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PubMed2004

[Thoracic malignancies in patients with chronic tuberculous empyema].

OBJECTIVES: To clarify features of thoracic malignancies occurred in patients with chronic tuberculous empyema. MATERIALS AND METHODS: We analyzed clinicopathological data of 15 patients with thoracic malignancies who had chronic tuberculous empyema, encountered at Tokyo National Hospital during the period from 1977 to 2002. RESULTS: There were 13 men and 2 women, with a mean age of 67 years. Most of all (13/15) patients had history of surgery for tuberculosis including artificial pneumothorax (9 cases). Malignancies consisted of pyothorax-associated lymphoma (PAL; 9 cases), lung cancer (4 cases), malignant fibrous histiocytoma (1 case), and angiosarcoma (1 case). There were no differences in background factors between PAL patients and the other patients. Common symptoms were chest pain (10 cases), fever (7 cases), and bloody sputum (4 cases) and it seemed that these symptoms were more evident in patients with PAL than in patients with other diseases. Plain chest X-ray films often failed to detect the tumor, and the diagnosis was often obtained by sputum cytology, bronchofiberscopy, transcutaneous biopsy, and resection with support of CT and/or MRI films. On radiographs, all tumors located in empyema cavities or around empyema walls, and a pulmonary mass adjacent to the empyema wall was characteristic of lung cancer. PAL showed certainly good outcome; 40% 5-year survival rate with resection or chemoradiotherapy. On the other hand, all of lung cancer cases were diagnosed at stage III, and had poor outcome, and the remaining patients with the other malignancies also had poor outcome. CONCLUSION: Clinicians should keep in mind occurrence of several thoracic malignancies during the follow-up of patients with chronic tuberculous empyema.

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PubMed2004

[Pyothorax associated lymphoma with increased neuron-specific enolase level in serum and pleural effusion: a case report].

A 72-year-old male with a past history of artificial pneumothorax for pulmonary tuberculosis at the age of 25 was referred to our hospital for the clinical signs of pain and swelling of the back. His neuron-specific enolase values were high in both serum and pleural effusion. The computed tomography image showed a tumor mass arising from the wall of chronic pyothorax. The tumor was resected including the wall of the chronic pyothrax and right chest wall with several ribs. The tumor was 7.2 x 7.0 x 3.0 cm in size and the pathological diagnosis was non-Hodgkin's lymphoma diffuse large cell, B-cell type. Postoperative chemotherapy and radiation therapy were performed but he died of recurrence and metastasis of the tumor 5 months later after the operation.

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PubMed2004

[Three cases of angiosarcoma complicated with chronic pleuritis].

We report three cases of angiosarcoma complicated with chronic pleuritis associated with tuberculosis. Patient 1 was a 55-year-old man who had received artificial pneumothorax therapy 30 years before. Patient 2 was a 85-year-old man who had suffered from pleuritis for 10 years; and patient 3 was a 72-year-old man who had received plombage thoracoplasty with plastic balls 40 years before. All cases had began with sudden-onset chest pain and bloody sputa. A surgical procedure was indicated in patient 1 only. Conservative therapy was indicated for the other cases because of aging, performance status and systemic metastasis. Prognoses from the onset were 83, 9 and 1 months, respectively. We concluded that angiosarcoma is a disease of equal importance as a malignant tumor to lymphomas appearing in the course of chronic inflammatory diseases such as chronic empyema, and that only aggressive resection, when it is possible, is effective in offering prolonged survival.

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PubMed2005

[Evaluation of open window thoracostomy for chronic tuberculous empyema with broncho-pleural fistula; a retrospective analysis of 33 cases].

We report here our 13-year experience treating chronic tuberculous empyema by open window thoracostomy. The subjects were 33 patients (28 males and 5 females) with a median age of 70 (range: 56-83) years who underwent surgery between January 1990 and December 2002. Patients with a history of pulmonary resection or thoracoplasty were excluded. All patients complained of cough and purulent sputum related to the presence of bronchopleural fistula. Previous illnesses included pulmonary tuberculosis (n = 20) and tuberculous pleurisy (n = 14) treated by artificial pneumothorax (n = 1) or chemotherapy (n = 22). Median duration from the initial episode of tuberculosis to surgery was 44 (range: 1-60) years. Mycobacterium tuberculosis (n = 9), Aspergillus fumigatus (n = 6), methicillin-resistant Staphylococcus aureus (MRSA) [n = 5], and Pseudomonas aeruginosa (n = 5) were representative microorganisms isolated from empyema. Preoperative mean %VC was 48 (range: 31-74)%. Mean follow-up was 34 (range: 1-131) months. Seven patients died of empyema-related disease within 6 months postoperatively. Nine patients underwent curative surgery to close the thoracostomy, including extrapleural pneumonectomy (n = 5), muscular transposition with thoracoplasty (n = 3), and lobectomy with muscular transposition and thoracoplasty (n = 1). In 17 patients, the thoracostomy was left open throughout the observation period because of severe impairment of pulmonary function. In elderly patients with severely impairment of pulmonary function, open window thoracostomy does not control empyema well and has a high rate of mortality.

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