Lingual Carcinoma Metastases Presenting as Spontaneous Pneumothorax

Abstract

Spontaneous pneumothorax is a rare manifestation of primary lung cancer or metastasis. We report a 39-year-old man with well-differentiated squamous cell carcinoma of the tongue and cervical lymph node metastases. He developed lung metastases and spontaneous pneumothorax 22 months later after intra-arterial infusion chemotherapy. The patient was managed with partial lung resection under thoracotomy. The pneumothorax resolved completely after the operation. Histological examination demonstrated metastatic squamous cell carcinoma, which had led to a bronchopleural fistula with subsequent induction of pneumothorax. The patient recovered uneventfully and continued to receive adjuvant chemotherapy in the oncology surgery outpatient department. Unfortunately, the tumors of the tongue and cervical lymph nodes progressively enlarged despite treatment. Eventually, the patient died of respiratory failure 5 months later. In most of the previously reported cases, pulmonary metastases associated with spontaneous pneumothorax usually originate from osteogenic or soft-tissue sarcomas. Although rare, pulmonary metastasis should be considered in the etiology of spontaneous pneumothorax. Despite advanced disease, surgical treatment may be feasible.

A Case of Bilateral Secondary Pneumothorax Shortly after the Completion of Concurrent Chemoradiotherapy for Tongue Cancer

“…There are only a few reports of pneumothorax attributed to lung metastases arising from an oral cancer. The possible mechanisms for development of pneumothorax due to metastatic lung cancer [2] are as follows: 1) formation of a bronchopleural fistula due to necrosis of subpleural metastases (necrosis, treatment, and infection); 2) compression due to metastases or invasion of bronchiolar tumours followed by the rupture of a cyst (formed possibly because of a check-valve mechanism) with necrotic substance discharged into the bronchial lumen; 3) positive pressure in the tumour cavity because of a check-valve mechanism due to tumour centre necrosis; and 4) direct tumour metastasis and invasion of the existing pulmonary cyst wall and pleura. In this study, the histopathological findings of the fistula from the right pulmonary artery showed pleural invasion by the squamous cell carcinoma.…”

“…According to reports, metastatic lung tumour rarely causes pneumothorax and the prevalence of metastatic lung tumour leading to pneumothorax is less than 1% [1]. Despite the fact that the most common site of distant metastasis in tongue cancer is the lung, only a few studies have reported secondary pneumothorax caused by lung metastasis from tongue cancer [2]. In this case study, we have reported the case of patient with late cervical lymph node metastases from tongue cancer (pT2N0M0), who was diagnosed with bilateral pneumothorax after undergoing neck dissection and postoperative concurrent chemoradiotherapy (CCRT).…”

Pulmonary metastasis presenting as a ground glass opacity-like lesion with a thin-walled cavity: A case report

“…However, a thin-walled lesion is sometimes observed in primary lung adenocarcinoma [4] or angiosarcoma [5], but rarely in lung squamous cell carcinoma [6]. There have been a few reports of a secondary pneumothorax caused by pulmonary metastasis of tongue cancer, in which case the lesions present as a cystic nodule with a cavity [6]. Our case report of pulmonary metastasis of tongue cancer is extremely rare from the viewpoint of pulmonary GGO-like lesions with a following thin-walled cavity and hilar lymph node metastasis.…”

Spontaneous pneumothorax in the elderly: a sign of a malignancy?

“…6 Secondary pulmonary malignancies with pulmonary metastases are also known to cause pneumothorax, the most commonly encountered malignancies are osteogenic and soft tissue sarcomas. [6][7][8] The overall incidence of SP secondary to lung malignancies was determined to be 0.7% in our clinic. Among the 1187 adult patients who were found to have SP from 2013 to 2017, 9 had lung cancer.…”