Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax

Our plain-English summary of Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax, by S. Tenconi, L. Luzzi, P. Paladini, et al (European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes, 2010).

The study

• Authors: S. Tenconi, L. Luzzi, P. Paladini, L. Voltolini, M.S. Gallazzi, F. Granato, G. Gotti
• Journal: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
• Published: 2010;44(3-4):201-3
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Talc poudrage is considered a safe pleurodesis technique to improve the results of video-assisted thoracoscopic surgery in cases of primary spontaneous pneumothorax (PSP).

Methods: We report the case of a patient with left pleural pseudo-nodular plaque and a high metabolic rate upon PET scan suspected for malignancy, occurring 42 years after slurry talc injection for conservative treatment of PSP. The patient presented with coughing, chest pain and weight loss. Thoracotomy was required to obtain a diagnosis and perform a complete pleurectomy.

Results: Histology was conclusive for pleural talc granuloma.

Conclusions: Indications and possible complications of talc use in young patients with PSP, and the management of possible consequent pleural lesions suspected for malignancy, need to be investigated.

(c) 2010 S. Karger AG, Basel.

In plain English

This article was a case report from a thoracic surgery unit in Siena, Italy. It described a 60-year-old man admitted in June 2008 with coughing, chest pain and weight loss over the previous six months. At age 18 he had had a left primary spontaneous pneumothorax (collapsed lung), which he first reported was treated with simple drainage. The article states he had no history of professional asbestos exposure. CT showed pleural plaques with pseudo-nodular features, mainly on the left. PET scanning showed high metabolic activity in the left pleural space (standardized uptake value 4.8), which was suspected to be malignancy. Lung washing (bronchoalveolar lavage) found no malignant cells or asbestos fibers. Keyhole surgery was converted to open surgery and the pleura was removed. The pathologist diagnosed chronic granulomatous pleuritis caused by a foreign body reaction, likely talc. Only on detailed questioning did the patient and relatives report a slurry talc injection 42 years earlier. The authors concluded that in young patients talc can cause a chronic inflammatory response that mimics malignancy and gives false-positive PET results.

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
• Who was studied: One 60-year-old man, a salesman and former smoker, admitted to the University Hospital of Siena, Italy, in June 2008
• Exposure: Slurry talc injected through a chest drain at age 18 to treat a left primary spontaneous pneumothorax, 42 years before admission. The article states he had no history of professional asbestos exposure.
• Main results:
  • The patient had no history of professional exposure to asbestos
  • At first, the patient reported that the left pneumothorax at age 18 had been treated with simple drainage
  • CT confirmed pleural plaques with pseudo-nodular features (mainly in the left lung) and mediastinal lymphadenopathy
  • PET showed a high metabolic rate in the left pleural space, with a standardized uptake value of 4.8, suspected for malignancy
  • Bronchoalveolar lavage was negative for malignant cells and for asbestos fibers
  • Video-assisted thoracoscopic surgery was converted to open surgery because of strong pleural adhesions, and a pleurectomy with left lower lobe decortication was performed
  • Histology diagnosed chronic granulomatous pleuritis caused by a foreign body reaction, likely talc
  • When questioned in detail, the patient and his relatives reported a slurry talc injection during the earlier pneumothorax treatment
  • At 3-month follow-up the chest X-ray was normal, with mild persistent pain related to the thoracotomy
• The authors' conclusion: The authors concluded that in young patients, talc injected into the pleural cavity can lead to a chronic inflammatory response that mimics malignancy, causes false-positive PET results and could require re-intervention

Topics

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

Medical terms in this study, explained in our Lexicon: Granuloma, Talc, Pneumothorax, Pleurodesis, Video-Assisted Thoracoscopic Surgery (VATS), PET Scan, Thoracotomy, Histology.

Related studies

• Positive FDG-PET/CT of the pleura twenty years after talc pleurodesis: three cases of benign talcoma — T. Vandemoortele, S. Laroumagne, et al. (2014)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• 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)
• Talc slurry pleurodesis. Pleural fluid and histologic analysis — L. Kennedy, R.A. Harley, et al. (1995)

Browse return to medical research.