Thorotrast-induced primary cerebral angiosarcoma: case report.
OBJECTIVE
Thorotrast was used as a contrast medium in clinical practice until the 1960s for outlining cerebral abscess cavities and ventricular cavities, and for angiography. Gliosarcomas, meningiomas, and schwannomas have been reported previously, as has Thorotrast-associated angiosarcoma, typically in the liver. A unique case of a primary intracerebral well-differentiated angiosarcoma in a 68-year-old man with a history of colocalized exposure to Thorotrast is described. This may be the first case of a primary angiosarcoma in the brain.


METHODS
The patient presented with a progressive left-sided weakness 62 years after initial surgery for a right parietal cerebral abscess, which included the instillation of Thorotrast into the abscess cavity. Computed tomography showed a right parietal tumor.


METHODS
An explorative craniotomy showed an intrinsic, infiltrating, very vascular tumor with surrounding calcification. The tumor appeared to arise from a benign cavernous vasoformative lesion intimately associated with a Thorotrast-type granuloma. The patient declined further surgery or radiotherapy.


CONCLUSIONS
The histology, confirmation of radioactivity of the material obtained from within the tumor, and latency period of presentation provide compelling support for tumor induction by the Thorotrast. Primary lesions of the central nervous system associated with Thorotrast are very rarely reported, despite its extensive use in cerebral angiography and management of brain abscess between 1930 and 1960.
Balamurali
Gopalakrishnan
G
Department of Neurosurgery, Salford Royal Hospitals, Manchester, England. drbala73@hotmail.com
du Plessis
Daniel G
DG
Wengoy
Moses
M
Bryan
Nicholas
N
Herwadkar
Amit
A
Richardson
Peter L
PL
D000368:Aged; D001932:Brain Neoplasms / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D002273:Carcinogens / Q000494:pharmacology*; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery; D006394:Hemangiosarcoma / Q000139:chemically induced* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D013911:Thorium Dioxide / Q000494:pharmacology*; D014057:Tomography, X-Ray Computed
D002273:Carcinogens; D013911:Thorium Dioxide