Gu Qihua, Hu Chengping, Qu Jingjing
Department of respiratory medicine, Xiangya Hospital affiliated to Central South University, Changsha City, Hunan, 410008, P.R. China.
Int J Clin Exp Pathol. 2013 Apr 15;6(5):973-7. Print 2013.
Malignant pleural effusion in patients with cancers or malignant pleural mesothelioma may often appear at the late stage of disease and significantly affect the patients' life quality and survival. However, there is still no very effective treatment to control malignant pleural effusion. Here we report that malignant pleural effusion in one patient was completely relieved for 15 months by the anti-tuberculosis therapy.
A 54-year-old female patient complained of cough, dyspnea, chest pain, night sweat and light fever in the afternoon. Computed tomography (CT) of the chest revealed bilateral pleural effusion. But no tumor was found in the lung, pleura and in other sites. Blood test revealed serum carcinoembryonic antigen (CEA) level at 300 ng/mL. One week after we tried anti-tuberculosis combined therapy with isoniazid, pyrazinamide, rifapentine and ethambutol. The pleural effusion in patient was eliminated, along with decreasing CEA. But the CEA increased gradually again when the anti-tuberculosis treatment was forced to discontinuation. Sixteen months after anti-tuberculosis treatment, the symptoms of cough and breathing difficulty relapsed. Chest CT revealed left pleural effusion, pleural thickness and pericardium nodules. Thoracoscopy and biopsy were conducted. The pleural nodules specimen was pathologically diagnosed as squamous cell carcinoma.
We reported a rare case of successfully treating malignant pleural effusion caused by squamous cell carcinoma of unknown primary site with the anti-tuberculosis combined. This report provides useful evidences for that the anti-tubercular agents may have potential anticancer activity in some carcinomas.
癌症或恶性胸膜间皮瘤患者的恶性胸腔积液常出现在疾病晚期，严重影响患者生活质量和生存期。然而，目前仍没有非常有效的治疗方法来控制恶性胸腔积液。在此我们报告一例患者的恶性胸腔积液通过抗结核治疗完全缓解达15个月。
一名54岁女性患者主诉咳嗽、呼吸困难、胸痛、盗汗及午后低热。胸部计算机断层扫描（CT）显示双侧胸腔积液。但在肺部、胸膜及其他部位未发现肿瘤。血液检查显示血清癌胚抗原（CEA）水平为300 ng/mL。在尝试使用异烟肼、吡嗪酰胺、利福喷汀和乙胺丁醇进行抗结核联合治疗一周后，患者胸腔积液消失，CEA水平下降。但当抗结核治疗被迫中断时，CEA又逐渐升高。抗结核治疗16个月后，咳嗽和呼吸困难症状复发。胸部CT显示左侧胸腔积液、胸膜增厚及心包结节。进行了胸腔镜检查和活检。胸膜结节标本经病理诊断为鳞状细胞癌。
我们报告了一例罕见病例，即采用抗结核联合治疗成功治愈了原发部位不明的鳞状细胞癌所致恶性胸腔积液。本报告为抗结核药物在某些癌症中可能具有潜在抗癌活性提供了有用证据。
