Mesothelioid reaction following talc pleurodesis: a case report

Our plain-English summary of Mesothelioid reaction following talc pleurodesis: a case report, by T. Faynberg, N. Patel, A.P. Nayar, et al (General Thoracic and Cardiovascular Surgery, 2017).

The study

• Authors: T. Faynberg, N. Patel, A.P. Nayar, A.J. Shienbaum
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2017;65(11):667-669
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Talc pleurodesis is a well-established procedure performed to obliterate the pleural space to prevent recurrent pleural effusion and/or recurrent pneumothorax. Pleurodesis is commonly accomplished by draining the pleural fluid, if present, followed by either a mechanical procedure, such as abrasion, pleurectomy, or instillation of a chemical irritant into the pleural space, which results in inflammation and fibrosis which obliterates the pleural space. The reported complications of talc pleurodesis are hypoxemia, hypotension, tachycardia, dyspnea, chest pain, and fever.

Case Presentation: Herein, we present a case of a 43-year-old female patient who developed an intense mesothelioid reaction which occurred 7 years following talc pleurodesis.

Conclusion: This case represents a unique mesothelioid reaction which became manifested several years after recurrent talc pleurodesis. Such a mesothelioid reaction can clinically and radiographically mimic malignant mesothelioma. We conclude that Talc pleurodesis played a causative role in this patient developing an intense mesothelioid reaction. A mesothelioid reaction should be included in the differential diagnosis in patients with pleural thickening/pleural plaque formation who have previously been treated with talc pleurodesis.

In plain English

This case report described one patient: a 43-year-old woman with a 40 pack-year smoking history who went to an emergency department with right-sided chest pain, fatigue and chronic cough. Repeated right-sided pneumothoraxes (collapsed lung) had been treated with talc pleurodesis in 1996 and 2006. Her father had worked in a shipyard and had a history of asbestos exposure and mesothelioma. A CT scan showed diffuse right-sided pleural thickening, nodularity and calcifications, and mesothelioma was initially favored. A 2013 needle biopsy instead showed foreign body giant cells containing crystals consistent with talc, in a background of fibrosis, with no evidence of malignancy. The authors considered prior asbestos exposure as a possible cause. They pointed to a 1996 biopsy, taken before talc treatment, that showed no talc particles. They concluded that talc pleurodesis played a causative role in this patient's intense mesothelioid reaction, which can mimic malignant mesothelioma, and that it should be considered in patients treated with talc pleurodesis. A single case does not show how often this happens.

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 (one patient)
• Who was studied: One 43-year-old Caucasian American woman with a 40 pack-year smoking history, seen in an emergency department (authors at Rowan University and Kennedy University Hospital, New Jersey, USA)
• Exposure: Talc pleurodesis by VATS for recurrent right-sided pneumothorax in 1996 and again in 2006. Each procedure used two cans of talc spray containing 4 g of talc each, described as a total of 8 g of talc. Separately, her father had shipyard work with asbestos exposure.
• Main results:
  • CT scan during the admission showed diffuse pleural thickening and nodularity in the right hemithorax with pleural calcifications
  • Based on the clinical and radiographic appearance, a diagnosis of mesothelioma was initially favored
  • The 2013 fine needle aspiration and core biopsy of the right pleura showed foreign body giant cells containing crystals consistent with talc, in a background of fibrosis, with no evidence of malignancy
  • The 1996 pleural biopsy, taken before talc pleurodesis, showed fibrosis without foreign body granulomata or foreign material
  • The 2006 pleural biopsy showed pleural fibrosis with hyalinization and foreign body granulomata containing crystals consistent with talc
  • The patient's father worked in a shipyard and had a history of asbestos exposure and mesothelioma
  • The authors raised prior asbestos exposure (her father's shipyard work) as a possible explanation for the reaction. They argued that the 1996 biopsies showing no talc particles supported the reaction having developed after talc pleurodesis.
• The authors' conclusion: The authors concluded that talc pleurodesis played a causative role in this patient's intense mesothelioid reaction. They noted that such a reaction can clinically and radiographically mimic malignant mesothelioma, and said it should be included in the differential diagnosis in patients treated with talc pleurodesis.

Topics

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

Medical terms in this study, explained in our Lexicon: Talc Pleurodesis, Pleural Effusion, Pneumothorax, Pleurodesis, Inflammation, Fibrosis, Dyspnea, Malignant Mesothelioma.

Related studies

• CT appearances of talc pleurodesis — S. Narayanaswamy, S. Kamath, et al. (2007)
• Talc slurry pleurodesis. Pleural fluid and histologic analysis — L. Kennedy, R.A. Harley, et al. (1995)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)

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