Chest wall tumour following iodized talc pleurodesis.

Chest wall tumour following iodized talc pleurodesis. A man of 37 had an iodized talc pleurodesis carried out for recurrent spontaneous pneumothorax. There was no history of industrial exposure to asbestos. Two years latei he presented with pain in the right chest and radiographs at that time showed some localized pleural thickening at the site of the thoracoscopy cannulation for introduction of talc. A provisional diagnosis of talc granuloma, chemical abscess or tumour was made and exploratory thoracotomy revealed a tumour involving the chest wall, lung, and pleura which, on histological examination, showed adenocarcinoma of varying degrees of differentiation and in some parts also presenting a more squamoid appearance. Numerous doubly refractile talc particles were intimately associated with the tumour and fibrous tissue. Shortly after excision the patient developed evidence of systemic dissemination of the disease and died four months later. The possibility of this tumour being induced by the talc is discussed. A brief review is made of the various forms of talc used in surgery over the past 40 years and attention is drawn to the significance of the proportion of asbestos mineral which is present in talc as mined in various parts of the world. We do not consider that this is a case of mesothelioma of the pleura. For over 30 years iodized talc pleurodesis has been a well tried and almost universally accepted method of treating recurrent spontaneous pneumo-thorax. Gowar (1941), in searching for a material to produce pleural symphysis, concluded that talc was superior to all the other substances he had investigated. The powder is most conveniently introduced using an insufflator and thoracoscope, a relatively minor procedure which may be carried out under local anaesthesia with a little sedation: but, as the initial reaction may be extremely painful, general anaesthesia is to be preferred. After insertion of the thoracoscope and inspection of the lung for cysts or bullae the visceral and parietal layers of the pleura are coated with a thin layer of talc. An intercostal tube is inserted and connected to an underwater seal to which suction may be applied. The tube is removed after chest films have shown the lung to be satisfactorily expanded and bubbling has ceased for 24 hours. The failure rate following this method has been extremely low. Two cases in a hundred required Requests for reprints: another poudrage because the lung had not become adherent. Both developed their …