Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Agent Orange(2,3,7,8-Tetrachlorodibenzo-p-dioxin), also referred to as “dioxin”, is a herbicide, extensively used during the Vietnam War. It is proven to be associated with various types of cancers, including chronic B-cell leukemias, Monoclonal gammopathy of undetermined significance(MGUS), Non-Hodgkin’s and Hodgkin’s lymphoma, as well as diseases such as diabetes mellitus type II and Parkinson’s disease. Primary ampullary carcinoma is a rare cancer of the gastrointestinal tract, with an incidence of 4 to 10 cases per million population. They can occur sporadically or in the setting of a hereditary syndrome. The etiology of sporadic ampullary tumors remains uncertain. Here, we present a case of ampullary carcinoma in a Vietnam War veteran with documented Agent Orange exposure. This report questions the possible relationship between Agent Orange exposure and ampullary carcinoma and the need for comprehensive evaluation and management of veterans exposed to hazardous substances during their military service.
Case: A 73-year-old male Vietnam War veteran with a history of Agent Orange exposure during military service, presented with obstructive jaundice. His medical history included diabetes mellitus type II, a known complication of Agent Orange exposure. Endoscopic retrograde cholangiopancreatography(ERCP) revealed the presence of a tumor in the ampulla of Vater, causing biliary obstruction. Biopsy obtained during ERCP revealed adenocarcinoma, positive for CK 19, CK7, p53, S100 P, p16, and negative for CK20, SMA D4. The immunophenotype was suggestive of pancreaticobiliary primary. He underwent a Whipple resection with final pathology revealing an adenocarcinoma, pancreaticobiliary type, moderately differentiated, limited to the ampulla of Vater measuring 2.0X1.0 cm in size, grade 2, all margins uninvolved, and 2 out of 15 regional lymph nodes involved. Given the aggressive nature of the disease, surgery was followed by adjuvant chemotherapy with gemcitabine and capecitabine for six cycles, followed by chemoradiotherapy. Afterward, regular follow-up visits with imaging studies and tumor marker monitoring were scheduled to detect recurrence or metastasis.
Discussion: This case highlights the possible association between Agent Orange exposure and the development of ampullary carcinoma. Agent Orange is a potent carcinogenic chemical classified as a group 1 human carcinogen by the International Agency for Research on Cancer(IARC). The dioxins in Agent Orange are highly lipophilic, and when exposed, they build up in the adipose tissue and are stored in the body for decades. It acts as a carcinogen by disrupting normal cellular signaling pathways and promoting malignant transformation. The patient’s exposure to Agent Orange during military service and the following medical complication: diabetes mellitus type II, as well as the development of ampullary carcinoma decades after exposure, suggest the possibility of Agent Orange as a causative role in the development of ampullary carcinoma. There has been continuous research on dioxin exposure and its association with increased risk of gastrointestinal malignancies such as colorectal cancer. However, further investigation is required to understand and establish the association between Agent Orange and ampullary cancer. This will result in optimal patient care with adequate screening and treatment for veterans with an Agent Orange exposure History.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Cho, Eunbee; Patel, Shreel; and Kondapavuluru, Roy Subash, "Ampullary Carcinoma in a Veteran with Exposure to Agent Orange" (2024). Research Symposium. 2.
https://scholarworks.utrgv.edu/somrs/2023/posters/2
Included in
Ampullary Carcinoma in a Veteran with Exposure to Agent Orange
Introduction: Agent Orange(2,3,7,8-Tetrachlorodibenzo-p-dioxin), also referred to as “dioxin”, is a herbicide, extensively used during the Vietnam War. It is proven to be associated with various types of cancers, including chronic B-cell leukemias, Monoclonal gammopathy of undetermined significance(MGUS), Non-Hodgkin’s and Hodgkin’s lymphoma, as well as diseases such as diabetes mellitus type II and Parkinson’s disease. Primary ampullary carcinoma is a rare cancer of the gastrointestinal tract, with an incidence of 4 to 10 cases per million population. They can occur sporadically or in the setting of a hereditary syndrome. The etiology of sporadic ampullary tumors remains uncertain. Here, we present a case of ampullary carcinoma in a Vietnam War veteran with documented Agent Orange exposure. This report questions the possible relationship between Agent Orange exposure and ampullary carcinoma and the need for comprehensive evaluation and management of veterans exposed to hazardous substances during their military service.
Case: A 73-year-old male Vietnam War veteran with a history of Agent Orange exposure during military service, presented with obstructive jaundice. His medical history included diabetes mellitus type II, a known complication of Agent Orange exposure. Endoscopic retrograde cholangiopancreatography(ERCP) revealed the presence of a tumor in the ampulla of Vater, causing biliary obstruction. Biopsy obtained during ERCP revealed adenocarcinoma, positive for CK 19, CK7, p53, S100 P, p16, and negative for CK20, SMA D4. The immunophenotype was suggestive of pancreaticobiliary primary. He underwent a Whipple resection with final pathology revealing an adenocarcinoma, pancreaticobiliary type, moderately differentiated, limited to the ampulla of Vater measuring 2.0X1.0 cm in size, grade 2, all margins uninvolved, and 2 out of 15 regional lymph nodes involved. Given the aggressive nature of the disease, surgery was followed by adjuvant chemotherapy with gemcitabine and capecitabine for six cycles, followed by chemoradiotherapy. Afterward, regular follow-up visits with imaging studies and tumor marker monitoring were scheduled to detect recurrence or metastasis.
Discussion: This case highlights the possible association between Agent Orange exposure and the development of ampullary carcinoma. Agent Orange is a potent carcinogenic chemical classified as a group 1 human carcinogen by the International Agency for Research on Cancer(IARC). The dioxins in Agent Orange are highly lipophilic, and when exposed, they build up in the adipose tissue and are stored in the body for decades. It acts as a carcinogen by disrupting normal cellular signaling pathways and promoting malignant transformation. The patient’s exposure to Agent Orange during military service and the following medical complication: diabetes mellitus type II, as well as the development of ampullary carcinoma decades after exposure, suggest the possibility of Agent Orange as a causative role in the development of ampullary carcinoma. There has been continuous research on dioxin exposure and its association with increased risk of gastrointestinal malignancies such as colorectal cancer. However, further investigation is required to understand and establish the association between Agent Orange and ampullary cancer. This will result in optimal patient care with adequate screening and treatment for veterans with an Agent Orange exposure History.