Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung

Our plain-English summary of Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung, by M. Franke, H.D. Chung, F.E. Johnson (American Journal of Surgery, 2010).

The study

• Authors: M. Franke, H.D. Chung, F.E. Johnson
• Journal: American Journal of Surgery
• Published: 2010;199(4):e34-5
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

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.

In plain English

This was a case report with a literature search. It described a 67-year-old Caucasian man whose right lung was removed (a right pneumonectomy) in 1998 for primary bronchogenic carcinoma. The 1998 specimen showed nonkeratinized, moderately differentiated squamous cell carcinoma, with no invasion of the pleura noted. He then developed a bronchopleural fistula, which was managed with an Eloesser procedure. In 2008 the fistula was still present and he reported constant right chest pain. The article stated that he had experienced extensive asbestos exposure, without further detail, and that mesothelioma was suspected. Endoscopy showed innumerable tumor nodules. Pleural biopsies showed multifocal, well-differentiated squamous cell carcinoma, distinctly different under the microscope from the original lung cancer. The tumor progressed rapidly and invaded the spine. He received palliative treatment and died 4 months after the pain began. The search found 9 previous reports of epidermoid carcinoma arising from the pleura in patients with a chronically draining empyema. Five of those patients had a prior pneumonectomy. The authors called such cases extremely rare. They believed this was the sixth such report in a patient with a chronic postpneumonectomy bronchopleural fistula.

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 with literature search
• Who was studied: one 67-year-old Caucasian man who had a right pneumonectomy for primary bronchogenic carcinoma in 1998, followed up to 2008 (St. Louis, USA)
• Exposure: extensive asbestos exposure, reported without details of fiber type, job or dose; the patient also had a long-standing bronchopleural fistula after pneumonectomy, managed with an Eloesser procedure
• Main results:
  • Endoscopy through the Eloesser opening in 2008 showed innumerable tumor nodules in the patient's pleura
  • The patient's pleural biopsies showed multifocal, well-differentiated squamous cell carcinoma, histologically distinct from the original lung cancer (mesothelioma had been suspected)
  • The patient's 1998 pneumonectomy specimen was nonkeratinized, moderately differentiated squamous cell carcinoma, with no pleural invasion noted
  • The patient's tumor progressed rapidly and invaded the spine; he received palliative treatment and died 4 months after chest pain began
  • The literature search found 9 previous reports of epidermoid carcinoma arising from the pleura in patients with a chronically draining empyema; 5 of these patients had a prior pneumonectomy
• The authors' conclusion: The authors stated that squamous cell carcinoma arising from the pleura in patients with a chronically draining empyema cavity is extremely rare. They believed this was the sixth report of such a cancer in a patient with a chronic postpneumonectomy bronchopleural fistula.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Squamous Cell Carcinoma, Pleura, Pneumonectomy, Bronchogenic Carcinoma, Asbestos Exposure, Mesothelioma, Endoscopy, Well-Differentiated.

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