Mark Franke1, Hyung D Chung, Frank E Johnson. 1. Department of Surgery, Saint Louis University Hospital, 3635 Vista Ave. at Grand Blvd., St. Louis, MO 63110, USA.
Abstract
BACKGROUND: A 67-year-old Caucasian man had a right pneumonectomy for primary bronchogenic carcinoma in 1998. He developed a bronchopleural fistula that was managed with an Eloesser procedure. His appearance 6 years later has been published previously. METHODS: We performed a case report and literature search. RESULTS: In 2008, the patient still had a bronchopleural fistula and reported a new symptom: constant right chest pain. He had experienced extensive asbestos exposure and mesothelioma was suspected. Endoscopy via the Eloesser aperture revealed innumerable tumor nodules. Biopsies of the pleura revealed multifocal, well-differentiated, squamous cell carcinoma with histology that was distinctly different from that of the original lung cancer. The tumor progressed rapidly during work-up and invaded the spine. He received palliative treatment but died 4 months after the onset of chest pain. We conducted a literature search and found 9 previous reports of epidermoid carcinoma arising from the pleura in patients with a chronically draining empyema; 5 patients had a prior pneumonectomy. CONCLUSIONS: Cancer can arise in areas of chronic inflammation such as osteomyelitis with a draining sinus, Crohn's disease, or chronic gastritis. Cases of squamous cell carcinoma arising from the pleura in patients with a chronically draining empyema cavity are extremely rare. We believe this is the sixth report in the literature of squamous cell carcinoma arising from the pleura in a patient with a chronic postpneumonectomy bronchopleural fistula. In vivo video footage of the involved pleura is available Published by Elsevier Inc.
BACKGROUND: A 67-year-old Caucasian man had a right pneumonectomy for primary bronchogenic carcinoma in 1998. He developed a bronchopleural fistula that was managed with an Eloesser procedure. His appearance 6 years later has been published previously. METHODS: We performed a case report and literature search. RESULTS: In 2008, the patient still had a bronchopleural fistula and reported a new symptom: constant right chest pain. He had experienced extensive asbestos exposure and mesothelioma was suspected. Endoscopy via the Eloesser aperture revealed innumerable tumor nodules. Biopsies of the pleura revealed multifocal, well-differentiated, squamous cell carcinoma with histology that was distinctly different from that of the original lung cancer. The tumor progressed rapidly during work-up and invaded the spine. He received palliative treatment but died 4 months after the onset of chest pain. We conducted a literature search and found 9 previous reports of epidermoid carcinoma arising from the pleura in patients with a chronically draining empyema; 5 patients had a prior pneumonectomy. CONCLUSIONS: Cancer can arise in areas of chronic inflammation such as osteomyelitis with a draining sinus, Crohn's disease, or chronic gastritis. Cases of squamous cell carcinoma arising from the pleura in patients with a chronically draining empyema cavity are extremely rare. We believe this is the sixth report in the literature of squamous cell carcinoma arising from the pleura in a patient with a chronic postpneumonectomy bronchopleural fistula. In vivo video footage of the involved pleura is available Published by Elsevier Inc.