Pneumonectomy of Primary Pulmonary Angiosarcoma with Malignant Effusion and Intrapleural Hypotonic Hyperthermic Chemotherapy: Case Report and Review of the Literature — Oak Academic Publishing
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Pneumonectomy of Primary Pulmonary Angiosarcoma with Malignant Effusion and Intrapleural Hypotonic Hyperthermic Chemotherapy: Case Report and Review of the Literature
Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
1 Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
2 Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
3 Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
4 Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
5 Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
Background: Primary pulmonary angiosarcoma is extremely rare and the prognosis is very poor. We report a combination therapy of pneumonectomy and intrapleural hypotonic hyperthermic chemotherapy (IPHHC). Case report: A 48-year-old male with exertional dyspnea was found to have a left massive pleural effusion. Bronchoscopic examination displayed endobronchial stenosis of the left lower bronchus B 8,9,10 and diagnosed with pulmonary angiosarcoma. Chest computed-tomographic scanning revealed a 5-cm mass in the left inferior lobe, which invaded the left upperbronchus. Intrapleural dissemination and malignant pleural effusion were also suspected (cT3N1M1a, c-stage IV). As a palliative initial therapy, we performed a pneumonectomy. On the 7 th postoperative day, under general anesthesia, we performed video-assisted IPHHC (43°C, 60 min, 200 mg/m 2 of CDDP). After the IPHHC, there was no major adverse event (more than Grade 3) during the postoperative course. Histological examination of the resected specimen revealed a highly-cellular growth of atypical spindle cells with a storiform pattern. By immunohistochemical testing, the tumor cells stained positive for markers including CD31 and the factor VIII related antigen, and the diagnosis of pulmonary angiosarcoma was made. No adjuvant chemoradiotherapy was given, and the postoperative clinical course was uneventful. Although there had been a recurrence in the chest wall, the patient eventually died twenty-one months later. Conclusion: As a new therapeutic option, we performed IPHHC after the pneumonectomy for an advanced pulmonary angiosarcoma with malignant pleural effusion. Although the patient had a recurrence in the chest wall, he had a reasonable postoperative outcome, that is, he returned to a work, retained a good quality of life and had a longer survival in spite of the poor prognosis of the pulmonary angiosarcoma.
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