Chest wall tumour following iodized talc pleurodesis

Our plain-English summary of Chest wall tumour following iodized talc pleurodesis, by J.W. Jackson, M.H. Bennett (Thorax, 1973).

The study

• Authors: J.W. Jackson, M.H. Bennett
• Journal: Thorax
• Published: 1973;28(6):788-93
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Jackson, J. W., and Bennett, M. H. (1973).Thorax, 28, 788-793. Chest wall tumour following iodized talc pleurodesis. A man of 37 had an iodized talc pleurodesis carried out for recurrent spontaneous pneumothorax. There was no history of industrial exposure to asbestos. Two years later he presented with pain in the right chest and radiographs at that time showed some localized pleural thickening at the site of the thoracoscopy cannulation for introduction of talc. A provisional diagnosis of talc granuloma, chemical abscess or tumour was made and exploratory thoracotomy revealed a tumour involving the chest wall, lung, and pleura which, on histological examination, showed adenocarcinoma of varying degrees of differentiation and in some parts also presenting a more squamoid appearance. Numerous doubly refractile talc particles were intimately associated with the tumour and fibrous tissue. Shortly after excision the patient developed evidence of systemic dissemination of the disease and died four months later. The possibility of this tumour being induced by the talc is discussed. A brief review is made of the various forms of talc used in surgery over the past 40 years and attention is drawn to the significance of the proportion of asbestos mineral which is present in talc as mined in various parts of the world. We do not consider that this is a case of mesothelioma of the pleura.

In plain English

This article was a case report about one man, aged 37. He had iodized talc pleurodesis for a right-sided spontaneous pneumothorax (collapsed lung) that kept coming back. In this procedure, talc is blown into the space around the lung so its linings stick together. The authors reported that he had no history of industrial exposure to asbestos. Ten grams of iodized talc were blown in through a tube inserted from the right armpit. Afterwards he had chest pain near the site of that incision that would not go away. Exploratory surgery found a tumour involving the chest wall, lung and pleura. It was a carcinoma, mainly clear-celled adenocarcinoma, and it appeared to have started in an area of old scarring in lung that was stuck to the chest wall. Numerous talc particles were closely associated with the tumour and fibrous tissue. Similar carcinoma appeared in the abdominal wall three weeks after the operation, and he died four months after it. The authors considered the tumour a 'scar carcinoma'. They thought it unlikely that the talc caused it, but believed the pleurodesis helped it spread to the chest wall. They did not consider it a pleural mesothelioma. They also briefly reviewed talcs used in surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient, with a brief discussion reviewing forms of talc used in surgery
• Who was studied: One man aged 37, a litho camera operator, treated at Harefield Hospital, Middlesex, after a right-sided spontaneous pneumothorax in May 1968 that recurred in July 1968
• Exposure: Iodized talc pleurodesis: 10 g of iodized talc blown into the right pleural space through a cannula inserted from the right armpit (axilla). The iodine percentage is garbled by OCR. The article does not report the asbestos content of the talc used.
• Main results:
  • The patient had no history of industrial exposure to asbestos
  • He returned in January and September 1970 with chest pain near the thoracoscopy incision. He was readmitted in November 1970 because the pain was getting worse.
  • The removed tissue showed carcinoma, mainly clear-celled adenocarcinoma, partly undifferentiated, with a few areas of more squamoid appearance
  • The tumour appeared to have arisen in adherent lung in an area of old fibrous scarring
  • Numerous doubly refractile talc particles were closely associated with the tumour and fibrous tissue
  • A nodule of similar poorly differentiated carcinoma was found in the abdominal wall three weeks after operation
  • The patient died four months after operation. Necropsy showed tumour in the chest wall and underlying lung, with secondary deposits in the suprarenal glands.
  • The authors regarded the case as a 'scar carcinoma' that became apparent after the pleurodesis
  • The authors believed the pleurodesis helped the tumour spread early to the chest wall along the cannula track
  • The authors did not consider this a case of pleural mesothelioma
• The authors' conclusion: The authors concluded that it seemed unlikely the talc caused the tumour, but that the pleurodesis helped it spread early to the chest wall

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc Pleurodesis, Thorax, Pneumothorax, Pleural Thickening, Thoracoscopy, Talc, Granuloma, Thoracotomy.

Related studies

• Mesothelioid reaction following talc pleurodesis: a case report — T. Faynberg, N. Patel, et al. (2017)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)
• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Chest wall resection---alloplastic replacement — L.H. Lampl, H. Loeprecht (1988)

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