TITLE:
Pneumonectomy of Primary Pulmonary Angiosarcoma with Malignant Effusion and Intrapleural Hypotonic Hyperthermic Chemotherapy: Case Report and Review of the Literature
AUTHORS:
Takanori Ayabe, Masaki Tomita, Eiichi Chosa, Katsuya Kawagoe, Kunihide Nakamura
KEYWORDS:
Pneumonectomy, Intrapleural, Hypotonic, Hyperthermic, Chemotherapy, Pulmonary Angiosarcoma
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.2,
February
17,
2015
ABSTRACT: 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 B8,9,10and 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 7thpostoperative day, under general anesthesia, we
performed video-assisted IPHHC (43°C, 60 min, 200 mg/m2of
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.