Thorotrast-associated mucoepidermoid carcinoma of the liver

Abstract

Thorotrast, once a popular radiographic contrast medium, is associated with an increased incidence of angiosarcoma, cholangiocarcinoma and hepatocellular carcinoma about 10 to 30 years after administration. Use of Thorotrast was discontinued in the 1950s primarily because of concern about potential long-term radiation effects. A 59-year-old female had received prior Thorotrast administration for investigation of a right-sided cerebrovascular accident in 1952. She was admitted in 1984 for evaluation of right upper quadrant pain, anorexia, weight loss and jaundice. A plain radiograph of the abdomen showed irregular opacification of the liver parenchyma, dense opacification in the region of the spleen and opacification of the mesenteric lymph nodes. Computed tomography (Fig. 1) showed a large tumour of the liver. A radionuclide liver scan confirmed the large mass in the liver, but an ultrasound examination was unhelpful. An arteriogram showed that the mass was hypovascular and a percutaneous needle biopsy demonstrated tissue consistent with squamous-cell carcinoma. The tumour was considered to be irresectable and her clinical condition rapidly deteriorated. She died 2 weeks after admission. At autopsy the liver was enlarged, weighing 2600 g. Occupying most of the right lobe was a tumour measuring 18 cm in greatest dimension. The cut surface of this tumour was a creamy-white colour with numerous areas of haemorrhage and necrosis, and surrounding this were peripheral nodules of tumour which merged into the main tumour mass.