Abstract
BackgroundMucinous neoplasms within the abdomen may disseminate by direct extension through the diaphragm to involve the pleural space. Treatment of this condition is by parietal and visceral pleurectomy followed by hyperthermic intrapleural chemotherapy.Case presentationIn this case report a patient developed persistent right upper lobe interstitial pneumonitis and progressive parenchymal fibrosis following intrapleural chemotherapy treatment with mitomycin C and doxrubicin. The condition persisted until death 28 months later. Death was from progressive intraabdominal disease with intestinal obstruction and sepsis associated with progressive pulmonary parenchymal disease. The right pleural space disease did not recur.ConclusionThis manuscript is the first case report describing interstitial pneumonitis and lung fibrosis following intrapleural chemotherapy. Since pulmonary toxicity from chemotherapy is a dose-dependent phenomenon, dose reduction of intrapleural as compared to intraperitoneal hyperthermic chemotherapy may be necessary.
Highlights
Mucinous neoplasms within the abdomen may disseminate by direct extension through the diaphragm to involve the pleural space
In this report we present a patient with appendiceal mucinous neoplasm with right pleural dissemination treated by pleurectomy and intrapleural hyperthermic chemotherapy
Parenchymal damage to the lung is well described from chemotherapy, a localized and persistent fibrosis of lung parenchyma as seen in this patient given intrapleural chemotherapy has not been previously reported
Summary
From our review of this patient's clinical course and our experience with other patients who had the same procedure, the causation of this interstitial fibrosis is not apparent. Parenchymal damage to the lung is well described from chemotherapy, a localized and persistent fibrosis of lung parenchyma as seen in this patient given intrapleural chemotherapy has not been previously reported. This localized pneumonitis which progressed to fibrosis and systemic sepsis was likely related to combined systemic and local-regional toxic effects of chemotherapy. It is likely that visceral pleurectomy prior to the hyperthermic intrapleural chemotherapy treatment could result in access of small amounts of drug solution to lung parenchyma. Surface treatment should have no parenchymal toxicity; damage to lung parenchyma by visceral pleurectomy may allow tissue penetration by chemotherapy. Progressive lung inflammation and fibrosis may result in a long-term disability and contribute to the demise of the patient
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