Ho Sheng-Yow, Tsai Chiang-Chin, Tsai Yi-Chang, Guo How-Ran
Department of Radiation Oncology, Sin-Lau Christian Hospital, Tainan, Taiwan.
J Formos Med Assoc. 2004 May;103(5):374-9.
Hepatic angiosarcoma (HAS) is a rare primary mesenchymal malignancy of liver with close association to arsenic intoxication. Although the southwest coastal area of Taiwan is well known for its prevalence of arsenic intoxication from drinking well water, few cases of HAS associated with arsenic ingestion have been reported. We report a case of HAS complicated by spontaneous hepatic rupture in a 68-year-old female farmer who presented with acute onset of abdominal pain and shock. The arsenic level in her drinking water had been found to be 0.12 ppm at her childhood home and 0.005 ppm at her residence from age 21 to 68 years. The total ingested arsenic was estimated to be 1.9 g, and the latent period was about 25 years with a weighted mean exposure of 0.12 mg/day. We also reviewed data collected by the National Cancer Registry Program from 1981 to 1999 and identified 25 additional reported cases. The median age of these patients was 55 years, and the male-to-female ratio was 1.9 (17:9). Whereas no case was found during this period in the blackfoot disease (BFD) endemic area, a hyperendemic area of arsenic intoxication in Taiwan, this case demonstrates the existence of cases of HAS associated with exposure to high levels of arsenic near the BFD area in Taiwan.
肝血管肉瘤（HAS）是一种罕见的肝脏原发性间质性恶性肿瘤，与砷中毒密切相关。尽管台湾西南沿海地区因饮用井水导致砷中毒流行而闻名，但与砷摄入相关的HAS病例报道较少。我们报告一例68岁女性农民的HAS并发自发性肝破裂，患者表现为急性腹痛和休克。她童年家中饮用水中的砷含量为0.12 ppm，21岁至68岁居住期间为0.005 ppm。估计总砷摄入量为1.9克，潜伏期约为25年，加权平均暴露量为0.12毫克/天。我们还回顾了国家癌症登记计划在1981年至1999年收集的数据，并确定了另外25例报告病例。这些患者的中位年龄为55岁，男女比例为1.9（17:9）。在台湾砷中毒的高流行区——黑脚病（BFD）流行区，在此期间未发现病例，但该病例表明台湾BFD区附近存在与高砷暴露相关的HAS病例。
