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Chen Z, Feng T, Wang M, Xu X, Wang Y, Li Y, Min L. Rare cause of repeated pulmonary embolism: a case of primary pleural squamous cell carcinoma and literature review. BMC Pulm Med 2020; 20:75. [PMID: 32216776 PMCID: PMC7099822 DOI: 10.1186/s12890-020-1077-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Malignant tumors are risk factors for a pulmonary embolism (PE), and a PE caused by a tumor is not uncommon. Primary pleural squamous cell carcinoma (PPSCC) is a rare malignancy; thus, a related PE is extremely rare. Case presentation A previously healthy 49-year-old female patient was admitted to Northern Jiangsu People’s Hospital owing to chest tightness, cough, and breathing difficulty that persisted for 3 days. Following admission, a computed tomography (CT) pulmonary angiography revealed an embolism in the main pulmonary artery, upper and lower pulmonary artery branch. The patient was treated with alteplase, warfarin, and antibiotics. Over the following year, she experienced recurrent chest pain and tightness and breathing difficulty, with multiple CT pulmonary angiography revealing thrombosis in the right and left main pulmonary artery. No abnormalities were observed in surrogate markers of autoimmune diseases, tumor antigen testing, or ultrasonography; thus, the cause of recurrent PE was not identified. Subsequently, a positron emission tomography-computed tomography (PET-CT) examination revealed diffuse heterogeneous thickening of the right pleura and substantially increased glucose metabolism. A CT-guided pleural biopsy was performed, and histopathological examination of the pleura eventually revealed a diagnosis of PPSCC. Conclusions PPSCC is a rare tumor that lacks specific clinical manifestations and is difficult to detect with imaging techniques. The occurrence of PE as the primary manifesting symptom in a patient with PPSCC is extremely rare. Thus, malignant tumors should be considered in patients with no risk factors for PE and/or in those with recurrent PE. An immediate diagnosis and adequate intervention can be achieved with increased awareness of this diagnosis and subsequent related examinations.
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Affiliation(s)
- Zhongzhong Chen
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Tingting Feng
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Meng Wang
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Xingxiang Xu
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Yuxiu Wang
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Yiran Li
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Lingfeng Min
- Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China.
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2
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Yaguchi D, Ichikawa M, Kimura H, Ito M, Watanabe K. Sudden Death Due to Recent Hemorrhage From an Intrathoracic Chronic Expanding Hematoma. J Forensic Sci 2018; 64:625-628. [DOI: 10.1111/1556-4029.13889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/25/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Daizo Yaguchi
- Department of Respiratory Medicine Gifu Prefectural Tajimi Hospital 5‐161, Maehata‐cho Tajimi Gifu 507‐8522 Japan
| | - Motoshi Ichikawa
- Department of Respiratory Medicine Gifu Prefectural Tajimi Hospital 5‐161, Maehata‐cho Tajimi Gifu 507‐8522 Japan
| | - Hayata Kimura
- Department of Respiratory Medicine Gifu Prefectural Tajimi Hospital 5‐161, Maehata‐cho Tajimi Gifu 507‐8522 Japan
| | - Masao Ito
- Department of Thoracic Surgery Gifu Prefectural Tajimi Hospital 5‐161, Maehata‐cho Tajimi Gifu 507‐8522 Japan
| | - Kazuko Watanabe
- Department of Pathology Gifu Prefectural Tajimi Hospital 5‐161, Maehata‐cho Tajimi Gifu 507‐8522 Japan
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3
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Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings. J Comput Assist Tomogr 2017; 41:772-778. [PMID: 28448410 DOI: 10.1097/rct.0000000000000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the characteristics of lung cancers in patients with tuberculous fibrothorax or empyema. METHODS We retrospectively evaluated 138 consecutive patients with a diagnosis of lung cancer combined with fibrothorax (n = 127) or empyema (n = 11) from January 2005 to May 2015. All patients underwent computed tomography, and 105 underwent F-fluorodeoxyglucose positron emission tomography. Clinical, pathologic, and computed tomography characteristics and maximum standardized uptake values on positron emission tomography of 76 cancers ipsilateral to the fibrothorax or empyema (group 1) were compared with those of 62 contralateral cancers (group 2). RESULTS The median age at diagnosis of patients was 70 years, with a male-to-female ratio of 8.9:1. The most common type was squamous cell carcinoma (41.3%) followed by adenocarcinoma (39.1%). Most were in the peripheral lung (70.3%), and half abutted the pleura. The median maximum standardized uptake value was 8.9. Tumors in group 1 were larger (median, 48.5 vs 42.8 mm, P = 0.036) and more advanced (T3 or T4) (P = 0.014) than those in group 2. CONCLUSIONS Lung cancers ipsilateral to tuberculous fibrothorax or empyema presented larger and advanced T stages, and the diagnosis could be delayed. The most common type cancer was squamous cell carcinoma.
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Schneider F, Murali R, Veraldi KL, Tazelaar HD, Leslie KO. Approach to Lung Biopsies From Patients With Pneumothorax. Arch Pathol Lab Med 2014; 138:257-65. [DOI: 10.5858/arpa.2013-0091-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Patients with pneumothorax occasionally require limited lung resections to control persistent air leaks. In some patients, especially smokers, histopathologic findings suggest that a ruptured bulla or bleb caused the pneumothorax. Other patients only exhibit histopathologic changes related to the physical trauma of acute, and likely occult recurrent, peripheral lung injury in the setting of “spontaneous,” or idiopathic, lung rupture. Sometimes, pneumothorax occurs secondary to an underlying localized or diffuse parenchymal lung disease. A comprehensive description of the morphologic findings that may be seen in these specimens will help the surgical pathologist distinguish patients with more common and indolent occurrences of pneumothorax from those requiring additional workup or treatment.
Objective.—To develop a diagnostic approach for surgical pathologists encountering lung specimens obtained in the context of pneumothorax repair.
Data Sources.—Literature review and consultation experience of the authors.
Conclusions.—Two general categories of histopathologic changes can be identified: (1) nonspecific changes, reflecting the lung's acute and chronic response to localized injury, and (2) changes suggesting an underlying lung disease that may have played an etiologic role in the development of pneumothorax. The latter changes are important to recognize because they may require additional workup or treatment of clinically occult lung disease. Difficulty arises when nonspecific histopathologic changes overlap with those of an underlying lung disease. Awareness of these diagnostic challenges and pitfalls, together with clinicoradiographic correlation, is essential in these situations and will help guide the surgical pathologist toward an accurate diagnosis and the appropriate management of clinically occult disease.
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Affiliation(s)
- Frank Schneider
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Rajmohan Murali
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Kristen L. Veraldi
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Henry D. Tazelaar
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
| | - Kevin O. Leslie
- From the Departments of Pathology (Dr Schneider) and Medicine (Dr Veraldi), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; the Department of Pathology and the Human Oncology and Pathogenesis Program Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Murali); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Tazelaar and Leslie). Drs Schneider and Murali contributed equally to this article
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5
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Abstract
Primary pleural tumors other than mesothelioma account for fewer than 1% of all lung cancers, and consequently they pose diagnostic and management challenges. Their treatment must be targeted toward the specific tumor type and is often quite different from the treatment for mesothelioma or metastases. Despite the best efforts at diagnosing and treating these tumors, the prognosis associated with some of the benign and many of the malignant variants of these tumors remains poor. In this review, we describe the radiologic and pathologic features of the less common primary pleural tumors and propose a diagnostic approach to their evaluation.
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Affiliation(s)
- Christopher T Erb
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street, TAC S-441, New Haven, CT 06520, USA
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6
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Massard G, Olland A, Santelmo N, Falcoz PE. Surgery for the Sequelae of Postprimary Tuberculosis. Thorac Surg Clin 2012; 22:287-300. [DOI: 10.1016/j.thorsurg.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Abstract
We report the first case in Korea of a chronic expanding hematoma, which presented as a huge mass in the pleural cavity. A 67-year-old woman exhibiting a slowly-expanding intrathoracic mass, as revealed by a chest radiograph, was admitted to our hospital. The patient had undergone a pneumonectomy 37 years earlier during treatment for pulmonary tuberculosis. Computed tomography revealed a huge mass in her right hemithorax. The differential diagnosis of this mass included chronic empyema combined with a malignancy, such as lymphoma or a soft tissue sarcoma. The tumor, which was classified as an encapsulated chronic hematoma, was removed surgically. Samples sent for histopathological and microbiological analysis revealed no evidence of neoplasia or infection. The patient was finally diagnosed with a chronic expanding hematoma of the thorax. This case is particularly rare due to the patient's development of a very large mass after undergoing treatment for tuberculosis more than 30 years earlier.
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Affiliation(s)
- Yong Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mok Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Shilo K, Colby TV, Travis WD, Franks TJ. Exuberant type 2 pneumocyte hyperplasia associated with spontaneous pneumothorax: secondary reactive change mimicking adenocarcinoma. Mod Pathol 2007; 20:352-6. [PMID: 17277763 DOI: 10.1038/modpathol.3800744] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A wide variety of pulmonary and pleural histological changes is recognized in the setting of spontaneous pneumothorax. In this study, we describe a previously unreported lesion that was encountered in four males, 24-41 years of age. In addition to reactive eosinophilic pleuritis, subpleural emphysematous blebs, prominent eosinophilic exudate and lung atelectasis, the histology comprised exuberant type 2 pneumocyte hyperplasia, which was atypical enough to consider a diagnosis of adenocarcinoma in all four cases. Lung atelectasis and localized acute lung injury are factors likely responsible for this unusual histology, and along with the clinical history are important in recognizing the benign nature of this lesion. Awareness of this severe pneumocyte reaction in the setting of pneumothorax can help to prevent misdiagnosis as malignancy.
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Affiliation(s)
- Konstantin Shilo
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-0001, USA.
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9
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Lee HY, Goo JM, Lee HJ, Lee CH, Chun EJ, Im JG. The value of computed tomography for predicting empyema-associated malignancy. J Comput Assist Tomogr 2006; 30:453-9. [PMID: 16778621 DOI: 10.1097/00004728-200605000-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the value of computed tomography (CT) scanning in detecting associated malignancy in patients with chronic empyema. METHODS Two radiologists retrospectively reviewed CT scans of 112 consecutive patients with chronic empyema and arrived at a consensus about the findings. Among these patients, 6 were confirmed by pathology evaluation to have empyema-associated malignancy (EAM), including 4 lymphomas. The CT scans were evaluated for the presence of the following findings: a mass in the empyema sac; mass involvement of the extrapleural fat, chest wall, rib, and lung; bulging of the empyema sac; nodular pleural thickening; empyema involvement of the mediastinal pleura; presence of lung nodules (>1 cm); and mediastinal lymph node enlargement. The association between the CT findings and the EAM was analyzed with the Fisher exact test. A multiple logistic regression analysis was used to determine the predictive variables for EAM. Sensitivity, specificity, and positive predictive value were calculated for each finding. RESULTS All CT findings, except rib involvement and bulging of empyema sac, were significantly associated with EAM (P<0.05). The finding of the presence of a mass, extrapleural fat, and mediastinal involvement showed relatively high sensitivity (100%, 67%, 67%, respectively) and specificity (81%, 87%, 91%, respectively). A bulging of the empyema sac and nodular pleural thickening showed 100% sensitivity, but low specificity (39% and 44%, respectively). Findings from the multiple logistic regression analysis revealed that the presence of a mass and empyema of the mediastinal pleura were significant variables associated with EAM (P<0.05). CONCLUSIONS Although many CT findings are associated with EAM, most showed either low positive predictive value or low sensitivity. A variety of CT findings should be considered when evaluating CT image-based detection of EAM.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology, Seoul National University College of Medicine, and the Institute of Radiation Medicine, SNUMRC, Seoul, Korea
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10
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Aozasa K, Takakuwa T, Nakatsuka SI. Pyothorax-associated lymphoma: a lymphoma developing in chronic inflammation. Adv Anat Pathol 2005; 12:324-31. [PMID: 16330929 DOI: 10.1097/01.pap.0000194627.50878.02] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pyothorax-associated lymphoma (PAL) is a non-Hodgkin lymphoma of exclusively B-cell phenotype developing in the pleural cavity of patients after more than 20-year history of pyothorax resulting from an artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The most common symptoms on admission are chest pain and fever. Serum neuron-specific enolase level suggesting a diagnosis of small cell lung cancer is occasionally elevated. Histologically PAL usually shows a diffuse proliferation of large cells of B-cell type (diffuse large B-cell lymphoma [DLBL]). In PAL cells, representative B-cell markers other than CD20 are frequently negative with aberrant expression of T-cell markers such as CD2. A gene expression profile of PAL is distinct from nodal DLBL in its higher expression level of interferon-inducible genes. PAL is strongly associated with Epstein-Barr virus (EBV) infection with expression of EBV latent genes such as EBNA-2, LMP-1, together with EBNA-1. Taken together, PAL is a distinct entity both in its clinicopathologic presentation as well as its gene expression profile. Use of an artificial pneumothorax, EBV infection, and cytokines and reactive oxygen species produced in longstanding pyothorax might be important factors for PAL development.
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Affiliation(s)
- Katsuyuki Aozasa
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan.
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11
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Nakatsuka SI, Yao M, Hoshida Y, Yamamoto S, Iuchi K, Aozasa K. Pyothorax-associated lymphoma: a review of 106 cases. J Clin Oncol 2002; 20:4255-60. [PMID: 12377970 DOI: 10.1200/jco.2002.09.021] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Pyothorax-associated lymphoma (PAL) is a non-Hodgkin's lymphoma developing in the pleural cavity after a long-standing history of pyothorax. Full details of PAL are provided here. PATIENTS AND METHODS Clinical and pathologic findings were reviewed in 106 patients with PAL collected through a nationwide survey in Japan. RESULTS Age of the patients with PAL was 46 to 82 years (median, 64 years), with a male/female ratio of 12.3:1. All patients had a 20- to 64-year (median, 37-year) history of pyothorax resulting from artificial pneumothorax for treatment of pulmonary tuberculosis (80%) or tuberculous pleuritis (17%). The most common symptoms on admission were chest and/or back pain (57%) and fever (43%). Laboratory data showed that the serum neuron-specific enolase level was occasionally elevated (3.55 to 168.7 ng/mL; median, 18.65 ng/mL), suggesting a possible diagnosis of small-cell lung cancer. Histologically, PAL usually showed a diffuse proliferation of large cells of B-cell type (88%). In situ hybridization study showed that PAL in 70% of the patients was Epstein-Barr virus (EBV)-positive. PAL was responsive to chemotherapy, but the overall prognosis was poor, with a 5-year survival of 21.6%. CONCLUSION This study established the distinct nature of PAL as a disease entity. PAL is a non-Hodgkin's lymphoma of exclusively B-cell phenotype in the pleural cavity of patients with long-standing history of pyothorax, and is strongly associated with EBV infection. Development of PAL is closely related to antecedent chronic inflammatory condition; therefore, PAL should be defined as malignant lymphoma developing in chronic inflammation.
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Affiliation(s)
- Shin-Ichi Nakatsuka
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
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12
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Rena O, Casadio C, Maggi G. Primitive squamous-cell carcinoma after extrapleural pneumothorax for active tuberculosis. Eur J Cardiothorac Surg 2001; 19:92-5. [PMID: 11163570 DOI: 10.1016/s1010-7940(00)00619-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Squamous-cell carcinoma into an extrapleural pneumothorax for active tuberculosis was incorrectly diagnosed as late tubercular empyema. Right axillary thoracostomy was carried out to drain large dense effusion decompressing the brachial plexus and the sympathetic chain with symptomatic release. Surgical biopsy of the extrapleural sac allowed to identify two different tissues: normal epithelium similar to epidermis and nodular fragments composed of well-differentiated squamous carcinoma. The cause of this tumour is not clear: probably the carcinoma arose from normal epidermis carried in the extrapleural cavity during multiple air-refills to maintain the therapeutic pneumothorax.
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Affiliation(s)
- O Rena
- Thoracic Surgery Department, University of Torino, Torino, Italy.
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13
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Tong XQ, Mizokuchi N, Hatakeyama K, Watanabe K. Case report: imaging features of pleural lymphoma complicating a long-standing pyothorax. Clin Radiol 1997; 52:879-81. [PMID: 9392470 DOI: 10.1016/s0009-9260(97)80090-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- X Q Tong
- Department of Radiology, Miyazaki Medical College, Kiyotake, Japan
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14
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Hanagiri T, Muranaka H, Hashimoto M, Nishio T, Sakai S, Ono M, Toyoshima S, Nagashima A. Chronic expanding hematoma in the chest. Ann Thorac Surg 1997; 64:559-61. [PMID: 9262620 DOI: 10.1016/s0003-4975(97)00557-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We herein report the successful surgical treatment of 2 cases of chronic expanding hematoma in the chest. The first patient, who had undergone thoracoplasty 42 years earlier due to tuberculosis, became aware of a slowly growing mass protruding in the lateral thoracic wall. The second patient, who had tuberculous pleurisy 36 years earlier, was referred to our department because of a slowly expanding intrathoracic mass revealed by a roentgenogram. The tumors, which were encapsulated chronic hematomas, were both surgically resected. These cases are rare because of the development of a very large mass after undergoing treatment for tuberculosis more than 30 years previously.
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Affiliation(s)
- T Hanagiri
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, Japan
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15
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Sapino A, Cavallo A, Donna A, Bussolati G. Pleural epidermoid carcinoma from displaced skin following extrapleural pneumothorax in a patient exposed to asbestos. Virchows Arch 1996; 429:173-6. [PMID: 8917719 DOI: 10.1007/bf00192440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This report illustrates a rare case of primary epidermoid carcinoma of the pleura in a patient previously treated by artificial extrapleural pneumothorax for active tuberculosis. The patient had also been occupationally exposed to asbestos. Light microscopic examination showed two different lesions: laminar pleural fragments were covered by normal squamous epithelium that was similar in all respects to epidermis, whereas nodular fragments were composed of well-differentiated infiltrating carcinoma. These findings support the hypothesis that the carcinoma arose from normal epidermis seeded in the pleural cavity during multiple air refills to maintain the pneumothorax. A possible interaction between asbestos fibres and chronic inflammation might have potentiated tumour development.
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Affiliation(s)
- A Sapino
- Department of Biomedical Sciences and Oncology, University of Torino, Italy
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17
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Hsu NY, Chen CY, Pan ST, Hsu CP. Pleural non-Hodgkin's lymphoma arising in a patient with a chronic pyothorax. Thorax 1996; 51:103-4. [PMID: 8658356 PMCID: PMC472813 DOI: 10.1136/thx.51.1.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A 69 year old man with a chronic left pyothorax was treated by decortication. Although the treatment rapidly improved respiratory function, histopathological examination revealed a diffuse large B cell non-Hodgkin's lymphoma. Subsequent bone marrow biopsy samples disclosed bone marrow involvement. It is possible that non-Hodgkin's lymphoma may develop from a chronic pyothorax.
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Affiliation(s)
- N Y Hsu
- Department of Surgery, Taichung Veterans General Hospital, Taiwan, Republic of China
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18
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Massard G, Rougé C, Wihlm JM, Ameur S, Dabbagh A, Kessler R, Roeslin N, Morand G. Decortication is a valuable option for late empyema after collapse therapy. Ann Thorac Surg 1995; 60:888-95. [PMID: 7574990 DOI: 10.1016/0003-4975(95)00541-r] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Infection of previous collapse therapy spaces may raise challenging problems. This study evaluated a conservative surgical approach based on decortication. METHODS Since 1979, 28 patients (mean age, 60 +/- 6 years) have presented at an average of 37 +/- 7 years after artificial pneumothorax for tuberculosis. Diagnosis of empyema was made on follow-up in 12 patients and on symptoms in 16 patients. Mean vital capacity was 66% +/- 16% of normal. Microorganisms were isolated in 13 patients (Aspergillus fumigatus in 5, Mycobacterium tuberculosis in 4, anaerobes in 4). Decortication was made in 24 patients, associated with thoracoplasty in 4, and with partial lung resection in 2 patients. Thoracoplasty alone was performed in 2 patients, and 2 patients underwent an extrapleural pneumonectomy. RESULTS Both extrapleural pneumonectomies were complicated with empyema requiring thoracoplasty, resulting in one postoperative death. Operative mortality after decortication was nil. Mean intraoperative blood loss during decortication was 1,830 +/- 1,310 mL. All patients were extubated within 24 hours, except 1 patient who was ventilator-dependent preoperatively. Prolonged air leaks were common (mean duration of drainage, 16 +/- 11 days), but ultimately sealed. Existence of symptoms was predictive of prolonged air leaks (p < 0.01). CONCLUSIONS We conclude that decortication may provide a one-stage cure avoiding the hazards of extrapleural pneumonectomy; the nonfunctioning remaining lung may resolve the space problem.
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Affiliation(s)
- G Massard
- Department of Thoracic Surgery, University Hospital of Strasbourg, France
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19
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Martin A, Capron F, Liguory-Brunaud MD, De Frejacques C, Pluot M, Diebold J. Epstein-Barr virus-associated primary malignant lymphomas of the pleural cavity occurring in longstanding pleural chronic inflammation. Hum Pathol 1994; 25:1314-8. [PMID: 8001926 DOI: 10.1016/0046-8177(94)90091-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Primary pleural non-Hodgkin's lymphomas (NHLs) have been described mostly in Japan and occasionally in western countries. We report three cases occurring in nonimmunocompromised patients demonstrating close similarities to the Japanese cases. These lymphomas occurred more than 20 years after thoracoplasty for the treatment of pleural or pulmonary tuberculosis. They were all high grade lymphomas of B phenotype (two immunoblastic with plasmocytoid differentiation and one immunoblastic with anaplastic large cells). In situ hybridization (ISH) detected small nuclear RNAs encoded by Epstein-Barr virus (EBERs) in most lymphomatous cells in all cases. This suggests a link between primary pleural lymphoma and the longstanding chronic inflammation, which could favor a clonal evolution of Epstein-Barr virus (EBV)-infected B cells through the production of growth factors or immunosuppressive cytokines produced by inflammatory cells.
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Affiliation(s)
- A Martin
- Service Central d'Anatomie et de Cytologie Pathologiques, Hôtel-Dieu, Paris
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20
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Matsuo T, Ito H, Anami M, Ikeda T, Nishihata S. Malignant peritoneal mesothelioma with squamous metaplasia. Cytopathology 1993; 4:373-8. [PMID: 8110978 DOI: 10.1111/j.1365-2303.1993.tb00117.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- T Matsuo
- Department of Pathology, Nagasaki University School of Medicine, Japan
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21
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Massard G, Roeslin N, Wihlm JM, Morand G. Extrapleural hematoma as a late complication of collapse therapy for tuberculosis. Chest 1992; 101:1476-7. [PMID: 1582334 DOI: 10.1378/chest.101.5.1476-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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22
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Montalbán S, Berlinches P, Pérez-Mila L, Pastor F, Ortuño G. Metaplasia escamosa y carcinoma epidermoide de la pleura. A propósito de un caso. Arch Bronconeumol 1992. [DOI: 10.1016/s0300-2896(15)31362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Abstract
Seventeen cases of soft tissue sarcoma (STS) developing in the pleural cavity were collected from Japanese hospitals, and their clinical and pathologic findings summarized. Eight of the 17 patients had a 15-year to 50-year (mean, 28.8) history of chronic pleural inflammatory disease (pleuritis, pyothorax, and pulmonary tuberculosis) before the onset of the pleural sarcoma. Histologically, malignant fibrous histiocytoma was the most common tumor type (11 cases), followed by angiosarcoma (four). The age at diagnosis of the sarcoma ranged from 15 to 74 years (mean, 58); the male-to-female ratio was 3.3:1. In the eight cases of sarcoma associated with chronic pleural inflammatory disease, male preponderance was more marked (7:1). The commonest presenting symptom was chest pain. A mass could be detected by chest roentgenograms in 13 patients and computed tomographic scans in 15 patients. No patient had distant metastases at first admission. Thirteen patients were treated by surgery, chemotherapy, and/or radiation therapy. Thirteen of the 17 patients died 1 to 87 months (mean, 14.2) after therapy for STS. The actuarial 1-year survival rate was 38.5%. These findings suggest that long-standing pleural inflammation might be an etiologic factor for development of pleural STS.
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Affiliation(s)
- A Myoui
- Department of Pathology, Osaka University Medical School, Japan
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24
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Prabhakar G, Mitchell IM, Guha T, Norton R. Squamous cell carcinoma of the pleura following bronchopleural fistula. Thorax 1989; 44:1053-4. [PMID: 2617446 PMCID: PMC1020887 DOI: 10.1136/thx.44.12.1053] [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: 01/01/2023]
Abstract
Squamous metaplasia of the pleura with malignant transformation was observed five months after the development of an empyema and bronchopleural fistula in a 58 year old woman with lingular bronchiectasis.
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Affiliation(s)
- G Prabhakar
- Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry
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25
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Iuchi K, Ichimiya A, Akashi A, Mizuta T, Lee YE, Tada H, Mori T, Sawamura K, Lee YS, Furuse K. Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax. Cancer 1987; 60:1771-5. [PMID: 3308054 DOI: 10.1002/1097-0142(19871015)60:8<1771::aid-cncr2820600817>3.0.co;2-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Malignant lymphomas developing in tissue affected by a long-standing severe inflammatory process of nonautoimmune nature are presented. Two men and a woman aged 50, 58, and 73 years, were admitted after 22 to 30 year histories of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The diagnoses at admission were chronic pyothorax associated with a lung mass. Microscopically, tumors diffusely or locally proliferated with thickened pleura were present. A histologic examination showed that all the tumors were diffuse non-Hodgkin's lymphomas (NHL) of immunoblastic type with (one case) or without (two cases) plasmacytoid differentiation. Immunohistochemistry on paraffin sections revealed restricted expression of immunoglobulin light chains in one case showing plasmacytoid differentiation. A review of the literature showed that malignant lymphomas of this type have been reported exclusively from Japan but never from Western countries.
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Affiliation(s)
- K Iuchi
- Department of Surgery, National Kinki Central Hospital for Chest Diseases, Sakai, Japan
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26
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Schmid FG, De Haller R. Late exudative complications of collapse therapy for pulmonary tuberculosis. Chest 1986; 89:822-7. [PMID: 3709247 DOI: 10.1378/chest.89.6.822] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In a retrospective study of 15 patients who were treated with collapse therapy for pulmonary tuberculosis on an average 30 years previously, we found 16 instances of exudation in the residual pocket: four were sterile and without fistula, ten had bronchial fistulae, one had an esophageal fistula, and one was a tuberculous empyema without fistula. Among the 11 exudations with bronchial or esophageal fistulae, none contained tubercle bacilli, six were infected with pyogenic microorganisms, and five remained sterile. In 12 cases, the diagnosis was suggested by chest x-ray film. Four of nine exudates which remained sterile and three of the seven infected ones could be stabilized by conservative measures; the others required a decortication, sometimes with parenchymal resection. This study shows that in late exudative complications of old collapse therapy, an initial conservative treatment can be curative in about 45 percent of the cases.
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27
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Abstract
Old scars of the pleura, for example from chronic empyema or therapeutic pneumothorax, can cause a malignant mesothelioma appearing some decades later. The authors describe two cases of primary pleural tumors, which probably had such an etiology. A literature review revealed 20 further cases, the majority of which were squamous cell carcinomas. Whether these tumors developed from metaplastic mesothelium or inplanted cells from the skin is not clear.
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28
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Abstract
The origins, nature, and reactions of the mesothelium have intrigued investigators for over 100 years. Recently, the use of sophisticated techniques has clarified earlier impressions of its development, structure, and function. The structure of mesothelium reflects its functional properties, its long slender microvilli entrapping a layer of glycosoaminoglycans, providing a frictionless free surface between the parietal and visceral serosa. Transport requirements are met by various surface modifications and both inter- and intra-cellular mechanisms occur. The presence of stomatal openings in the mesothelial membrane has been established, and they may have a major role to play in the movement of cells to and from the serosal cavities. In addition, mesothelial cells can respond to situations of increased functional demand and during the course of inflammation, the mesothelium's fibrinolytic properties are of major importance in preventing the formation of adhesions and the enhancement of healing. Of all the unanswered questions the most significant is the nature, localization, and potentialities of mesothelial precursors. A mesodermal origin is readily acknowledged, but the healing process of damaged mesothelium is less clear. It seems probable that "mature" mesothelium is one source of cell renewal, but mesenchymal cells located in the submesothelial serosa are also strong contenders. Neoplastic mesothelium can adopt a spectrum of histological appearances, reflecting its mesodermal origins. In fact, overacceptance of this concept has erroneously led to the classification of other neoplasms arising in the serosal area as mesotheliomas. Although the ocogenic sequence is still obscure, asbestos is recognized as the major etiologic agent in malignant mesotheliomas. In 1955, Hartwell described differing impressions of the peritoneum as seen through the eyes of an anatomist, an histologist, and a surgeon. In this review on the mesothelium we have attempted to unravel some of its complexities as viewed by embryologists, electronmicroscopists, cell biologists, pathologists, and oncologists.
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29
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Kwee WS, Veldhuizen RW, Golding RP, Donner R. Primary ?adenosquamous? mesothelioma of the pleura. ACTA ACUST UNITED AC 1981. [DOI: 10.1007/bf00430835] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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