[Thoracic malignancies in patients with chronic tuberculous empyema].
OBJECTIVE
To clarify features of thoracic malignancies occurred in patients with chronic tuberculous empyema.


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.


CONCLUSIONS
Clinicians should keep in mind occurrence of several thoracic malignancies during the follow-up of patients with chronic tuberculous empyema.
Tamura
Atsuhisa
A
Department of Respiratory Diseases, Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan. tamura@tokyo.hosp.go.jp
Hebisawa
Akira
A
Sagara
Yuzo
Y
Suzuki
Junko
J
Masuda
Kimihiko
K
Baba
Motoo
M
Nagai
Hideaki
H
Akagawa
Shinobu
S
Nagayama
Naohiro
N
Kawabe
Yoshiko
Y
Machida
Kazuko
K
Kurashima
Atsuyuki
A
Komatsu
Hikotaro
H
Yotsumoto
Hideki
H
D000368:Aged; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000150:complications; D004654:Empyema, Tuberculous / Q000150:complications*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology*; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed