Arsenic, vinyl chloride, viral hepatitis, and hepatic angiosarcoma: a hospital-based study and review of literature in Taiwan.
BACKGROUND
Hepatic angiosarcoma (HAS) is a rare type of liver cancer that is often fatal, and arsenic and vinyl chloride monomer (VCM) are two major causal agents. Whereas Taiwan is an endemic area of liver cancer, epidemiologic data on HAS are limited. We reviewed the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic, and viral hepatitis in the occurrence of HAS.


METHODS
We reviewed the medical records of patients with pathological proof of HAS from January 2000 to August 2010 at a teaching hospital which is adjacent to the major VCM processing area in Taiwan and nearby an endemic area of arsenic exposure from drinking water. We also conducted a literature review and included all patients of HAS reported in Taiwan.


RESULTS
Six male and three female cases aged from 56 to 83 years (64.6 ± 8.2 years) were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6 ± 15.5 years) were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection.


CONCLUSIONS
HAS is rare in Taiwan, and we found no evidence supporting a major role of VCM, arsenic in drinking water, or viral hepatitis in its occurrence.
Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Neng-Chyan
NC
Huang
Shue-Ren
SR
Wann
Hong-Tai
HT
Chang
Shoa-Lin
SL
Lin
Jyh-Seng
JS
Wang
How-Ran
HR
Guo
D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic / Q000633:toxicity*; D005260:Female; D006394:Hemangiosarcoma / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006526:Hepatitis C / Q000150:complications*; D006784:Hospitals, Teaching; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014752:Vinyl Chloride / Q000633:toxicity*
D001151:Arsenic; D014752:Vinyl Chloride