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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

  1. 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).

  2. 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.

  3. Bleiberg J, Wallen M, Brodkin R, Applebaum JL. Industrially acquired porphyria. Arch Dermatol 1964;89:793-7.

  4. Jirasek L, Kalensky J, Kubec K, Pazderova J, Lukas E. Chlorakne, Porphyria cutanea tarda and andere Intoxikationen durch Herbizide. Hautarzt 1976;27:328-33.

  5. 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.

  6. Hardell L, Sandstrom A. Case-control study: soft-tissue sarcomas and exposure to phenoxyacetic acids or chlorophenols. Br J Cancer 1979;39:711-7.

  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.

  8. 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.

  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.

  10. Honchar PA, Halperin WE. 2,4,5-T, trichlorophenol, and soft tissue sarcoma. Lancet (letter) 1981;I:268-9.



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