Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma

Our plain-English summary of Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma, by S. Sartori, I. Nielsen, L. Trevisani, et al (Supportive Care in Cancer, 1999).

The study

• Authors: S. Sartori, I. Nielsen, L. Trevisani, D. Tassinari, V. Abbasciano
• Journal: Supportive Care in Cancer
• Published: 1999;7(5):362-4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Intrapleural catheters are useful in the palliative treatment of malignant effusions. Complications are infrequent and of little importance. We report a case of subcutaneous implantation metastasis along the course of intrapleural catheter, which had been placed under sonographic guidance in a patient with pleural mesothelioma. After drainage of the effusion, cisplatin plus cytarabine was administered via the chest tube, achieving complete remission of the pleural effusion. Subcutaneous metastasis became evident 3 months later and was the only sign of disease progression for 2 months. The seeding of cancer cells was probably caused by a small leakage of fluid around the chest tube that occurred during the placement procedure as a result of the increased intrapleural pressure caused by the large quantity of fluid that had accumulated in the pleural space.

In plain English

This short communication was a case report about one patient. A 72-year-old man had a massive right pleural effusion, and tests showed stage Ib pleural mesothelioma of the epithelial subtype. His condition ruled out surgery and systemic chemotherapy, so doctors placed a small (8-F) catheter into his chest under ultrasound guidance, drained 3500 ml of fluid over 2 days, and instilled cisplatin plus cytarabine through the tube. The effusion did not return in the next few days, but he had reversible grade 4 kidney toxicity. Three months later a painful 1.5-cm lump appeared under the skin at the tube scar. A needle sample was consistent with spread of mesothelioma, and the lump grew until the skin ulcerated. After 2 months fluid returned, and he died 3 months later of disease progression. The authors thought fluid leaking around the tube at insertion seeded cancer cells. They reported this as the only such case among 74 catheter patients (unpublished data). They concluded the complication is probably rare and not a reason to avoid the procedure. The article does not describe any asbestos exposure.

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 (short communication)
• Who was studied: One 72-year-old man admitted with a massive right pleural effusion, diagnosed with stage Ib pleural mesothelioma of the epithelial subtype
• Exposure: No asbestos exposure is reported. The exposure studied was ultrasound-guided placement of an 8-F intrapleural catheter and intrapleural instillation of cisplatin 100 mg/m2 plus cytarabine 1000 mg
• Main results:
  • The patient was diagnosed with stage Ib mesothelioma of the epithelial subtype
  • 3500 ml of pleural fluid was drained through the catheter in the first 2 days
  • Cisplatin plus cytarabine was instilled into the pleural space via the chest tube
  • The patient had reversible grade 4 renal toxicity
  • Three months later, ultrasound showed a 1.5-cm hypoechoic nodule in the subcutaneous tissue at the chest tube scar
  • Fine-needle aspiration of the nodule showed a picture consistent with metastasis of mesothelioma
  • After 2 months pleural fluid accumulated again, and the patient died 3 months later of disease progression
  • A small leakage of fluid occurred around the tube immediately after insertion, which the authors thought was probably due to increased intrapleural pressure
  • In the authors' experience this was the only such case in a series of 74 patients who had small-bore catheter placement (unpublished data)
• The authors' conclusion: The authors concluded that implantation metastasis is probably rare and should not be seen as a contraindication to placing intrapleural small-bore catheters, but that special care should be taken. They suggested a preliminary fine-needle thoracocentesis to reduce pressure before the tube is inserted.

Topics

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

Medical terms in this study, explained in our Lexicon: Ultrasound, Palliative Care, Pleural Mesothelioma, Metastasis, Cisplatin, Pleural Effusion, Disease Progression.

Related studies

• Intrabronchial injection, an unusual complication of interpleural analgesia — D. Dutta, P.A. Hardy (1995)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Palliation of malignant ascites with a Tenckhoff catheter — D.A. Lomas, P.J. Wallis, et al. (1989)
• Prevention of malignant seeding at drain sites by hypofractionated radiotherapy in patients with pleural mesothelioma — P. Kara, I. Ugur, et al. (2010)
• Pseudo-tumor mimicking indwelling pleural catheter tract metastasis in mesothelioma — R.L. Shrestha, B.A. Wood, et al. (2014)

Browse more research in Supportive Care in Cancer, or return to medical research.