Primary hepatocellular carcinoma in workers exposed to vinyl chloride: a report of two cases

Vinyl chloride (VC), an industrial toxic gas, has a dose-dependent carcinogenicity in rodents and has been responsible for multiple cases of liver angiosarcoma in humans. The aim of this study was to describe histopathologic liver alterations and to evaluate risk factors for hepatocellular carcinoma in two workers from the same plant, both of whom had primary nonangiosarcoma liver tumors and were exposed to VC.

Clinical, biochemical, serologic, and pathologic data were reviewed at the time of hepatic resection. Clinical and biologic follow-up were available for several years before the diagnosis of hepatocellular carcinoma.

Liver alterations distant from the tumor site were compatible with ongoing exposure to VC in both cases. Several areas containing dysplastic hepatocytes were present in nontumoral liver in one patient. Both patients are alive after partial liver resection, and 1 has had 5 years of follow-up without recurrence.

Exclusion of classic risk factors for noncirrhotic hepatocellular carcinoma of the liver in both patients suggests a relationship between VC exposure and observed tumors. Systematic long term follow-up with biology and ultrasonography for workers exposed to VC may result in relatively early diagnoses of liver tumors and long term survival in some cases.