Pulmonary metastasis presenting with pneumothorax in a patient with osteosarcoma

Abstract

Secondary pneumothorax in association with pulmonary metastasis from sarcoma is rarely seen, with osteosarcoma being the most common histology. We report a case of pulmonary metastasis from osteosarcoma presenting with pneumothorax. A 14-year-old boy was diagnosed with osteosarcoma of the tibia and underwent surgical resection of the tumor. Six months after the completion of adjuvant chemotherapy, he presented with a right moderate pneumothorax. Computed tomography revealed a small cystic lesion in the right upper lobe, whereas no other solid nodules were seen, suggesting metastases. During surgery, a cystic lesion was identified as the source of air leakage and was completely resected surgically. Histological findings showed abnormal spindle cells that were compatible with osteosarcoma spreading to the subpleural space. We conclude that clinicians should be aware of the possibility of pulmonary metastasis when pneumothorax is encountered in a patient with osteosarcoma and the surgical approach is beneficial for the treatment of pneumothorax and confirmation of the pathological diagnosis.