Tissue dosage from thorotrast in the body.
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Monitoring the incidence of angiosarcoma of the liver (ASL) between 1974 and 1977 has led to the confirmation by a panel of pathologists of 7 new cases of ASL in patients who had received intra-arterial Thorotrast for radiological investigations. A cluster of cases has appeared in and around Edinburgh where the use of Thorotrast was pioneered in Britain in 1933-48, and a mortality study of 113 Edinburgg patients has confirmed a significant excess of liver-tumour deaths in recent years. Deaths from cancers of the lung and breast, and from hepatic cirrhosis, were also in excess, but the limitations of the death-certificate data are described in relation to the clinical and pathological findings. Thorotrast was also used in other centres, and an increased incidence in Britain of liver tumours attributable to this agent is indicated.
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Thorotrast was used as a radiographic contrast agent in the United States from about 1930 to the mid-1950 s. Its use was discontinued when it was recognized that its radioactivity caused long-term deleterious effects. Such long-term sequelae of intravascular Thorotrast injection include, most notably, hepatic and hematologic malignancies and hepatic fibrosis. Some patients who had received Thorotrast subsequently received liver transplants. However, it was not known whether or not Thorotrast could become redistributed within the new allograft. A single report in 1994 demonstrated that radioactivity was detected by gamma-ray spectroscopy in liver allografts shortly after transplantation. No report has identified Thorotrast in the allografts of long-term transplant survivors, and the redistribution of Thorotrast into allografts has not been documented histologically or by electron microscopy. We report a case of recurrent Thorotrast into a liver allograft 10 years post-transplant. We evaluated the native liver and allograft specimens for the presence of thorium utilizing light microscopy, electron microscopy and electron X-ray microanalysis. This case report demonstrates for the first time the redistribution of Thorotrast into a long-surviving liver allograft using histologic, electron microscopic and X-ray microanalysis techniques.
Simplified and reliable methods for identifying thorotrast are demonstrated. On gamma-ray spectrometry, as little as 0.1 g of liver tissue gives gamma-ray spectrum characteristics to the thorium decay series, despite a low net count. When conventional film for photography is kept in contact with a paraffin section of the liver for 4 months, it develops silver grains exactly corresponding to the area of granular deposition. By combining this method with clinical and pathological findings, a diagnosis of thorotrastosis can be established without the need for special instruments or materials.
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A carcinoma of the renal pelvis was diagnosed in a female patient 42 years after a retrograde Thorotrast pyelogram. The patient died as a result of the carcinoma at the age of 60. The literature is reviewed. As a result of this case, the need is stressed for early recognition of Thorotrast depositis in the kidney. In this case it was demonstrated by autoradiography. Appropriate treatment is discussed.
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