Hashinokuchi Asato, Akamine Takaki, Kometani Takuro, Shikada Yasunori, Nozoe Tadahiro, Kato Seiya
Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.
Division of Pathology, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.
Gen Thorac Cardiovasc Surg. 2021 Jan;69(1):137-141. doi: 10.1007/s11748-020-01423-1. Epub 2020 Jul 2.
We report a 69-year-old woman with spontaneous pneumothorax associated with cavitating pulmonary metastasis from breast cancer. She was treated for right breast cancer (invasive ductal carcinoma, ypT4bN1M0, stage IIIB) 2 years earlier, and was admitted for right pneumothorax and chest computed tomography, which showed multiple small cavitating lesions in bilateral lungs. The pneumothorax was treated conservatively with chest drainage, but subsequently recurred ipsilaterally. During video-assisted thoracic surgery, we detected small white nodules with visceral pleural rupture; therefore, we performed partial lung resection. The pathological findings revealed metastatic breast cancer with pleural invasion. Forty days later, ipsilateral pneumothorax recurred, and chemical pleurodesis was performed, which resolved the pneumothorax and prevented subsequent recurrence. Early diagnosis and definitive treatment, including pleurodesis, should be considered to prevent recurrence of spontaneous pneumothorax and improve patients' quality of life, even in patients with advanced malignancy.
我们报告一例69岁女性，患有自发性气胸，伴有乳腺癌空洞性肺转移。她两年前因右乳腺癌（浸润性导管癌，ypT4bN1M0，IIIB期）接受治疗，此次因右侧气胸入院，胸部计算机断层扫描显示双侧肺部有多个小空洞性病变。气胸采用胸腔闭式引流保守治疗，但随后同侧复发。在电视辅助胸腔镜手术中，我们发现了伴有脏层胸膜破裂的小白结节；因此，我们进行了部分肺切除术。病理结果显示为转移性乳腺癌伴胸膜侵犯。40天后，同侧气胸复发，遂进行了化学性胸膜固定术，该术式使气胸得到缓解并防止了后续复发。即使是晚期恶性肿瘤患者，也应考虑早期诊断和包括胸膜固定术在内的确定性治疗，以预防自发性气胸复发并提高患者生活质量。
