A 58-year-old man who worked for 22 years in a polyvinyl chloride factory presents with rapidly enlarging hepatomegaly and recurrent hemoperitoneum. Imaging shows multiple hemorrhagic hepatic masses. Biopsy reveals malignant spindle cells forming vascular channels lined by atypical endothelium. Which tumor is this exposure most characteristically associated with?

• A Undifferentiated embryonal sarcoma
• B Fibrolamellar hepatocellular carcinoma
• C Epithelioid hemangioendothelioma
• D Hepatic angiosarcoma ✓

Explanation

Vinyl chloride monomer, along with thorium dioxide (Thorotrast), arsenic, and anabolic steroids, is a classic causative agent for hepatic angiosarcoma, a rare malignant neoplasm of endothelial origin presenting with hemorrhagic masses and Kupffer cell involvement. Fibrolamellar HCC occurs in young noncirrhotic patients without toxic exposures. Epithelioid hemangioendothelioma is a lower-grade vascular tumor not linked to vinyl chloride, and undifferentiated embryonal sarcoma affects children.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.