Spätschäden nach Thorotrastinjektion mit besonderer Berücksichtigung physikalisch-quantitativer Befunde

Thorotrast-Induced Angiosarcoma Complicated by Disseminated Intravascular Coagulation and Microangiopathic Hemolytic Anemia: Case Report and Review

Thorium dioxide was first used for radiographic imaging studies as early as 1915. Carcinogenesis was clearly established by the 1940s, such that by 1956 worldwide usage had ceased. Malignancies were noted to appear from 15 to 45 years after injection. A case of thorotrast-induced hepatic angiosarcoma is presented, which was complicated by disseminated intravascular coagulation and microangiopathic hemolytic anemia. Since multiple medical conditions existed, it was unclear which was primarily responsible for these complications. This is the first reported association between thorotrast-induced malignancy and disseminated intravascular coagulation. The world literature is reviewed.

Thorotrast-induced oro- and hypopharyngeal fibrosis with recurrent bleeding

Thorium dioxide, widely used as a contrast material, is a producer of alpha particle radiation. This is well demonstrated by autoradiography. The case described illustrates that life-threatening, thorium dioxide-induced pharyngeal haemorrhage may occur even with an occluded carotid artery. The radiation exposure caused an intense foreign body reaction with a marked cell-deficient fibrosis. The alpha particles are well demonstrated by autoradiography. In addition, we were able to show a defect in the wall of the carotid artery due to the Thorotrast injection, which was closed by cell-depleted connective tissue. As the radioactivity of the nuclides of thorium dioxide peaks 30-40 years after its first application, the morbidity will increase and the disease has to be taken into careful consideration in head and neck tumour lesions.

Thorotrast-associated gliosarcoma. Including comments on thorotrast use and review of sequelae with particular reference to lesions of the central nervous system

The occurrence of a glioblastoma with sarcoma, a gliosarcoma, in the left frontal-temporal area of a 49-year-old woman with a history of Thorotrast exposure, is described. Thorotrast-laden histiocytes and free Thorotrast material were found in both components of the tumor. An overlying, adherent dural cranial lesion was found to contain massive deposits of Thorotrast embedded in a dense fibrotic and sclerotic stroma with focal calcification. These features are typical of "Thorotrastoma." Thorotrast stains greenish-brown with hematoxylin and eosin and appears as refractile granular particles of relatively uniform size either within histiocytes or as free material. The radioactivity of the deposits was confirmed through the use of a scintillation counter, and 232 thorium was definitively identified though the use of scanning electron microscopy with energy-dispersive X-ray analysis. Immunohistochemical studies of the tumor demonstrated glial fibrillary acid protein (GFAP) immunoreactivity in areas of glioma and focal vimentin and actin immunoreactivity in areas of sarcoma. Thorotrast-associated lesions of the central nervous system (CNS) are infrequently reported, and a Thorotrast-associated gliosarcoma has not yet been reported. The use of Thorotrast, its radiobiology, and sequelae are reviewed with particular emphasis on lesions occurring in the CNS.