title: [Thoracic malignancies in patients with chronic tuberculous empyema].
abstract: 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.
authors.affiliation: Department of Respiratory Diseases, Tokyo National Hospital, 3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585, Japan. tamura@tokyo.hosp.go.jp
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Tamura
authors.forename: Akira
authors.initials: A
authors.lastname: Hebisawa
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Sagara
authors.forename: Junko
authors.initials: J
authors.lastname: Suzuki
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Masuda
authors.forename: Motoo
authors.initials: M
authors.lastname: Baba
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.forename: Shinobu
authors.initials: S
authors.lastname: Akagawa
authors.forename: Naohiro
authors.initials: N
authors.lastname: Nagayama
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kawabe
authors.forename: Kazuko
authors.initials: K
authors.lastname: Machida
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Kurashima
authors.forename: Hikotaro
authors.initials: H
authors.lastname: Komatsu
authors.forename: Hideki
authors.initials: H
authors.lastname: Yotsumoto
mesh_terms: 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