Document 06zz2QD5VxOdzvJqmbKEE8pxm

1 Tclcpmone (BOB) 446*3737 ELAINE B. PANTO. M. D. OCCUPATIONAL. AND ENVIRONMENTAL MEDICINE EAST WINDSOR PROFESSIONAL PARK ONE MILE ROAD EXTENSION HICHTSTOWN. NEW JERSEY 08320 March 2C, IS85 Ronald E. Grayzel, Esquire So James Sneer. Edison, KJ C8823 Re: Jonn Eyor is Deer Mr. Grayzel: At your rc-cusst, 1 have reviewed the medical records and occupational history, supplied by your office, regarding John Byoris, deceased since 9/4/32. History of Final Illness Mr. iiyorie was a 59-year-old white hypertensive -.ale laborer, working for VJitco Chemical Company, when he became ill in April 1982. Initial evaluations revealed fever of unknown origin, anemia, a 43 pound weight loss, and an elevated LDH blood level. Admission to Perth Amboy General Hospir.al in June 1982 revealed extensive enlargement of lymph nodes in the abdomen. Atr.zmpts to obtain tissue for diagnosis were initially unsuccessful. After 4 weeks of steroid therapy, a laparotomy produced tissue that was diagnosed as a malignant lymphoma ("histiocytic" type, now referred to as "diffuse large cell" type). Mr. Byoris was treated with chemotherapy but died on 9/4/32 after progressive bone marrow and renal failure. Gross findings at autopsy included: an enlarged heart with slightly eniargad chambers but normal wall thickness, moderate atherosclerotic change in the coronary arteries, a mottled pleural surface witn a moderate amount of anthracotic pigment, multiple matted an thrsco tic lymph nodes around the trachea, retroperitoneal hemorrhagic tissues, and superficial ulcers of the stomach 1 in i nc . Microscopic autopsy findings included moderate to severe a the rose! err,.; is of the coronary arteries, mild an thr arr.sis ir. toe lung parenchyma, and de ter lorn i:ed, scarred tissues in the boro marrow and supporting tissues about the intestines r.rd pancreas. These damaged tissues no douot. repees *n ted the lymunome tissue after treatment with chc.T.otr.srspy. PCB-ARCH-EXT0371273 Occupa tional Hi-Stor y ' According to information provided by your office. Hr - Byoris was employed at Kitco Chemical, Perth Amboy, KJ, from 1962 to 19&2. During his years at the plant, Mr. Byoris worked as a laborer in the Pioneer Division's asphalt production area. He spent, approximately 2 days each w#e out tanks used to store flux oil (the petroleum residuum that is converted to asphalt by an air-blowing process). It was his job to climb inside the unventilated tanks, without respiratory protection, and scrape out accumulated "coke" on the- tank surfaces. He performed this operation by hand, using scrapers. Such cleaning operations took anywhere from 1 to 7 cays to complete, and reportedly involved exposure to "large amounts of dust and fumes" within the tanks. In 1S'76 the asphalt plant was closed and Mr. Ever is became a forklift operator. He apparently opera ted of the plant which have subsequently been found to be highly contaminated with polychlor inated by the New Jersey Department of Environmental Protection. DEP claims that soil borings from parts of the Witco property showed levels in the thousands of parts per million, or up to 3.5% of the soil. DISCUSSION Maiignant Lymphomas The lymphomas are a group of malignant diseases affecting the lymphoreticular system, usually arising in the lymph nodes. The lymphomas are usually classified as eir.her Hodgkin or non-Hodgkin lymphoma, depending on histologic appearance. There currently some 12 different varier.ies of nonHodgkin lymphoma^ of which Mr. Byoris' tumor ("histiocytic" or iara^sl^is nne. For a number of years, investigators have suspected that some malignant lymphomas have an environmental etiology. This suspicion nas stemmed from the "clustering" of lymphoma cases among people who live together, whether genetically related or not, anc among people in trie same geographical location. The incidence of malignant 1 ympr.o.uas nas also beer, notes to os increasing around the world since 1973. Independent researchers in the cancer field believe that some iympnom.as are asaociarec wi r.h chemical.-, in the workplace . This oe 11 e: ns ^ grown s t.cr. o 11 ^ ^.rce Mia *o o, iro... i.-. l ..cit i i. 3... .v observations arourm tne vorid, ana ir- a variety of occupational settings. A sign if ican t in C r C: a U c; i n the nturner of m.a 1 i yr. r. t Iympnom.as has been repor te d a ) in the ce tr Ov'hem. ical and r ubb or industries [Tnomas 19b2 JO:'. 24:13b t \! ; * 1 . 1*. hael 197b JO.'-i 17 : 234 , Mon son 19 7 c JNCI 61:1947] t b ) am on c c r. v.Tw i i: Is and too se who wor k with organic solvents [Li 19 69 J.Swi 4 3:1 159, Clin 197S La n ce t 2: SIT., Clin 19S2 PCB-ARCH-EXT0371274 Env.Res.22:154j, c) among woodworkers and those using wood preservatives such as pen tachlor ophenol [EriUsor. 1981 DJ1H 38:27J, d) in workers exposed to pher.oxy acid herbicides such as 2,4,5-T [Hardeil 1981 BJC 43:169], e) in plumbers and pipefitters fabricating plastic pipe and using solvents [Dolan 1963 JGK 25:613], and f) in anesthesiologists using multiple chemical agents [Vessey 1978 Anaes. 33:436j. Although an increase in lymphomas is noted to occur in these occupational groups with multiple chemical exposures, no single agent has been proven conclusively to be causative in such groups. Benzene has long been shown to cause hematologic disorders in various worker groups. Interestingly, there have also been case reports suggesting that benzene affects the lymphoreticular system (as well as the hematopoietic system) leading to lymphomas and related disorders (see below). Several studies have suggested an association between malignant lymphoma and occupational exposure to asbestos [Gerber 1978 Am.J.Cl in.Pa th. 53:264, Kagan 1979 Am.J.Med. 67:325, Foss 1952 Lancet 2:1118], and asbestos is known to affect the immune system in man Predilection for lymphomas in man appears to be associated with abnormalities of the immure system, whether genetically or environmentally acquiree. It is speculated that lymphomas arise through chemical alteration of the immune system. For example, the therapeutic use of immunosuppressive chemicals in man (in transplantation, autoimmune disorders, cancer) markedly increases the risk of malignant, lymphoma. The risk of developing non-Hodgkin lymphoma is mult.ipled some SG times in I transplant patients receiving immunosuppressive drugs. Embyologicaliy-related tumors, known as soft, tissue sarcomas, are also increased in such a setting. Remarkably, the induction (or latency) period required to increase the lymphoma risk has been demonstrated to be as little as one nsontn, This short latency period stands in contrast to the long latencies associated with other carcinogens in man. Petroleum Residuum Petroleum residuum ("flux oil") is the material remaining after treatment of crude petroleum in an oil refinery. It is a mixture of materials of poorly defined and indefinite hydrocarbon composition. Its cousins include such complex mixtures as soots, pitch, coal tar and products, creosote, shale, mineral oils, and cutting oils. Depending on the boiling point reached during distillstinn, petroleum residuum may contain up to 5C& aromatic hybr near bon s, widely held to be carcinogenic in both animals and man. Aromatic hydrocarbons are characterized by the presence of one or more benzene rings. Tney are classified inr.o tnree :r.a in cr oups. depending on number of benzene rings and binding: PCB-ARCH-EXT0371275 a) benzene and its derivatives, f oji poiypnenyis (incJ I polychlorinated biphenyls or PCBs) , c) polynuclear aromatic hydrocarbons (or FAH) . Although distillation of coal in the coking process was the original source for aromatic hydrocarbons, at the present time the petrochemical industry is the major source of such aromatic compounds. Benzene Although most benzene is driven off from crude petroleum in. the oil refinery, petroleum residuum may continue to evolve small amounts of benzene and other volatiles, which can accumulate inside unventilated tanks such as those cleaned by Mr. Evoris. While most petrochemical workers today avoid significant benzene exposures because of largely outdoor work settings, those who work indoors or in unventilated situations (shoemaking, rubber manufacture) have continued to demonstrate benzene-related health effects, including increased lymphomas [Delzell 1931 JCM 22:677). It is because of the possible accumulation of aromatic volatiles such as benzene that management is constrained to "sniff 'test" such tanks before the entry of workers. The major routes of exposure is through inhalation and skin absorption. Benzene is well-known for its effects on the bone marrow in workers chronically exposed: aplastic anemia and various forms of leukemia. Animal studies have demonstrated that benzene also ( causes changes in the lymph nodes of rats (Wirtschafter, Z.T., et.al. Arch. Path. 67:146, 1960). A relationship to lymphoma in man was first suggested by Eousser in 1947, who reported a case of diffuse histiocytic lymphoma in a worker after 3.5 years of chronic benzene exposure. In IS 3 0 , Aksoy (Kaetr.a tolog ica 65: 370) reported 4 cases of malignant lymphoma in chronically exposed (10-17 years) shoe-workers, one of which was a diffuse histiocytic lymphoma in a worker 42 years old. Certain other occupational groups, such as chemists, with presumed chronic exposure to benzene, have demonstrated increased occurrence of lymphoma (Clin 1930 Env.. Res. 22.154, Clin 1975 Lancet 2:916, Li 1969 JKCI 43 : 1159 , Viglianni 1976 Env.r.es. 11:122, Infante 1977 Lancer. " - y-j anna 1575 Lancet 1 : 1394). Pol yen lorinateo Eiohenvl Polychlorinated biphenyls (PCEs) were found in hi. concentrations on the Witco proper tv. FCEs are generali_ considered to be_____ con tarn, i no tec: with polychlorinated d ihei^zodiox^ns^ tne most "` .ox;c of which is tetracniorocibenzodioxin, or TCCD, referred to often as "dioxin". I do not know of TCDD levels measurer, on V. i tco proper ty, bu t other areas around___ the USA with >>* t'uu contamination have de:r.onsTT5^ecT,'TuDDMTeTeTTTMl r m 1 To"777T"15?n!T5""3HT"TrrTTTBTT7 TOLL is a potent animal carcinogen, and recent government publications have indicated that "soil levels greater than 1 part per billion pose a leve) of concern" to human beings. PCB-ARCH-EXT0371276 TCDD is considered to be the most toxic synthetic compound known, and it is highly persistent in the environment. In animals end people it concentrates mainly in the liver, fat, thymus, and spleen. Animal studies have demonstrated that immunotoxici ty is a serious health effect at low doses of TCDD: atrophy of lymphoid tissues and suppression of humoral immune function, with decreased resistence to infection (Dean lSo J. Reticuloendothel. Soc. 28:571, Vos 1981 Tox.App.Phsrm. 61:18, Roller 1973 Am.J.Vet.Res. 34:1685, Thomas 1S78 Tox.App.Pharm. 44:41, Loose 1981 Env.Health Perse. 39:79). It is noteworthy that workers exposed to PCBs biy TCDD), both in SwederTTncintheTMT??T7TMT5 ve demonstrated an I irrrrz ase ir. lymphomas and/or soft tissue sarcomas, tumors tha t !| are known to occur in other immunocompromised patients (see above, Halignant Lymphomas). Exposure to TCDD occurs through three routes: dermal absorption through direct contact with the sol), ingestion of soil, and the inhalation of dust to which TCDD is attached. Anywhere from 1 to 1 101 of TCDD in the soil may be absorbed through the skin, and may | increase with higher soil concentrations. Some 301 of ingested' TCDD is absorbed into the body. Inhaled TCDD is deposited in the respiratory tract or ingested after being brought up from the respiratory tract. As a forklift driver moving about the VJitco property, it is probable that Hr. Byoris had significant inhalation and ingestion of airborne TCDD-1acen dust. There may also have been some dermal absorption. Polynuclear Aroma tic Hydrocarbons Hydrocarbon mixtures, such as petroleum residuum, are widely considered to contain substances that are thought or known to be carcinogenic in animals and in man. They are known to contain polynuclear aromatic hydrocarbons, or PAH, a group of.chemicals that have been linked to human lung cancer. Certain members of the PA.H family, notably banco (a) pyrene , 3-me tnylchoiar.threne, anc d ibenzan r.hracena , have exhibited marked carcinogenic activity in animals. Tumors have developed in rodents within weeks or months after minute exposure to nne se com po un c* s . In .qC t, **o r s ci the FAK family were among the first pure chemicals used for cancer induction in animals. A recent study has demons tra ted tha r. mice pre treated with 3methy 1cholanthrene (member of FAK family) exhibit much greater bone marrow chromosomal damage when subsequently exposed to benzene (Cad-el-Karim 1954 Hut. Res. 135:225). Such synergism is likely to exist among numerous carcinogens, greatly enhancing tne toxicity of exposures (such as Hr. Byoris') to a rr.ixt.ur: Oj chemicals. PCB-ARCH-EXT0371277 > k> t ( ( SUMMARY Mr. Byoris was exposed to petroleum residuum and PCHs over a period of years while working for Witco Chemical from 1962 to 1982. During 1982 he developed a malignant lymphoma at age 59. The tumor apparently had its origins in retroperitoneal lymphatic tissues. Mr. Byoris received chemotherapy but developed progressive bona marrow suppression and renal failure. He died less than 5 months after the onset of symptoms. Mr. Byoris spent a number of years cleaning out unventilated tanks that contained petroleum residuum and accumulated "coke". He worked many hours inside these tanks with no respiratory w J jccio. xii 4*i % v/yin imi / w.i l. cabiutcuic the exposures to aro.T,aUcJi^cy^fljaafta substantial conti lymphoma in Mr. B` me i ws i pi"Ei! l. wwa w A x A j -V nr~^ were malignant Yours truly EBP/jb l n closure Elaine B. Fanitz, ML' 6 PCB-ARCH-EXT0371278