Lung Cancer: Lung Cancer |

Lung Adenocarcinoma Ipsilaterally to Previous Talc Pleurodesis for Recurrent Spontaneous Pneumothorax: Possible Association or Just an Observation? FREE TO VIEW

Eleftheria Haini, MD; Elpida Poulaki, MD; Eleftherios Markatis, MD; Georgia Levidou, MD; Manos Antonakis, MD; Ilias Papanikolaou, MD; Dimitra Haini, MD; Kostas Pagkratis, MD; Pinelope Korkolopoulou, MD; Miltos Vassiliou, MD; Kyriakos Hainis, MD
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Corfu General Hospital, Corfu, Greece

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A266. doi:10.1016/j.chest.2016.02.278
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Talc pleurodesis is recommended for recurrent primary spontaneous pneumothorax. Previous studies referred that talc disseminates to neighboring organs, inducing potentially carcinogenic granuloma tissue. However, to our knowledge, talc related lung cancer has not been reported.

CASE PRESENTATION: A 48-year-old male smoker (30 pack years), with negative family history for malignancies, was admitted in the Pneumonology dept of Corfu’s General Hospital with right chest pain. Four years before, the patient had undergone talc pleurodesis for right-sided relapsing primary spontaneous pneumothorax. Physical ad biochemical examinations, malignancy markers included, were negative. Chest Radiograph and CT revealed a peripheral longitudinal consolidation in the right upper lung field, along the pleural surface, and an osteolytic lesion of the right 3rd rib. Bronchoscopy was negative for endobronchial lesions. Biopsy of the lesion described multifocal presence of moderate to low-differentiated adenocarcinoma in the lung segments and in the visceral pleura. The neoplasmatic cells were strongly positive for cytokeratin 7 and p63, weakly positive for cytokeratin 18 and focally positive for cytokeratin 19. The markers for TTF-1, napsin, CD31, CD34, WT-1, calretinin, cytokeratin 20 and cytokeratin 14 were negative. Further patient investigation for other primary or metastatic lesions was negative. The patient followed a chemotherapy schedule with Carboplastin, Pemetrexed and Bevacizumab without any response. Local Radiotherapy and second line chemotherapy with Docetaxel were also unsuccessful and the patient died 11 months after the diagnosis.

DISCUSSION: According to clinical and laboratory data of the present case, the development of lung and pleural adenocarcinoma could be related to the previously applied talc pleurodesis. This hypothesis is reinforced by the very low incidence (2.8%) of new lung cancer cases in the 40-49 years-old-age group in Corfu (data of the Corfu lung cancer calendar) as well as the patient’s negative family history for malignancies. Previous studies showing talc dissemination into neighboring organs support such a suspicion, too. Nevertheless, this is only estimation, since the causal association of the present lung cancer case to the previously applied talc pleurodesis was not sufficiently and indubitably proved.

CONCLUSIONS: A 48-years-old smoker male developed lung and pleural adenocarcinoma, 4 years later after talc pleurodesis for primary spontaneous pneumothorax. This is, at least, an interesting observation but any causal association between talc pleurodesis and the developed lung cancer cannot be affirmatively confirmed by this study data.

Reference #1: V. Steger, T. Walles, T. Walker and G. Friedel. To the Editors: Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax. ERJ September 1, 2007 vol. 30 no. 3 598-599.

DISCLOSURE: The following authors have nothing to disclose: Eleftheria Haini, Elpida Poulaki, Eleftherios Markatis, Georgia Levidou, Manos Antonakis, Ilias Papanikolaou, Dimitra Haini, Kostas Pagkratis, Pinelope Korkolopoulou, Miltos Vassiliou, Kyriakos Hainis

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