Clinical Topics & News

The Long Legacy of Agent Orange

Clinicians study a veteran patient experiencing adverse effects related to Agent Orange exposure more than 50 years prior to receiving a cancer diagnosis.


For some veterans, exposure to Agent Orange and its many health ramifications is an ongoing concern—even though they might have been exposed more than 50 years ago. Clinicians from Sinai Hospital of Baltimore in Maryland report on a patient who reminded them that a current illness could be related to that long-ago exposure.

Related: Bladder Cancer and Hyperthyroidism Linked to Agent Orange

The 69-year-old man came to their clinic with a painful, enlarging mass of the right lateral thigh, which ultrasound revealed as a myxofibrosarcoma. He underwent radical excision of the sarcoma with adjuvant radiotherapy. Histologic examination revealed an 8.3 cm, grade 3 pleomorphic liposarcoma. The patient asked, “Was it related to Agent Orange?” It may have been, the clinicians decided.

Agent Orange tends to accumulate in the liver and adipose tissue; it also affects lipid metabolism and may lead to hyperlipidemia. Although in the early days after the Vietnam War, many pathologies were labeled as “stress induced,” a number of illnesses have since been linked to Agent Orange, including B-cell leukemia, Hodgkin and non-Hodgkin lymphoma, prostate cancer, and, perhaps, multiple myeloma. But the authors say the toxin’s role in sarcomagenesis has been controversial in part because of conflicting case-control studies and because large-scale clinical trials are not feasible.

Related: Link Found Between Agent Orange Exposure and Multiple Myeloma

There has been no well-established precipitating factor for liposarcoma, the authors note. But they suggest that clinicians should have a high degree of suspicion for persistent and evolving soft tissue masses in patients with a previous military background, which should prompt the search for a possible toxin exposure.

Their patient experienced the enlarging soft tissue mass over the course of a year. A simple question: “Have you ever been in the military or had any previous wartime toxin exposure?” early on would have impelled the physicians to do a swifter workup, the authors say, particularly in a case with high risk of metastasis and poor prognosis. The patient will continue to be monitored “for years,” the authors say.

“While these days we have access to a vast amount of diagnostic tests and imaging,” the authors conclude, “one cannot underestimate the importance of understanding a patient’s past history.”

Related: A Retrospective Analysis of the Association of Dioxin (Agent Orange) Exposure and Cutaneous T-Cell Lymphoma

Khan K, Wozniak SE, Coleman J, Didolkar MS. BMJ Case Rep. 2016;2016. pii: bcr2016217438.
doi: 10.1136/bcr-2016-217438.

Recommended Reading

Targeted Therapy for Chronic Lymphocytic Leukemia
New Treatments for Chronic Lymphocytic Leukemia
Cytarabine Combination: Long-term Effects
Initial Cytogenetic Features of Veteran Patients With Chronic Lymphocytic Leukemia: A National VA Tumor Registry Study
Patterns of Initial Treatment in Veteran Patients With Chronic Lymphocytic Leukemia: A National VA Tumor Registry Study
Improving Access to Care for Veterans Referred for Stem Cell Transplant Using Video-Based Telemedicine
More Illnesses Linked to Camp Lejeune Water
Dronabinol: A Controversial Acute Leukemia Treatment
Pneumatic Tube-Induced Reverse Pseudohyperkalemia in a Patient With Chronic Lymphocytic Leukemia
What Do Parasites Have to Do With Leukemia?

Related Articles