Residual splenic function in the presence of thorotrast-associated hepatic tumor: case report

A 50-year-old man had received intravenous colloidal thorium dioxide (thorotrast) 27 years previously. Scintiscans with both 99mTc-sulfur colloid and 131I-rose bengal revealed an extensive intrahepatic defect. At operation, the lesion proved to be an infiltrating hemangiosarcoma. The spleen was small but the chronic internal radiation of the spleen had not completely destroyed the function of radiocolloid uptake. Review of the literature disclosed other cases in which the spleen was still capable of accumulating radiocolloid some years after thorotrast administration. In at least one other instance, radiocolloid uptake was not accompanied by splenic ability to clear Howell-Jolly bodies: a disassociation of splenic functions. The effects of the internal radiation dose to the spleen from thorotrast are discussed and compared with the effects of external radiation. The discrepancy between the effects of the two doses may be related to the high relative biologic effectiveness of the alpha rays from thorotrast compared with gamma-radiation, to nonuniformity of distribution, and to the effects of reticuloendothelial blockade.