Journal of Clinical Oncology, Vol 21, Issue 15
(August), 2003: 2998-2999
© 2003 American Society for Clinical Oncology
Uncommon Presentations of Malignancies
CASE 4. TUMOR IMPLANTATION AFTER PNEUMONECTOMY FOR LUNG CANCER
Vinay Raja,
David Bessman
Departments of Medical Oncology and Internal Medicine, University of Texas Medical Branch Galveston, TX
Two years before his present admission, a 45-year-old white male had undergone a curative resection of the left upper lobe of the lung for stage 1 squamous-cell cancer. He did not receive adjuvant chemotherapy or radiation for this early-stage cancer. He now presented with a painful lump in the left upper chest wall that had been gradually increasing in pain and size for about 6 months. He did not have any other symptoms. Physical examination revealed an 8 by 12 cm hard mass, mobile horizontally and vertically, and tender to deep palpation. The overlying skin had an old healed surgical scar and otherwise appeared normal without erythema or ulceration (Fig 1 ). CT scan (Fig 2) and MRI (Fig 3) revealed a subcutaneous mass in the chest wall involving the subscapularis, teres major, and latissimus dorsi muscles. There were no pulmonary lesions. A core biopsy revealed poorly differentiated squamous-cell carcinoma. This was again managed by surgical resection.
Implantation of malignant cells in the chest wall after pneumonectomy is extremely rare.1,2 Incisional recurrences may occur as a result of direct imiplatation of tumor cells at the time of operation,3 or as a result of hematogenous dissemination.4 Subcutaneous recurrences have also rarely occurred after common procedures such as fine-needle aspiration biopsy,5,6 as well as video-assisted thoracoscopic surgery.7 Careful follow-up and early detection of such lesions will allow surgical excision and yield a more favorable prognosis. Surgery, chemotherapy, and radiation therapy alone or in combination are used for treatment. An aggressive multimodality treatment approach can be potentially curative.
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5. Kara M, Alver G, Sak Sd, et al: Implantation metastasis caused by fine needle aspiration biopsy following curative resection of stage 1B non-small cell lung cancer. Eur J Cardiothoracic Surg 20:868–870, 2001[Abstract/Free Full Text]
6. Raftopoulos Y, Furey WW, Kacey DJ, et al: Tumor implantation after computed tomography-guided biopsy of lung cancer, J Thorac Cardiovasc Surg 119:1288–1289, 2000[Free Full Text]
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