Exposure to polymeric materials in vascular soft-tissue sarcomas

Abstract

Known etiologic factors related to endothelial angiosarcomas are exposures to arsenic, thorium dioxide, therapeutic irradiation, and certain congenital diseases. Little is known on the etiology of hemangiopericytomas. Since 1974, several reports have appeared on a distinct relationship between the exposure to vinyl chloride monomers and angiosarcomas of the liver. The early reports on this matter provided the reason to collect the occupational histories of vascular sarcomas accumulated since that time. Methods: Data on the occupational histories of patients with different forms of angiosarcomas, treated between 1975 and 1995 in two institutions, were prospectively collected and analyzed. In this personal series the only selection criteria were the referral of patients for postoperative or palliative irradiation and their personal care by the author. Findings: Among 21 adult cases of vascular sarcomas there were 4 patients with occupational exposure to vinyl chloride (VC) either alone or together with other artificial polymers. Seven other patients showed exposure to several plastics or resins other than VC. Altogether, 11 of 21 (52%) of the explored patients were found to have been exposed to artificial polymeric materials over a mean period of 18 years. The patients without such exposure were 4 farmers, 2 house-wives, and 1 woodworker, telephonist, mason, and inland revenue official, respectively. Two cases were radiation-induced. The series contained no angiosarcoma of the liver. Interpretation: This study offers new evidence of the occurrence of vinyl-chloride-induced angiosarcomas outside the liver and confirms observations that have previously been published in case reports. Moreover, it may be suspected from this analysis that polyvinyl chloride and its monomers are not the only polymeric materials that may contribute to an induction of angiosarcomas in humans. Repeated occupational histories have to be taken from the patients to achieve data of the greatest value, since there are many professional activities that do not primarily lead to the assumption of specific exposure to polymeric materials.