Epidemiologic Notes and Reports Porphyria Cutanea Tarda
and Sarcoma in a Worker Exposed to 2,3,7,8-
Tetrachlorodibenzodioxin -- Missouri
In a recent survey of workers employed at St. Louis, Missouri,
trucking terminals contaminated with
2,3,7,8-tetrachlorodibenzodioxin
(TCDD), the National Institute for Occupational Safety and Health
(NIOSH) found that a former worker had developed porphyria cutanea
tarda and sarcoma (1).
In the early 1970s, three trucking terminals in St. Louis were
sprayed with TCDD-contaminated waste oil to control dust. To
evaluate
potential health effects to the approximately 600 workers employed
at
these sites, NIOSH investigators interviewed past and current
employees at the terminals. During the initial interviews in
December
1983, the investigators were contacted by a former worker at one of
the firms. The worker, a 59-year-old male, had been in good health
until June 1982, when he developed blistering and increased hair
growth over the dorsa of his hands. Subsequent medical
investigation
confirmed a diagnosis of porphyria cutanea tarda. The patient's
symptoms improved with phlebotomy, avoidance of sun, and cessation
of
alcohol ingestion. He had previously consumed one case of beer
weekly
for many years.
In February 1983, after complaining of right groin pain and
right
leg weakness for a few months, the man was found (by CAT scan) to
have
multiple lytic lesions of his proximal right femur and pelvis, with
involvement of adjacent soft tissue. Biopsy of the right ilium
revealed a sarcoma. Two consultant pathologists concluded that the
tumor was an angiosarcoma; it was not possible, however, to
determine
whether the tumor arose from bone or soft tissue.
The patient had worked as a truck driver for over 21 years, and
in
the early 1970s, worked for several years at one of the
TCDD-contaminated trucking terminals. (Soil samples taken at this
terminal in 1983 had shown that TCDD was present in subsurface soil
at
concentrations as high as 17 parts per billion (ppb).) For several
months during the 1970s, he had worked unhooking trailers from
trucks
in the sprayed area of the terminal and thus had potentially higher
exposure to TCDD than in his usual work as a driver. He reported
that
his feet, legs, hands, and arms frequently became covered with oil
from the terminal. He continued to work at the terminal through
early
1980. Also, he occasionally made deliveries to a chemical plant
and
to other trucking terminals now known to be contaminated with TCDD.
He had no history of other exposure to TCDD either at work or at
home.
Reported by W Hope, ScD, St. Louis City Health Div, D Lischwe, MD,
St.
Louis, Missouri; W Russell, MD, North Ridge General Hospital, Ft.
Lauderdale, Florida; S Weiss, MD, Armed Forces Institute of
Pathology,
Washington, DC; Hazard Evaluations and Technical Assistance Br, Div
of
Surveillance, Hazard Evaluations, and Field Studies, NIOSH, CDC.
Editorial Note
Editorial Note: Although this worker was probably exposed to TCDD
through cutaneous absorption of contaminated oil and also by
inhalation of aerosolized dust containing TCDD, the possible
relationship between this exposure and the development of
subsequent
disease is far from clear. Chronic alcohol ingestion has been
reported to result in porphyria cutanea tarda (2). Also, porphyria
cutanea tarda has been reported in two groups of workers exposed
occupationally to TCDD (and possibly also to hexachlorobenzene).
In
both instances, all cases of porphyria appeared during the time of
actual chemical exposure (3,4).
Although this patient's tumor was clearly a sarcoma, it was not
possible to determine whether it had arisen from bone or soft
tissue.
Soft-tissue sarcoma is a rare tumor, with an incidence in the
general
U.S. population of 3.9 per 100,000 (5). Two recent case-control
studies in Sweden have shown an approximate sixfold increase in the
risk of death from soft-tissue sarcoma among workers with histories
of
occupational exposures to TCDD-contaminated phenoxy acid herbicides
or
chlorophenols (6,7). Other epidemiologic studies have been
inconclusive because of their small study populations and
consequent
low statistical power (8,9). Additionally, a recent analysis of
data
from three cohort mortality studies of workers exposed at chemical
manufacturing plants to TCDD-contaminated trichlorophenol or to the
herbicide 2,4,5-trichlorophenoxy acetic acid suggests the existence
of
an association between TCDD exposure and soft-tissue sarcoma (10).
As part of a series of studies of persons in Missouri exposed
to
TCDD, NIOSH is continuing to interview and examine workers from
TCDD-contaminated trucking sites. In addition, NIOSH is conducting
a
mortality study and a cross-sectional medical study of workers
exposed
to TCDD at several chemical plants.
References
National Institute for Occupational Safety and Health. Health
hazard evaluation report no. HETA 83-297. Cincinnati, Ohio:
National Institute for Occupational Safety and Health (in
progress).
Grossman ME, Bickers DR, Poh-Fitzpatrick MB, Deleo VA, Harber
LC.
Porphyria cutanea tarda. Clinical features and laboratory
findings in 40 patients. Am J Med 1979;67:277-86.
Jirasek L, Kalensky J, Kubec K, Pazderova J, Lukas E.
Chlorakne,
Porphyria cutanea tarda and andere Intoxikationen durch
Herbizide. Hautarzt 1976;27:328-33.
National Cancer Institute. Third national cancer survey:
incidence
data. Cutler SJ, Young JL, eds. Bethesda, MD.: National Cancer
Institute, 1975. NCI Monograph 41:1-454.
Hardell L, Sandstrom A. Case-control study: soft-tissue
sarcomas
and exposure to phenoxyacetic acids or chlorophenols. Br J
Cancer
1979;39:711-7.
Eriksson M, Hardell L, Berg NO, Moller T, Axelson O.
Soft-tissue
sarcomas and exposure to chemical substances: a case-referent
study. Br J Ind Med 1981;38:27-33.
Smith AH, Fisher DO, Pearce N, Teague CA. Do agricultural
chemicals cause soft tissue sarcoma? Initial findings of a
case-control study in New Zealand. Community Health Studies
1982;6:114-9.
Riihimaki V, Sisko A, Hernberg S. Mortality of
2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic
acid herbicide applicators in Finland. Scand J Work Environ
Health
1982;8:37-42.
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