A chemical plant worker exposed to vinyl chloride monomer (VCM) for 20 years develops right upper quadrant pain, hepatomegaly, and a hepatic mass on imaging. The MOST likely occupational malignancy is:
- A Hepatocellular carcinoma (HCC)
- B Angiosarcoma of the liver ✓
- C Cholangiocarcinoma
- D Hepatoblastoma
Explanation
Vinyl chloride monomer (VCM) is the classic occupational carcinogen for hepatic angiosarcoma (haemangiosarcoma of the liver) — a rare but highly malignant vascular tumour of hepatic sinusoidal endothelial cells. It is a listed scheduled occupational disease in many jurisdictions. Chronic VCM exposure causes acro-osteolysis of distal phalanges as another occupational hallmark. HCC is associated with hepatitis B/C and cirrhosis. Cholangiocarcinoma is associated with primary sclerosing cholangitis and liver flukes. Arsenic and Thorotrast (thorium dioxide) are other agents causing hepatic angiosarcoma.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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