{"paper_id":"d499ea80-f379-42a1-bc2e-d47fac5606d7","body_text":"Abstract\nObjectives\nAccumulating evidence suggests that spontaneous pneumothorax (SP) in women, while relatively rare, has higher rates of post-treatment recurrence than in men. Our aim was to further elucidate the clinical and pathological characteristics of SP in women.\nMethods\nWe retrospectively reviewed 59 female patients with no known underlying lung disease undergoing surgery for their SP from January 1990 to December 2015. We divided the study population into those older than or equal to 50 years and those younger than 50 years, the latter of which was further subdivided into catamenial and non-catamenial pneumothorax.\nResults\nAmong the study population, 11 (18.6%) had catamenial pneumothorax, 40 (67.8%) had non-catamenial pneumothorax, and 8 (13.6%) were older than 50 years. Pathological diagnoses of catamenial pneumothorax were diaphragmatic endometriosis (n = 4), emphysematous bullae (n = 4), solitary pulmonary capillary hemangiomatosis (SPCH, n = 2), and hematoma (n = 1). By contrast, emphysematous blebs/bullae accounted for all but one case of non-catamenial pneumothorax and all cases in the ≥ 50 years age group. Catamenial pneumothorax showed a significantly higher postoperative recurrence rate compared to non-catamenial pneumothorax (p = 0.0043). The 2-year cumulative ipsilateral recurrence rates of catamenial, non-catamenial, and ≥ 50 years age group were 39.4, 13.8, and 14.3%, respectively.\nConclusions\nCatamenial pneumothorax affected approximately 20% of female patients undergoing surgery for spontaneous pneumothorax with no underlying lung disease and showed a significantly higher postoperative recurrence rate. Diaphragmatic endometriosis and subpleural blebs/bullae were common pathological findings in catamenial pneumothorax, but SPCH might be a possible pathological diagnosis of catamenial pneumothorax.\nSimilar content being viewed by others\nReferences\nCommittee for Scientific Affairs, The Japanese Association for Thoracic Surgery. Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, et al. Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2016;64:665–97.\nBobbio A, Dechartres A, Bouam S, Damotte D, Rabbat A, Regnard JF, et al. Epidemiology of spontaneous pneumothorax: gender-related differences. Thorax. 2015;70:653–8.\nSadikot RT, Greene T, Meadows K, Arnold AG. Recurrence of primary spontaneous pneumothorax. Thorax. 1997;52:805–9.\nMehta CK, Stanifer BP, Fore-Kosterski S, Gillespie C, Yeldandi A, Meyerson S, et al. Primary spontaneous pneumothorax in menstruating women has high recurrence. Ann Thorac Surg. 2016;102:1125–30.\nAlifano M, Trisolini R, Cancellieri A, Regnard JF. Thoracic endometriosis: current knowledge. Ann Thorac Surg. 2006;81:761–9.\nAlifano M, Jablonski C, Kadiri H, Falcoz P, Gompel A, Camilleri-Broet S, et al. Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med. 2007;176:1048–53.\nYasui T, Hayashi K, Mizunuma H, Kubota T, Aso T, Matsumura Y, et al. Association of endometriosis-related infertility with age at menopause. Maturitas. 2011;69:279–83.\nAlifano M. Catamenial pneumothorax: a prospective study. Chest. 2003;124:1004–8.\nAlifano M, Legras A, Rousset-Jablonski C, Bobbio A, Magdeleinat P, Damotte D, et al. Pneumothorax recurrence after surgery in women: clinicopathologic characteristics and management. Ann Thorac Surg. 2011;92:322–6.\nKanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.\nKorom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, et al. Catamenial pneumothorax revisited: clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128:502–8.\nRedwine DB. Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril. 2002;77:288 – 96.\nHavlik DM, Massie LW, Williams WL, Crooks LA. Pulmonary capillary hemangiomatosis-like foci. An autopsy study of 8 cases. Am J Clin Pathol. 2000;113:655 – 62.\nHashimoto H, Kurata A, Fujiwara M, Hara K, Matsumoto J, Kusakabe M, et al. Solitary pulmonary capillary hemangioma of adult cases: clinicopathologic characteristics as an unrecognized entity. Am J Surg Pathol. 2016;40:1380–9.\nO’Keefe MC, Post MD. Pulmonary capillary hemangiomatosis: a rare cause of pulmonary hypertension. Arch Pathol Lab Med. 2015;139:274–7.\nSaito T, Maniwa T, Kaneda H, Minami K, Sakaida N, Uemura Y, et al. Coexistence of catamenial pneumothorax and catamenial hemoptysis in a patient with pulmonary hemangiomatosis-like foci: a case report. J Thorac Cardiovasc Surg. 2010;139:e14-6.\nCiriaco P, Negri G, Libretti L, Carretta A, Melloni G, Casiraghi M, et al. Surgical treatment of catamenial pneumothorax: a single centre experience. Interact Cardiovasc Thorac Surg. 2009;8:349 – 52.\nTakahashi R, Kurihara M, Mizobuchi T, Ebana H, Yamanaka S. Left-sided catamenial pneumothorax with thoracic endometriosis and bullae in the alveolar wall. Ann Thorac Cardiovasc Surg. 2017;23:108 – 12.\nHaga T, Kurihara M, Kataoka H, Ebana H. Clinical-pathological findings of catamenial pneumothorax: comparison between recurrent cases and non-recurrent cases. Ann Thorac Cardiovasc Surg. 2014;20:202–6.\nAttaran S, Bille A, Karenovics W, Lang-Lazdunski L. Videothoracoscopic repair of diaphragm and pleurectomy/abrasion in patients with catamenial pneumothorax: a 9-year experience. Chest. 2013;143:1066–9.\nMuramatsu T, Nishii T, Takeshita S, Ishimoto S, Morooka H, Shiono M. Preventing recurrence of spontaneous pneumothorax after thoracoscopic surgery: a review of recent results. Surg Today. 2010;40:696–9.\nAcknowledgements\nThe authors thank Dr. Akiharu Okamura and Dr. Yoshiko Uemura for their pathological review. The authors acknowledge the contributions of Ms. Tomoko Hasegawa and Ms. Yoko Oda toward facilitating this study.\nFunding\nNo funding was received for this study.\nAuthor information\nAuthors and Affiliations\nContributions\nTS is the guarantor of the content of this manuscript. TS designed the work, collected and analyzed the data, and wrote the manuscript. YS and TM supervised the study. KT contributed to the verification of pathological diagnosis. KJF, HM, TN, YT, HK, and TK contributed to collection of data. All authors contributed to the final version of the manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nAuthors declared that they have no conflict of interests.\nAdditional information\nSome of the data described in this manuscript have been described in an abstract presented at CHEST 2017 in Toronto on November 1, 2017.\nElectronic supplementary material\nBelow is the link to the electronic supplementary material.\nRights and permissions\nAbout this article\nCite this article\nSaito, T., Saito, Y., Fukumoto, K.J. et al. Clinical and pathological characteristics of spontaneous pneumothorax in women: a 25-year single-institutional experience. Gen Thorac Cardiovasc Surg 66, 516–522 (2018). https://doi.org/10.1007/s11748-018-0952-8\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s11748-018-0952-8","source_license":"CC0","license_restricted":false}