Abstract:

Objective The clinical features of tuberculous pyothorax combined with pleural angiosarcoma were summarized and analyzed in order to improve clinical diagnosis and treatment.Methods The clinical manifestation, laboratory findings, treatment and prognosis of one case with tuberculous pyothorax combined with pleural angiosarcoma who were admitted to Shandong Provincial Chest Hospital Affiliated to Shandong University in September 2016 were reported, and the corresponding domestic and foreign literatures were reviewed and analyzed. The PubMed, Wanfang, and CNKI databases were searched by using “pleural angiosarcoma” and “pleura; angiosarcoma” as search terms and the date of retrieval was set from January 1995 to November 2018. The patient’s general condition, past medical history, imaging performance, pathological immunohistochemistry results, treatments, outcome and duration of disease were collected.Results The 56-year-old male patient complained of dyspnea, cough for more than one month, and blood-stained sputum for 20 days. The patient underwent multiple thoracotomies. The pathological diagnosis was tuberculous empyema complicated with pleural angiosarcoma. The patient died after 17 months of onset. A total of 31 articles were retrieved through literatures review. Data on 32 patients with pleural angiosarcoma were obtained. The total number of subjects was 33 cases including the case reported in this study. There were 23 males and 10 females, who aged from 24-87 years (average 64.12±13.90 years). For past medical history, 9 cases had a tuberculous pyothorax history and 1 case had a pyothorax history; 2 cases had received chemoradiotherapy and 1 case had received radiotherapy only; and 1 case had a history of dust exposure. The lesions were located in the right hemithorax in 14 cases, the left hemithorax in 12 cases, and in bilateral thorax in 7 cases. There were 4 cases with pleural fluid only, 12 cases with pleura-thicking and pleural mass, and 17 cases with both plrural fluid, pleura-thinking and pleural mass; 16 cases were confirmed with hemothorax; 5 cases deve-loped metastases; 27 cases were positive with CD31, 17 cases positive with CD34, 15 cases positive with Vimentin, and 9 cases positive with Factor Ⅷ-related antigen. The therapy methods included surgery, chemotherapy, radiotherapy, interventional arterial embolism, microwave ablation, pleural immobilization, vascular-targeted drugs. All of the 33 cases were diagnosed by pathology. The therapies included surgery (14 cases), chemotherapy (10 cases), radiotherapy (6 cases), interventional arterial embolization (2 cases), microwave ablation (1 case), pleural fixation (3 cases), and targeted drug therapy (5 cases). Duration of disease were 2 months to 15 years, with a media time of 7 months. At last, 24 patients died, 3 had unknown outcome, 3 lost were lost to follow-up, and 3 patients were still alive at the last follow-up.Conclusion The clinical manifestations of pleural angiosarcoma are not typical. Tuberculous pyothorax is high risk factor for pleural angiosarcoma. Pleural angiosarcoma should been taken into considera-tion when unexplained osmolar lesion occurs in tuberculous pyothorax.

Key words: Empyema, tuberculous, Hemangiosarcoma, Pleural neoplasms, Comorbidity, Disease attributes