A Case of Pneumothorax Caused by Cystic Lung Metastasis of Angiosarcoma
- Affiliations
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- 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. pms70@yuhs.ac
- 2Department of Patholgy, Yonsei University College of Medicine, Seoul, Korea.
- 3The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
- KMID: 1478194
- DOI: http://doi.org/10.4046/trd.2008.64.5.374
Abstract
- Angiosarcoma is a rare but highly malignant tumorthat usually arises in the scalp or face of elderly males. Distant metastases favor the lung, liver, lymph nodes and skin. Metastatic pulmonary angiosarcoma commonly takes the form of a nodule but can sometimes appear as a thin-walled cyst. We report a case of 65 years-old male with a spontaneous pneumothorax, who underwent excision and radiotherapy for an angiosarcoma of the scalp 2 years ago. A chest CT scan revealed multiple cysts in the lung. The video-assisted thoracoscopic lung biopsy demonstrated subpleural cysts without tumor cells. A skin biopsy of the scalp showed an angiosarcoma. This case was diagnosed as a recurrence of an angiosarcoma with a supposed lung metastasis. This case suggests that a spontaneous pneumothorax in elderly people may be secondary to a pulmonary metastasis from an angiosarcoma of the scalp.
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Figure
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Figure 1 When angiosarcoma of the scalp was diagnosed, chest CT scans showed no cavitary lesions.
Figure 2 When patient visited outpatient department due to repiratory symptom, Chest CT scans showed multiple cysts and ground glass opacity.
Figure 3 On admission, Chest X-ray showed left pneumothorax.
Figure 4 Subpleural cyst formation was seen in viedo-assited thoracoscopic lung biopsy, but tumor cells were not seen (H&E stain, ×10).
Figure 5 Skin biopsy showed that cysts and intracytoplasmic spaces were formed by tumor cells (A, H&E stain, ×200), which were positive for CD 31, marker of endothelial cells, on the immunohistochemical stain (B, ×400).
Figure 6 Chest CT scans revealed that multiple cysts have increased in size and number. During disease progression, increased ground glass opacity was observed and pneumothorax was recurred.
Reference
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