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Refractory pneumothorax and hemothorax associated with metastatic scalp angiosarcoma
Masahide Isowa1, Satona Tanaka1, Ryo Nakanobo1
1Department of Thoracic Surgery, Kyoto University Hospital, Shogoin-kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
Surgical Case Reports
|October 22, 2020
Summary
Metastasis of scalp angiosarcoma (SA) to the pleura can cause pneumothorax and hemothorax. Diagnosis requires surgical biopsy, as imaging and cytology are unreliable for detecting pleural SA metastasis.
Area of Science:
- Oncology
- Thoracic Surgery
- Pathology
Background:
- Scalp angiosarcoma (SA) metastasis to the lungs is rare and life-threatening.
- Diagnosis and management of SA pleural metastasis are challenging.
- Pneumothorax and hemothorax can be presenting signs of SA pleural metastasis.
Purpose of the Study:
- To highlight the diagnostic challenges of scalp angiosarcoma pleural metastasis.
- To emphasize the importance of surgical biopsy over cytology for diagnosis.
- To underscore the limitations of conventional treatments for SA pleural metastasis.
Main Methods:
- Case report of two patients with scalp angiosarcoma.
- Inclusion of computed tomography (CT) imaging findings.
- Utilized video-assisted thoracoscopic surgery (VATS) for diagnosis and treatment.
- Performed surgical biopsy of pleural lesions for pathological confirmation.
Main Results:
- Computed tomography (CT) findings were not predictive of SA pleural metastasis.
- Cytology of pleural effusion failed to detect malignancy in one case.
- Surgical biopsy confirmed metastatic scalp angiosarcoma in the parietal pleura in both cases.
- Conventional interventions like pleurodesis were ineffective.
Conclusions:
- Metastatic scalp angiosarcoma (SA) to the pleura must be considered in patients with SA who develop pneumothorax/hemothorax.
- Surgical biopsy is essential for accurate pathological diagnosis, surpassing cytology.
- Standard surgical interventions and pleurodesis show unsatisfactory outcomes for SA pleural metastasis.
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