WBR0593

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Will Gibson and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 58 year-old man with a past medical history of uncontrolled diabetes mellitus, hypertension, and dyslipidemia, presents to the physician's office with complaints of excessive fatigue, weight loss, and new-onset abdominal pain. The patient explains that his pain has progressively worsened over the past 3 weeks. He states that his pain is located in right upper abdominal quadrant and radiates to the right shoulder. Following extensive work-up, the patient is diagnosed with a malignant hepatic tumor of endothelial origin. Chronic exposure to which of the following is most likely associated with this patient's condition?]]
Answer A	AnswerA::Plastics
Answer A Explanation	AnswerAExp::Polyvinyl chloride (PVC) is a component of plastics. Chronic exposure to PVC is associated with development hepatic angiosarcoma.
Answer B	AnswerB::Rubber
Answer B Explanation	AnswerBExp::Chronic exposure to rubber is associated with development of bladder cancer.
Answer C	AnswerC::Textiles
Answer C Explanation	AnswerCExp::Chronic exposure to textiles is associated with development of bladder cancer.
Answer D	AnswerD::Chimneys
Answer D Explanation	AnswerDExp::Chimney sweeping is associated with scrotal cancer.
Answer E	AnswerE::Shipyards
Answer E Explanation	[[AnswerEExp::Shipping industry and construction is associated with exposure to asbestos. Asbestosis is associated with bronchogenic carcinoma of the lungs and mesothelioma. While bronchogenic carcinoma is a much more common disease than mesothelioma, nearly all cases of mesothelioma have been associated with chronic asbestos exposure.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Hepatic angiosarcoma is a rare, malignant, vascular tumor that is associated with chronic exposure to chemical carcinogens, such as polyvinvyl chloride (PVC), thorium dioxide (Thorotrast), radium, and arsenic. Hepatic angiosarcoma is very aggressive and has a very poor prognosis with a very high rate of mortality. The disease was first discovered among employees of PVC industry. Patients often present with non-specific abdominal complaints, such as dull abdominal pain in the right upper quadrant, fatigue, and unexplained weight loss. It is considered one of the most common forms of plastics. On the other hand, arsenic (a metalloid element) is usually found in water and food contaminated with pesticide. Educational Objective: Chronic exposure to polyvinyl chloride, a material often found in plastics, is associated with development of hepatic angiosarcoma. References: Molina E, Hernandez A. Clinical manifestations of primary hepatic angiosarcoma. Dig Dis Sci. 2003; 48(4):677-682. First Aid 2014 page 362]]
Approved	Approved::Yes
Keyword	WBRKeyword::Plastics, WBRKeyword::Plastic, WBRKeyword::PVC, WBRKeyword::Polyvinyl chloride, WBRKeyword::Arsenic, WBRKeyword::Contaminated water, WBRKeyword::Hepatic, WBRKeyword::Angiosarcoma, WBRKeyword::Malignant, WBRKeyword::Tumor, WBRKeyword::Right upper quadrant, WBRKeyword::Abdominal pain, WBRKeyword::Shoulder radiation, WBRKeyword::Chronic exposure
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