura, et al. (2015)
• Papillary peritoneal tumors in women — A. Foyle, M. Al-Jabi, et al. (1981)

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