SECONDARY SPONTENEOUS PNEUMOTHORAX AS A PRESENTATION OF BREAST CANCER RECURRENCE: CASE REPORT

Abstract

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous pneumothorax is a common pathology described as gas trapped in the pleural space, not caused by an external event. When a lung associated pathology is found as the cause of the spontaneous pneumothorax then a subclassification arises and the events are characterized as Secondary spontaneous pneumothorax. Secondary spontaneous pneumothorax (SSP) are most frequently caused by chronic obstructive lung disease, necrotizing lung infections, genetically associated disease like cystic fibrosis or primary lung malignancy. There are lesser-known causes of SSP and, this is one such example where we showcase an unusual presentation revealing a unique etiology. CASE PRESENTATION: A 60-year-old Hispanic female with hypothyroidism who underwent left radical mastectomy 10 years ago for breast CA presented with sudden onset left-sided chest pain. She denied shortness of breath, recent trauma or smoking history. Heart rate, peripheral oxygen saturation, and laboratory tests were unremarkable, including 12 lead electrocardiogram. Physical examination was remarkable for decreased breath sounds on the left side of the chest. Chest CT scan revealed large left pneumothorax with paraaortic, right paratracheal and subcarinal lymph nodes with central necrosis. Also, a tissue density within the left main bronchus and hilum was identified, resulting in partial obstruction of the left lower lobe bronchus. General surgery service was consulted for emergent chest tube placement. A bronchoscopy was performed, and the endobronchial mass was biopsied. Pathology results showed metastatic recurrence of breast cancer. The patient was observed for three days after chest tube placement and chest radiography demonstrated resolution of pneumothorax. At that moment, the chest tube was removed, and the patient was discharged home the next day. DISCUSSION: Presently, the patient continues stable since being discharged from our institution. She was started on Letrozole and Palbociclib by the Oncology Service and has had no new episode of spontaneous pneumothorax. The patient will continue to receive conservative management by Oncology at our institution. CONCLUSIONS: This vignette illustrates a unique presentation of a metastatic breast cancer recurrence debuting as spontaneous pneumothorax. The most common type of malignancies associated with secondary spontaneous pneumothorax are primary lung cancer and sarcomas. To our knowledge, there are no cases that report an SSP as the presentation of breast cancer recurrence. Reference #1: Srinivas, S., & Varadhachary, G. (2000). Spontaneous pneumothorax in malignancy: A case report and review of the literature. Annals of Oncology, 11(7), 887–889. doi: 10.1023/a:1008323632078 Reference #2: Bini, Alessandro; Zompatori, Maurizio; Ansaloni, Luca; Grazia, Manuele; Stella, Franco; Bazzocchi, Ruggero. (2000). Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: Report of a case. Surgery today. 30. 469-72. 10.1007/s005950050628. DISCLOSURES: No relevant relationships by Juan Feliciano-FIgueroa, source=Web Response No relevant relationships by Angel Laureano, source=Web Response No relevant relationships by Giovanni Veloz Irizarry, source=Web Response