RARE CASE OF PAZOPANIB-ASSOCIATED BILATERAL PNEUMOTHORACES IN A PATIENT WITH METASTATIC SYNOVIAL SARCOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bilateral pneumothoraces are a rare occurrence, comprising 1.4% to 7.6% of cases [1]. Secondary causes pneumothorax include bullous emphysema, cystic parenchymal lung disease and tuberculous [2]. Malignancy is cause pneumothorax, yet sarcomas have been associated with in 2% patients [3]. Pazopanib, tyrosine kinase inhibitor used the treatment metastasized sarcoma, has shown 3.3% risk developing [4]. CASE PRESENTATION: A 24-year-old previously healthy Yemeni female initially presented left-sided groin pain swelling. Computed tomography pelvis showed large heterogeneous mass proximal left thigh. Biopsy was consistent synovial sarcoma. Staging via chest computed multiple pulmonary nodules concerning for metastasis. Over course two years, she failed lines chemotherapy had progression new enlarging bilateral nodules. She started on fourth-line pazopanib (Votrient) 400 mg daily. Two months later, shortness breath, found be tachypneic, tachycardic hypoxemic. Chest x-ray revealed mediastinal shift tension pneumothorax. tube thoracostomies were placed; however, complicated by persistent air leak bilaterally, requiring video-assisted thoracoscopic surgery bullectomy surgical talc pleurodesis. Patient slow resolution subsequently discharged home without recurrence. DISCUSSION: can life-threatening poor long term prognosis, especially underlying function [5]. Pneumothorax seen approximately sarcoma metastases. In metastases, 41.6% bilateral, typically nodules, or cavitary lesions, presence pleural thickening Additionally, cytotoxic agents induce cavitation lesions increase development [6]. Per PALETTE trial which led approval use there [4], comparable baseline rate Nevertheless, carry potentially fatal consequences. CONCLUSIONS: undergoing pazopanib, though rare, may life threatening should acutely suspected. REFERENCE #1: TG Rim, JS Bae, YS Yuk. Life-Threatening Simulatenous Spontaneous Tension - case report. Korean J Thorac Cardiovasc Surg. 2011 Jun; 44(3): 253-256.2. Mason RJ, Braoddus VC, Murray JF, Nadel JA. Nadel's Textbook Respiratory Medicine. 4th ed. Elsevier Saunders (2005); Vol 2, Chapter 81. Philadelphia, PA. #2: Hoag JB, Sherman M, Fasihuddin Q, Lund ME. comprehensive review spontaneous complicating CHEST. 2010 Sep; 138(3);510-8.4. Van der Graaf WT, Blay JY, Chawla SP, Kim DW, et al. Pazopanib metastatic soft-tissue (PALETTE): randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012 May 19; 379(9829):1879-86. #3: Graf-Deuel E, Knoblauch, A. Simultaneous 1994 Apr; 105(4):1142-6.6. Interiano RB, McCarville MB, Wu J, Davidoff AM, Sandoval Navid F. as complication combination antiangiogenic therapy children young adults refractory/recurrent solid tumors. Pediatr 2015 50(9):1484-9. DISCLOSURES: No relevant relationships Sally Askar, source=Web Response Owais Nadeem,