On the histopathology of liver and liver tumours in thorium-dioxide patients

Our plain-English summary of On the histopathology of liver and liver tumours in thorium-dioxide patients, by J. Visfeldt, H. Poulsen (Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology, 1972).

The study

• Authors: J. Visfeldt, H. Poulsen
• Journal: Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology
• Published: 1972;80(1):97-108
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Among 5819 autopsies carried out over the years 1966 to 1969, 6 cases were found having thorotrast deposits in the liver. One case presented non-specific reactive hepatitis, and 5 cases had cirrhosis. The cirrhoses were of the irregular type, in 4 cases with recent and long-lasting confluent necroses, in all 5 cases with extensive passive septa. The morphogenesis of the thorotrast cirrhosis is discussed on the basis of the histological changes. Four of the patients had malignant tumours which are likely to be induced by thorotrast deposits in the liver: mesothelioma, angiosarcoma, hepatoma and cholangiohepatocarcinoma. Angiosarcomas develop relatively frequently in the liver in thorotrast patients, and in the majority of cases these tumours contain large blood-filled cavities. Consequently, liver biopsy without previous angiography is contra-indicated in cases where former intravasal application of thorotrast is known or suspected. In all 6 cases the cause of death is regarded as late effects of thorotrast administration.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This Danish autopsy study described the livers of patients who had been given thorotrast, a thorium dioxide contrast medium. The article is not about asbestos. Among 5819 autopsies at the Institute of Pathology in Copenhagen from 1966 to 1969, the authors found 6 people with thorotrast deposits in the liver. These patients had received an intra-arterial thorotrast injection 24 to 29 years before death. The dose was known for 5 of them and ranged from 20 to 50 ml. Five of the 6 had cirrhosis, and the sixth had only very slight liver changes. Four had malignant tumours: a mesothelioma, an angiosarcoma, a hepatoma and a cholangiohepatocarcinoma. In the mesothelioma patient, tumour tissue was found on the peritoneum-covered parts of the intestine and stomach. No thorotrast was seen in the tumour itself, but large amounts were in the liver and its thickened capsule. The authors regarded all 6 deaths as late effects of thorotrast and considered it probable that thorotrast induced the mesothelioma. They noted that only routine histology was used, so some deposits may have been missed.

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: Autopsy case series: liver tissue examined under the microscope from consecutive autopsies, with liver biopsies available for some patients
• Who was studied: 6 patients with thorotrast deposits in the liver, found among 5819 consecutive autopsies at the Institute of Pathology, Kommunehospitalet, Copenhagen, 1966 to 1969
• Exposure: Intra-arterial injection of thorotrast (thorium dioxide contrast medium) 24 to 29 years before death. The dose was known for 5 patients and ranged from 20 to 50 ml. No asbestos exposure is discussed.
• Main results:
  • 5 of the 6 patients had developed cirrhosis
  • In patient No. 1 (the mesothelioma patient), only very slight changes were found in the liver itself
  • Among the 5 patients with cirrhosis, confluent necroses were found in 4 and passive septa in all 5
  • 4 of the 6 patients had malignant tumours: mesothelioma, angiosarcoma, hepatoma and cholangiohepatocarcinoma
  • In patient No. 1, numerous small whitish tumour growths were found on the parts of the intestine and stomach covered by the peritoneum
  • In patient No. 1, the tumour looked characteristic of a mesothelioma. No thorotrast was found in the tumour tissue, but abundant thorotrast was found in the liver, with considerable accumulation in the thickened fibrous capsule
  • The angiosarcoma (patient No. 2) contained large blood-filled cavities
  • Thorotrast was not more abundant in areas with confluent necroses than elsewhere in the liver tissue
  • All 6 patients were judged to have died from diseases regarded as late effects of the thorotrast injection
• The authors' conclusion: The authors considered it probable that the mesothelioma was induced by thorotrast in the liver and in its fibrous capsule
• Limitations the authors state:
  • Only routine histology was done and no special effort was made to trace thorotrast, so some deposits may have been overlooked
  • Autoradiographic studies were not done
  • The study included only a limited number of patients
  • For patient No. 1, the authors could not say whether the slight liver changes were caused by the tumour or by thorotrast

Topics

Medical terms in this study, explained in our Lexicon: Histopathology, Mesothelioma, Biopsy.

Related studies

• Wilson disease, ABCC2 c.3972C > T polymorphism and primary liver cancers: suggestions from a familial cluster — G. Brandi, A. Rizzo, et al. (2020)
• Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report — S. Nagata, M. Tomoeda, et al. (2011)
• An unusual liver mass: primary malignant mesothelioma of the liver : CT and MRI findings and literature review — A. Serter, N. Buyukpinarbasili, et al. (2015)
• Benign tumors of the liver — K.G. Ishak, L. Rabin (1975)
• Giant solitary fibrous tumor of the liver with metastasis to the skeletal system successfully treated with trisegmentectomy — S. Yilmaz, V. Kirimlioglu, et al. (2000)
• Benign cystic mesothelioma of the liver — P. Flemming, T. Becker, et al. (2002)

Browse more research in Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology, or return to medical research.