Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung.
BACKGROUND
A 67-year-old Caucasian man had a right pneumonectomy for primary bronchogenic carcinoma in 1998. He developed a bronchopleural fistula that was managed with an Eloesser procedure. His appearance 6 years later has been published previously.


METHODS
We performed a case report and literature search.


RESULTS
In 2008, the patient still had a bronchopleural fistula and reported a new symptom: constant right chest pain. He had experienced extensive asbestos exposure and mesothelioma was suspected. Endoscopy via the Eloesser aperture revealed innumerable tumor nodules. Biopsies of the pleura revealed multifocal, well-differentiated, squamous cell carcinoma with histology that was distinctly different from that of the original lung cancer. The tumor progressed rapidly during work-up and invaded the spine. He received palliative treatment but died 4 months after the onset of chest pain. We conducted a literature search and found 9 previous reports of epidermoid carcinoma arising from the pleura in patients with a chronically draining empyema; 5 patients had a prior pneumonectomy.


CONCLUSIONS
Cancer can arise in areas of chronic inflammation such as osteomyelitis with a draining sinus, Crohn's disease, or chronic gastritis. Cases of squamous cell carcinoma arising from the pleura in patients with a chronically draining empyema cavity are extremely rare. We believe this is the sixth report in the literature of squamous cell carcinoma arising from the pleura in a patient with a chronic postpneumonectomy bronchopleural fistula. In vivo video footage of the involved pleura is available
Franke
Mark
M
Department of Surgery, Saint Louis University Hospital, 3635 Vista Ave. at Grand Blvd., St. Louis, MO 63110, USA.
Chung
Hyung D
HD
Johnson
Frank E
FE
D000368:Aged; D001983:Bronchial Fistula / Q000150:complications* / Q000209:etiology; D002283:Carcinoma, Bronchogenic / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D004322:Drainage; D004653:Empyema / Q000150:complications / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000209:etiology; D010166:Palliative Care; D010995:Pleural Diseases / Q000150:complications / Q000209:etiology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011013:Pneumonectomy / Q000009:adverse effects*; D016156:Respiratory Tract Fistula / Q000150:complications / Q000209:etiology; D013125:Spinal Neoplasms / Q000556:secondary