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Buchanan J, Shatila M, Menon A, Patel AJ. Small cell lung carcinoma presenting initially with recurrent pneumothoraces: a case report. J Cardiothorac Surg 2024; 19:347. [PMID: 38907267 PMCID: PMC11191300 DOI: 10.1186/s13019-024-02857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Pneumothorax is a non-physiological collection of air in the pleural space. Pneumothoraces can be broadly divided into Primary, Secondary, and Traumatic. Cancer of the lung is a known cause of secondary pneumothorax in both primary and metastatic lesions, however, pneumothorax as the presentation of lung cancer is exceedingly rare. Non-small cell lung carcinoma (NSCLC) has been reported in the literature to present with a pneumothorax, particularly in adeno/squamous cell carcinomas. It is almost completely unheard of for small cell lung carcinoma (SCLC) to present with a pneumothorax. CASE PRESENTATION We present the case of a 62-year-old male patient, presenting twice in two months with spontaneous pneumothorax. The initial management involved admission and chest drain insertion. The patient has a past medical history of COPD and a significant smoking history. On the second admission, he underwent a video-assisted thoracoscopic (VATS) bullectomy and talc pleurodesis. The pathology report of the resected specimen confirmed SCLC with extensive infiltration. No gross evidence of metastatic spread was present on CT. Due to the R1 resection and significant risk of recurrence, the management plan included four cycles of adjuvant chemotherapy with carboplatin and etoposide, and radiotherapy as a consideration upon completion. CONCLUSIONS Pneumothorax as the presentation of lung cancer imparts a very poor prognosis, however the reasons for this are largely unknown. Furthermore, the mechanisms underlying spontaneous pneumothorax in lung cancer are also not well understood.
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Affiliation(s)
- John Buchanan
- University of Birmingham Medical School, Edgbaston, Birmingham, B15 2TT, West Midlands, UK
| | - Mohamed Shatila
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University Hospital, Alexandria, Egypt
| | - Ashvini Menon
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK
| | - Akshay J Patel
- Department of Thoracic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, UHB Hospitals NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, England, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT, UK.
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Ng BH, Ban AYL, Low HJ, Faisal M. Indwelling pleural catheter for malignant pleural effusion with persistent air leak. BMJ Case Rep 2022; 15:e248574. [PMID: 35985740 PMCID: PMC9396150 DOI: 10.1136/bcr-2021-248574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/04/2022] Open
Abstract
Malignant pleural effusion with persistent air leak (PAL) is a rare manifestation of lung malignancy. We present a woman in her 50s with postpleuroscopy PAL. Pleural biopsy confirmed adenocarcinoma with detection of epidermal growth factor receptor mutation in exon 19. An indwelling pleural catheter (IPC) was inserted and connected to an Atrium Express Mini ambulatory drain. This procedure reduced the length of hospital stay. Autopleurodesis with resolution of PAL occurred at week 3 of IPC insertion.
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Affiliation(s)
- Boon Hau Ng
- Respiratory Unit, Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Hsueh Jing Low
- Department of Anaesthesiology and Intensive Care, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohamed Faisal
- Respiratory Unit, Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Sauter JL, Butnor KJ. Pathological findings in spontaneous pneumothorax specimens: does the incidence of unexpected clinically significant findings justify routine histological examination? Histopathology 2014; 66:675-84. [DOI: 10.1111/his.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Jennifer L Sauter
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
| | - Kelly J Butnor
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
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Higuchi M, Yamaura T, Kanno R, Suzuki H, Asano S, Gotoh M. Incidental early lung adenocarcinoma after surgery for catamenial pneumothorax. Fukushima J Med Sci 2013; 58:74-7. [PMID: 22790895 DOI: 10.5387/fms.58.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 40-year-old female patient underwent surgery at our hospital for recurrent pneumothorax. A defect on the right diaphragm was diagnosed as ectopic endometriosis. However, air leakage continued 2 days after surgery. Chest computed tomography identified a 5-mm ground glass opacity in the right S3 field, suggestive of lung cancer. Ten days after the initial surgery, she underwent curative surgery for both pneumothorax and the lung tumor. The tumor was diagnosed as bronchioloalveolar carcinoma, but no other endometriosis was identified. The patient has remained well with no recurrence of lung cancer or pneumothorax since the second surgery.
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Affiliation(s)
- Mitsunori Higuchi
- Division of Thoracic Surgery, Department of Surgery 1, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, Japan.
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Vencevičius V, Cicėnas S. Spontaneous pneumothorax as a first sign of pulmonary carcinoma. World J Surg Oncol 2009; 7:57. [PMID: 19566945 PMCID: PMC2711062 DOI: 10.1186/1477-7819-7-57] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 06/30/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. CASE PRESENTATION Here we present a case in which pneumothorax occurred as a first manifestation of lung cancer. The chest x-ray of a 68 year old man revealed a right partial pneumothorax. VATS was then performed: the visceral pleura lying over segment S3 was destroyed and air leaks were found in this section. Pathologic examination of the biopsy specimen revealed non-small cell carcinoma. Thoracoscopic talc pleurodesis was performed. CONCLUSION Spontaneous pneumothorax in association with lung cancer is rarely seen. Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. Lung cancer should always be considered as a possible cause of SP in elderly patients or in heavy smokers.
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Affiliation(s)
- Vladislavas Vencevičius
- Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, Santariškių 1, Vilnius, Lithuania
| | - Saulius Cicėnas
- Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, Santariškių 1, Vilnius, Lithuania
- Vilnius University, Medical Faculty, Institute of Rehabilitation, Sport Medicine and Nursing, Vilnius, Lithuania
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6
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Martín Marco A, Vilà Justribó M, López Fernández A. [Bronchogenic carcinoma associated with spontaneous pneumothorax and bullae]. Arch Bronconeumol 2001; 37:101-2. [PMID: 11181250 DOI: 10.1016/s0300-2896(01)75027-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Regueiro F, Arnau A, Pérez D, Cañizares MA, Martínez P, Cantó A. [Pneumothorax as the clinical presentation of bronchogenic carcinoma. A report of 3 cases]. Arch Bronconeumol 2000; 36:55-7. [PMID: 10726186 DOI: 10.1016/s0300-2896(15)30234-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The association of pneumothorax and lung cancer is rare and diagnosis is complex in such cases. Clinical suspicion of cancer must be based on radiological findings and the existence of risk factors. We discuss the mechanisms involved in the development of pneumothorax in patients with lung cancer, the clinical significance of the association, and the recommended diagnostic approach and therapeutic guidelines.
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Affiliation(s)
- F Regueiro
- Servicio de Cirugía Torácica, Hospital General Universitario de Valencia
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 46-1994. A 35-year-old smoker with an air-fluid level in an upper lobe bulla. N Engl J Med 1994; 331:1761-7. [PMID: 7984199 DOI: 10.1056/nejm199412293312608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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9
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Minami H, Sakai S, Watanabe A, Shimokata K. Check-valve mechanism as a cause of bilateral spontaneous pneumothorax complicating bronchioloalveolar cell carcinoma. Chest 1991; 100:853-5. [PMID: 1653681 DOI: 10.1378/chest.100.3.853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We present a rare case of simultaneous bilateral pneumothorax complicating bronchioloalveolar cell carcinoma. Autopsy revealed that numerous subpleural alveolar spaces were distended and most of the small airways were narrowed by cancer cells. We conclude that a check-valve mechanism may be responsible for pneumothorax in patients with bronchioloalveolar cell carcinoma.
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Affiliation(s)
- H Minami
- Department of Internal Medicine, Japanese Red Cross Nagoya First Hospital
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10
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Kitagawa M, Tanaka I, Takemura T, Matsubara O, Kasuga T. Angiosarcoma of the scalp: report of two cases with fatal pulmonary complications and a review of Japanese autopsy registry data. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1987; 412:83-7. [PMID: 3120405 DOI: 10.1007/bf00750735] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two cases of angiosarcoma of the scalp were reported. The patients were elderly men and died from pulmonary complications, including pneumothorax, pulmonary haemorrhage and pneumonia, associated with metastatic tumours in the lungs. The data recorded from 95 autopsies of patients with angiosarcoma in Japan during 1980-1984 were analyzed. According to the anatomical distribution of the primary tumour, the patients could be subdivided into a scalp group and non-scalp group. In both groups, the most common metastatic site was the lung. The patients of the scalp group had more frequent pulmonary complications such as pneumonia, haemothorax, atelectasis and pneumothorax, when compared with the patients of the non-scalp group. In particular, pneumothorax was observed only in the patients of angiosarcoma of the scalp. The results indicate that angiosarcoma of the scalp tends to metastasize to the lung, especially to the subpleural or surface pleural area and these metastatic tumours are prone to necrosis, causing characteristic pulmonary complications.
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Affiliation(s)
- M Kitagawa
- Second Department of Pathology, Faculty of Medicine, Tokyo Medical and Dental University, Japan
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Abstract
Among 338 adults (258 men and 80 women) presenting with spontaneous pneumothorax, there were six men with lung cancer: five squamous cell carcinoma and one oat cell carcinoma. Pneumothorax led to the diagnosis in five cases and the remaining occurred as a complication of known neoplastic disease. The average age was 67 years. We analyze these six cases, along with 46 others from the literature. In patients less than 40 years old with normal chest x-ray film findings after lung expansion, further investigation for neoplastic disease is not justified. However, heavy smoking, chronic bronchitis, bullous emphysema and incomplete lung expansion after chest drainage in patients over 40 years old are indications for cancer screening through sputum cytologic study, bronchoscopic examination and surgical exploration. The occurrence of a pneumothorax neither alters the treatment of the underlying disease nor modifies the one-year prognosis. Five-year survival is nil, suggesting that lung cancers present as pneumothorax at an advanced stage of disease.
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12
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Torres Lanzas J, Rivas de Andres J. Recidiva del neumotorax espontaneo y su relacion con la presencia de bullas. Arch Bronconeumol 1985. [DOI: 10.1016/s0300-2896(15)32110-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Rodriguez Paniagua J, Garcia Sanchez-Giron J, Canseco Gonzalez F, Varela Simo G, Hernandez Ortiz C, Casillas Pajuelo M. Neumotorax espontaneo, rara manifestacion del carcinoma broncopulmonar. Arch Bronconeumol 1981. [DOI: 10.1016/s0300-2896(15)32399-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Schafler K, McKenzie CG, Salm R. Postmastectomy lymphangiosarcoma: a reappraisal of the concept--a critical review and report of an illustrative case. Histopathology 1979; 3:131-52. [PMID: 457040 DOI: 10.1111/j.1365-2559.1979.tb02989.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The syndrome of postmastectomy lymphangiosarcoma (LAS) has been universally accepted since it was first outlined by Stewart & Treves (1948), except for a small number of authors who concluded that the neoplasms arising in the chronic lymphoedematous arms were in fact due to retrograde spread from the original breast carcinoma (Laffargue, Pinet & le Go 1960, Giannardi, Pelù & Zampi 1960, Giannardi & Pelù 1961, Delarue 1962, Salm 1963, Laugier, Olmos, Hunziker & Orusco 1973), but their views have been largely ignored. A case is reported in whom neoplastic arm lesions appeared 27 years after mastectomy and were due, in our opinion, to recent metastases from a new primary Carcinoma of the lung. The validity of the entire concept of LAS is re-examined.
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15
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CHEST PAIN IN THE NONTRAUMATIZED PATIENT. Radiol Clin North Am 1978. [DOI: 10.1016/s0033-8389(22)01635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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