Abdominal malignancies in patients with Wilson's disease.
BACKGROUND
Wilson's disease is associated with heavy copper overload, primarily in the liver. Copper is a toxic metal, and might be expected to be associated with cancer induction, as iron is in haemochromatosis. However, liver cancer is currently believed to be extremely rare in this disease, and other intra-abdominal malignancies have not been reported.


OBJECTIVE
To assess the frequency of abdominal malignant disease in patients with Wilson's disease on long-term follow-up.


METHODS
Retrospective study in two specialist Wilson's disease clinics: Cambridge/London and Uppsala.


METHODS
We reviewed the case records of 363 patients seen at three centres: Addenbrooke's Hospital, Cambridge, 1955-1987; the Middlesex Hospital, London, 1987-2000; and the University Hospital, Uppsala, Sweden, 1966-2002. Patients were grouped by length of follow-up: 10-19 years; 20-29 years; 30-39 years; and 40 years or more.


RESULTS
No cancers were seen in patients followed for <10 years. For patients in the 10-19 years group, the frequency was 4.2%; at 20-29 years, it was 5.3%; and at 30-39 years, 15%. No cancers were seen in the 40+ years follow-up group. The cancers consisted of hepatomas, cholangiocarcinomas, and poorly differentiated adenocarcinomas of undetermined primary site.


CONCLUSIONS
Patients with Wilson's disease appear to be vulnerable to the formation of aggressive malignant intra-abdominal tumours during long-term follow-up, irrespective of treatment. Ultrasound scanning of the abdomen seems to be a useful screening procedure.
Walshe
J M
JM
Department of Neurology, The Middlesex Hospital, London, UK. penicillamine@waitrose.com
Waldenström
E
E
Sams
V
V
Nordlinder
H
H
Westermark
K
K
D000008:Abdominal Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D002648:Child; D018281:Cholangiocarcinoma / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D008134:Long-Term Care; D008297:Male; D009154:Mutation; D010190:Pancreatic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors