WBR0593

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 58 year-old-male male with a past medical history of uncontrolled diabetes mellitus, hypertension, and dyslipidemia, presents to the physician's office complaining of excessive fatigue and new-onset progressive right upper quadrant pain that radiates to the right shoulder. Following extensive work-up, the patient is found to have angiosarcoma of the liver. 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 one of the most commonly used plastic components. Exposure to PVC is associated with development hepatic angiosarcoma.
Answer B	AnswerB::Rubber
Answer B Explanation	AnswerBExp::Rubber exposure is associated with bladder cancer.
Answer C	AnswerC::Textiles
Answer C Explanation	AnswerCExp::Industrial exposure to textiles is associated with 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 are associated with exposure to asbestosis. Asbestosis is significantly associated with bronchogenic carcinoma or the lungs and mesothelioma. Bronchogenic carcinoma is a much more common complication, but nearly all cases of mesothelioma are associated with asbestos exposure.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::This patient presents with symptoms that are typical of a rare type of liver cancer, hepatic angiosarcoma. Hepatic angiosarcoma is a malignant vascular tumor that represents approximately 1-2% of all liver tumors. Development of hepatic angiosarcoma is not associated with residence in any geographical areas. However, it is notorious for its association with chemical carcinogens, such as polyvinvyl chloride (PVC) and arsenic. Hepatic angiosarcoma has a very poor prognosis with a very high rate of mortality. PVC is considered one of the most common forms of plastics. On the other hand, arsenic, a metalloid element, is usually found in contaminated water or food. Both are known to be significantly associated with hepatic angiosarcoma upon chronic exposure. Educational Objective: Chronic exposure to polyvinyl chloride, a material often found in plastics, is strongly associated with hepatic angiosarcoma. References: Molina E, Hernandez A. Clinical manifestations of primary hepatic angiosarcoma. Dig Dis Sci. 2003; 48(4):677-682.]]
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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