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 patient, 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. It is associated with hepatic angiosarcoma. |
| Answer B | AnswerB::Rubber |
| Answer B Explanation | AnswerBExp::Rubber exposure is associated with bladder cancer. |
| Answer C | AnswerC::Textile |
| Answer C Explanation | AnswerCExp::Textila exposure 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 to a much lesser rate, mesothelioma. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::The 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 only, and does not have a geographical predominance, but it is notorious for its association with chemical carcinogens, such as polyvinvyl chloride (PVC) and arsenic. Hepatic angiosarcoma is of 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 PVC, often found in plastics, is strongly associated with hepatic angiosarcoma, a rare malignant vascular tumor of the liver. Reference:
Molina E, Hernandez A. Clinical manifestations of primary hepatic angiosarcoma. Dig Dis Sci. 2003; 48(4):677-682. |
| Approved | Approved::No |
| Keyword | WBRKeyword::plastics, WBRKeyword::plastic, WBRKeyword::PVC, WBRKeyword::polyvinyl, WBRKeyword::chloride, WBRKeyword::arsenic, WBRKeyword::contaminated, WBRKeyword::water, WBRKeyword::hepatic, WBRKeyword::angiosarcoma, WBRKeyword::malignant, WBRKeyword::tumor, WBRKeyword::right, WBRKeyword::upper, WBRKeyword::quadrant, WBRKeyword::pain, WBRKeyword::shoulder, WBRKeyword::radiation, WBRKeyword::chronic, WBRKeyword::exposure |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |