Annals of Oncology 3: 297-300, 1992. O 1992 Kluwtr Academic Publishers. Primed in the Netherlands.

Original article Pneumothorax following induction chemotherapy in patients with lung metastases: A case report and literature review H. Biran,1 R. Dgani,2 J. P. Wasserman,3 D. Weissberg4 & A. Shani1 'Departments of Oncology; ^Obstetrics and Clynecology, ' Diagnostic Radiology, 4 Kaplan Hospital (affiliated with Hadassah-Hebrew University Medical School, Jerusalem) and Surgery "C", Wolfson Government Hospital, Rehowt, Israel

Summary. A 29-year-old patient presented with bilateral pulmonary lesions following surgery for recurrent placental site trophoblastic tumor (PS'IT). On day seven after institution of the 'EMA' regimen (etoposide, medium dose methotrexate with folinic acid rescue and actinomycin-D), complete pneumothorax occurred. Closed-system air drainage brought only transient lung expansion and subsequent talc pleurodesis was needed. During follow-up, complete regres-

sion of lung metastases was observed. A literature survey of post-chemotherapy pneumothorax in patients with lung metastases disclosed fourteen hitherto reported cases. Including the present PSTT case, non-epithelial gynecologic malignancy (3 patients) ranks second to osteogenic sarcoma (6 cases) with regard to the primary tumor involved. Key words: pneumothorax, lung metastases, chemotherapy

40 mlu. Trans-vaginal sonogram showed a multilocular 3 x 5 cm mass located at the left posterior uterine wall. Spontaneous pneumothorax, albeit uncommon, is a Thoracic CT scan was normal. The patient underwent well-documented phenomenon in patients with intra- total abdominal hysterectomy and omental biopsy. The thoracic malignancy, particularly metastatic. Reports tumor was limited to the uterine wall, as previous dedate back to the fourth decade of this century [1, 2]. scribed. Histopathology showed placental site trophoOccasionally, the phenomenon occurs as the presenting blastic tumor, positively immunostained by human plasymptom of either primary or secondary lung neo- cental lactogen. Her post-operative recovery was unplasms [3, 4). A variety of tumor types has been re- eventful, and her serum beta-HCG dropped to 5 mlu. ported with a predominance of mesenchymal tumors, In December 1990, the patient became aware of a in both pediatric and adult patients [2, 3, 5-7]. Con- vaginal fullness. A 2 cm mass was found and completesequently, the median age of the affected population is ly excised. Histopathologic examination confirmed the rather young. Of particular interest are patients in presence of metastatic PSTT. Later in the same month whom pneumothorax occurred in either once or recur- the patient reported the onset of a persistent mild rently, while they were receiving combination chemo- cough; a CT scan on 22/1/91 revealed about 8 parentherapy [6, 8, 9|. chyma! densities, consistent with metastatic deposits, We present herewith a patient with metastatic pla- located peripherally on both lungs (Fig. 1). cental site trophoblastic tumor (PSTT), whose inducFollowing the evidence, chemotherapy by 'EMA-CO" tion chemotherapy was accompanied by unilateral was instituted: etoposide, actinomycin-D: days 1 & 2; pneumothorax. methotrexate day 1 with subsequent folinic acid rescue; cyclophosphamide, vincristine: day 8; cycle repeated on day 15 |10]. On day 7 (2/10/91) the pateint presented with dyspnea and severe pleuritic pain. A chest Results X-ray showed complete collapse of the left lung, mediastinal shift to right and pneumothorax (Fig. 2). Case report Insertion of a chest tube, under negative pressure, led In March 1990, a 29-year-old women presented with to re-expansion of the left lung. However, the lung colvaginal bleeding, following delivery of her third child. lapsed again when the tube was removed. The patient A moderate circulating beta-HGC elevation (38 mlu, was transferred to a thoracic surgery service, where upper normal level necol Oncol 1990; 39:56-9. ately after cytotoxic treatment, which is not frequently 11. Bourke S. Kelly C, Bundi RS, Boyd G. Bilateral talc pleurodesisin metastatic pneumothorax. Chest 1987: 92: 57ft. the case (Table 1). The longer lag time is indeed more consistent with the time needed for sufficient tumor 12. Smevic B. Klepp O. The risk of spontaneous pneumothorax in patients with osteogenic sarcoma and testicular cancer. Cancer lysis to occur [16j. 1982:49: 1734-7. The temporal relationship between chemotherapy 13. Light RW, OHara VS. Monitz TF. et al. for the Department of administration and lung collapse suggests that our case Veterans Affairs Cmperative Study Group on Spontaneous Pneumothorax: Intraplcural tetracycline for the prevention of fits best into the fourth category. Pneumothorax may Table 2. Relationship of pneumothorax to concomitant tumor response.

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300 recurrent spontaneous pneumothorax. JAMA 1990; 264: 2224-30. 14. Liu TC, Lin SP, Liu HW, Chen TP. Spontaneous pneumothorax following chemotherapy for malignant thymoma with pulmonary metastasis; report of a case. J Foremosan Med Assoc 1989; 88: 839-41. 15. Devereux DF, Thibault T, Boretos BS, Brennan MF. The quantitative and qualitative impairment of wound healing by adriamycin. Cancer 1979; 43: 932-8. 16. Biran H, Feld R, Malkin A. Circulating argjninevasopressin, calcitonin, carcinoembryonic antigen, neuron specific enolase

Book review Melanoma research: Genetics, growth factors, metas-

tases, and antigens. L. Nathanson (ed). Kluwer Academic Publishers, Boston/Dordrecht/London, 1991. 190 pp, $ 105.00, £62.50, Dfl. 225.00. Malignant melanoma is one of the few cancers whose incidence and mortality is increasing every year. The incidence of melanoma between 1973 and 1989 tops the list, with an 85% increase, while the mortality due to this cancer has increased by 29%. Nothing has modified the outcome of malignant melanoma in the past 70 years. This book is an update of current melanoma research and represents the joint effort of more than 20 contributing authors. The first chapter by J. M. Cowan and U. Francke presents cytogenetic data from dysplastic nevi and melanomas and suggests a possible sequence of genetic changes that result in malignancy. The second chapter, subdivided into four sections, is devoted to growth regulation and oncogenes. The first section, by R. HaJaban, summarizes the growth factors and growth factor receptors which play a critical role in the growth and development of normal melanocytes. The second section, by A. Kock et al., describes the numerous cytokines and growth-regulatory peptides released by melanoma cells. The potential clinical use of recombinant cytokines and growth factors is briefly discussed. In section three, D. L. Coppock et al. show the effect of phorbol esters on the growth regulation of metastatic melanoma cell lines. They conclude that cells of melanocytic lineage are affected by phorbol

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and beta-2 microglobulin fluctuations during combined modality therapy for small cell bronchogenic carcinoma. Tumor Biol (Basel) 1991; 12: 131-7. Received 30 October 1991; accepted 18 December 1991. Correspondence to: H. Biran, MD Sheibe Institute of Oncology Kaplan Hospital 76100 Rehovot, Isreal

Annals of Oncology 3: 300, 1992.

esters through a pathway other than stimulation of protein kinase C. In section four, I. T. Valyi-Nagy and M. Herlyn review the currently available data on maturation, growth requirements, and antigen expression of melanocytes and their interactions with keratinocytes. In the first section of the third chapter, D. Herlyn et al. present an experimental model of human melanoma metastases in nude mice. They further show that monoclonal antibodies directed against GD2/GD3 gangliosides inhibit the formation of such metastases. The second section by R. M. Schultz reviews the collagenolytic activity of metalloproteinases and their activity in modulating the metastatic process. The first section of the final chapter of this book discusses the importance of expression of a set of gangliosides on melanoma cells and their possible role in stimulating the host immune response. In the second and last section J. L. Murray and M. G. Rosenblum review the current status of interferon regulation of melanoma-associated antigens and histocompatibility antigens, both in vitro and in vivo. Altogether, this book gives a nice update of some of the more recent developments in melanoma research. The chapters are comprehensive and clinicians will find this volume of interest, in view of the fact that it is probably from such laboratory work that new clinical approaches in the treatment of melanoma will emerge. S. Carrel Lausanne

Pneumothorax following induction chemotherapy in patients with lung metastases: a case report and literature review.

A 29-year-old patient presented with bilateral pulmonary lesions following surgery for recurrent placental site trophoblastic tumor (PSTT). On day sev...
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