A Case of Squamous Cell Carcinoma Developed in Chronic Tuberculous Empyema Following Therapeutic Extrapleural Pneumothorax

Abstract

A 72-year-old woman was admitted to our hospital for persistent right-sided chest pain for 6 months and osteolytic changes in some ribs on chest x-rays. The patient had a past history of pulmonary tuberculosis at 19 years of age and underwent treatment for rightsided therapeutic extrapulmonary pneumothorax. A computed tomography (CT) scan of her chest demonstrated a ring-enhanced tumor adjacent to the chronic empyema, which invaded the thoracic wall and eroded some ribs. A poorly differentiated squamous cell carcinoma (SCC) was pathologically diagnosed by percutaneous CT-guided biopsy. Radiation therapy with a total dose of 74.4 Gy was performed instead of surgical resection considering poor pulmonary function. The effi cacy of the treatment was confi rmed by positron emission tomography (PET) scanning with 18-fl uorodeoxyglucose (18 FDG), which demonstrated a reduction both in the size and the standardized uptake value (SUV) at the hot spot at the invasive site of the tumor to the thoracic wall. This case was recognized as SCC developed in chronic tuberculous empyema since the tumor had only contacted with the empyema and the lung parenchyma surrounding the empyema was intact.