A case of surgical intervention for refractory pneumothorax associated with pulmonary metastases from osteosarcoma during pazopanib administration

Dobashi Ryota, Ishihara Shunta, Shimomura Masanori, Tsunezuka Hiroaki, Ikebe Satoshi, Inoue Masayoshi

doi:10.2995/jacsurg.38.50

<p>A 31-year-old man with osteosarcoma of the left femur underwent pulmonary metastasectomy after primary tumor resection and systemic chemotherapy. Since chemotherapy for recurrence with multiple bilateral pulmonary metastases was ineffective, pazopanib was administered (600 mg/day). The left pneumothorax was monitored, it worsened 4 days after pazopanib administration, and chest drainage and pleurodesis using talc and OK-432 were performed. Due to the failure of conservative therapy, surgical intervention was indicated. Although the visceral pleura was thickened after pleurodesis, the pleural adhesion was mild. Massive air leak was observed in the vicinity of the tumor. Partial resection including the air leak point and suture repair were performed. Without postoperative air leakage, the patient was discharged on postoperative day nine. The histological findings revealed that the visceral pleura at the tumor site was destroyed with necrosis and the tumor was exposed outside of the pleura. Silica deposition and granulation were observed in the area of pleural thickening, but pleural thickening in the area of pleural collapse near the tumor was not found. Thus, the visceral pleura might be severely injured in patients with prolonged air leak during pazopanib administration for pulmonary metastases from soft tissue sarcoma, and surgical intervention could be considered.</p>

A case of surgical intervention for refractory pneumothorax associated with pulmonary metastases from osteosarcoma during pazopanib administration

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