Clinical and pathological characteristics of spontaneous pneumothorax in women: a 25-year single-institutional experience

Objectives Accumulating 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.

We 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.

Among 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.

Catamenial 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. Similar content being viewed by others

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The 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. Funding No funding was received for this study. Author information Authors and Affiliations Contributions TS 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. Corresponding author Ethics declarations Conflict of interest Authors declared that they have no conflict of interests. Additional information Some of the data described in this manuscript have been described in an abstract presented at CHEST 2017 in Toronto on November 1, 2017. Electronic supplementary material Below is the link to the electronic supplementary material. Rights and permissions About this article Cite this article Saito, 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 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11748-018-0952-8