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Soleimani N, Hosseinzadeh M, Amirian A, Hassani M, Mohammadzadeh S. Solitary Langerhans cell histiocytosis of the sternum in a 21-year-old woman. Clin Case Rep 2024; 12:e8391. [PMID: 38173895 PMCID: PMC10761613 DOI: 10.1002/ccr3.8391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Children are more likely to develop Langerhans cell histiocytosis (LCH), a rare disorder with an unknown cause. LCH often invades skeletal systems, while it has occasionally been seen in the sternum or ribs. The best course of treatment for single-site, skeletal LCH is yet unknown. We present an instance of sternal LCH with adult onset. By fusing and reconstructing chest computed tomography, it was possible to determine the extent of surrounding soft tissue invasion. Because LCH is so uncommon, it could be challenging to recall when we see a sternal lesion. Adult Patients who arrive with anterior chest discomfort and an osteolytic sternal lesion should include LCH on their differential diagnosis list.
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Affiliation(s)
- Neda Soleimani
- Department of PathologyShiraz University of Medical SciencesShirazIran
| | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | - Masha Hassani
- Department of PathologyShiraz University of Medical SciencesShirazIran
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Tsuge I, Saito S, Sakamoto A, Matsuda S. Anterior chest wall reconstruction after resection of a sternal tumor with a single mandibular plate and Gore-Tex® sheet. Asian J Surg 2020; 44:563-565. [PMID: 33341335 DOI: 10.1016/j.asjsur.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ciarrocchi AP, Dell'Amore A, Campisi A, Diodato S, Giunta D, Dolci G, Guidalotti P, Fanti S, Stella F. Long-Term Metabolic Assessment of Cryopreserved Sternal Allograft: A Case Series. Ann Thorac Surg 2020; 111:1059-1063. [PMID: 32745518 DOI: 10.1016/j.athoracsur.2020.05.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sternal resection and reconstruction with cryopreserved allografts provides a safe alternative to traditional methods of anterior chest wall reconstruction. Despite favorable results, successful integration of the graft sternum has never been demonstrated owing to the invasiveness of bone biopsy. We describe our experience of using 18F-sodium fluoride positron emission tomography/computed tomography scans as a noninvasive method of evaluating graft integration. METHODS Seven patients underwent surgery and radiologic follow-up. Surgical indications were sternal metastases (n = 5) and sternal dehiscence (n = 2). Sternal reconstruction was performed using a cryopreserved cadaveric sternal allograft fixed in place with titanium plates and screws. Follow-up with 18F-sodium fluoride positron emission tomography/computed tomography scans was performed at 1 and 2 years after surgery. RESULTS Three patients underwent total sternectomy. Two underwent partial upper sternectomy involving the manubrium, clavicle (1 patient only), and upper sternal body; and 2 had partial sternectomy of the sternal body and xiphoid process. Focal tracer accumulation occurred at the junctions between native bone and graft bone. The median maximum standardized uptake value at 1 year was 16.8 (range, 11.2 to 37.9; interquartile range, 13.6 to 19.4), and at 2 years it was 10.8 (range, 6.1 to 30.2; interquartile range, 8.9 to 15.1). In 6 cases accumulation was lower at the second scan, whereas in 1 patient the accumulation was higher at the second scan. CONCLUSIONS Sternal reconstruction with cryopreserved allograft is safe and well tolerated. The 18F-sodium fluoride positron emission tomography/computed tomography scans are a useful and promising noninvasive method of demonstrating the metabolic activity of the graft and its incorporation into the host skeleton during follow-up.
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Affiliation(s)
- Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Andrea Dell'Amore
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Padua, Italy
| | - Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy.
| | - Stefania Diodato
- Nuclear Medicine, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Domenica Giunta
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Giampiero Dolci
- Department of Cardiothoracic and Vascular Surgery, University Hospital S. Orsola Malpighi, Bologna, Italy
| | - Pierluigi Guidalotti
- Nuclear Medicine, Department of Hematology and Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, Department of Hematology and Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
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Anterior Middle Chest Wall Reconstruction Using a Free Anterolateral Thigh Flap Resulted in Flail Chest: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2386. [PMID: 31592392 PMCID: PMC6756648 DOI: 10.1097/gox.0000000000002386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text.
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Mujtaba B, Nassar SM, Aslam R, Garg N, Madewell JE, Taher A, Hanafy AK, Whitman G. Primary Osteosarcoma of the Breast: Pathophysiology and Imaging Review. Curr Probl Diagn Radiol 2019; 49:116-123. [PMID: 30655112 DOI: 10.1067/j.cpradiol.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/14/2018] [Accepted: 01/01/2019] [Indexed: 11/22/2022]
Abstract
Extraskeletal osteosarcoma are rare malignant mesenchymal neoplasms of soft tissues representing around 1% of all soft tissue. The exact mechanism of tumorigenesis of primary breast osteosarcoma is still unclear. However, most of the cases develop without a recognized etiologic factor. Primary osteosarcoma of the breast is often initially misdiagnosed as breast fibroadenoma. Different imaging modalities and pathology play important role in differentiating breast osteosarcoma from other benign and malignant lesions of the breast resulting in dramatic change in the management.
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Affiliation(s)
- Bilal Mujtaba
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sameh M Nassar
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Rizwan Aslam
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Garg
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John E Madewell
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Taher
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdelrahman K Hanafy
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gary Whitman
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Zhang Y, Li JZ, Hao YJ, Lu XC, Shi HL, Liu Y, Zhang PF. Sternal tumor resection and reconstruction with titanium mesh: a preliminary study. Orthop Surg 2016; 7:155-60. [PMID: 26033997 DOI: 10.1111/os.12169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/16/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To explore the clinical efficacy and complications of treating sternal tumors by resection and titanium mesh thoracic reconstruction. METHODS This retrospective analysis of eight patients with sternal tumors treated in the Department of Orthopedic Surgery at the First Affiliated Hospital of Zhengzhou University from January 2008 to June 2012 included five men and three women aged 37-66 years (mean, 50.4 years). The histological diagnoses were chondrosarcoma (two cases), osteosarcoma (one), malignant fibrous histiocytoma (two), eosinophilic granuloma (one) and sternal metastasis from breast cancer (two). The tumors were invading the manubrium sterni (three cases), manubrium sterni and body (three) and sternal body (two). All patients underwent needle or incisional biopsy prior to sternal tumor resection and titanium mesh thoracic reconstruction. RESULTS All patients were followed for 9 months to 4 years. There were no intraoperative complications or operative or postoperative deaths. One patient developed a deep wound hematoma 1 week postoperatively; incisional drainage and debridement resulting in healing within 2 weeks. There was no loosening or exsertion of the titanium mesh and no patients developed respiratory complications or thoracic deformity. One patient with malignant fibrous histiocytoma died of lung metastases 9 months postoperatively, another with malignant fibrous histiocytoma died of liver metastases 14 months postoperatively; the remaining patients survived without tumor recurrence. CONCLUSION Titanium mesh chest reconstruction after sternal tumor resection has the advantages of simplifying the procedure, achieving a good shape and having few complications. Titanium mesh is an ideal material for reconstruction of the sternum.
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Affiliation(s)
- Yan Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia-zhen Li
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-jie Hao
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-chang Lu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-long Shi
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Liu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng-fei Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Zhang G, Liang C, Shen G, Li W, Huang L, Pan S, Chai Y. Autogenous rib grafts for reconstruction of the manubrium after resection: technical refinements and outcomes. J Thorac Cardiovasc Surg 2014; 148:2667-72. [PMID: 25199477 DOI: 10.1016/j.jtcvs.2014.07.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/25/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sternal reconstruction after resection is essential for restoring the rigidity of the chest cavity. However, no consensus has been reached regarding the most physiologic or efficacious material for this procedure. We present our clinical experience with autogenous rib grafts for reconstruction of the manubrium after resection and discuss the refinements in this procedure. METHODS Twelve consecutive patients with a confirmed diagnosis of a primary neoplasm in the manubrium between March 2003 and August 2013 were analyzed retrospectively. All patients underwent manubrium resection and immediate reconstruction with autogenous rib grafts. RESULTS No cases of perioperative mortality were noted. The median operation time was 129 minutes. One patient experienced mild paradoxical movement; the other patients recovered well without any complications. The median follow-up period after surgery was 69 months. Two patients died. One patient with chondrosarcoma died as a result of cardiac disease 26 months after surgery and another patient with non-Hodgkin lymphoma died as a result of local recurrence 6 months after surgery. Computed tomographic scans for the other 10 patients have shown neither dislocation nor abnormality of the transplanted ribs; moreover, no absorption of the grafts or recurrence was noted. None of the patients required prescription analgesics for the pain at the donor site at the 3-month follow-up visit. CONCLUSIONS This case series demonstrates the successful use of autogenous rib grafts in the reconstruction of the manubrium after resection. We consider that the reconstruction technique is a safe and effective alternative to a complex problem.
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Affiliation(s)
- Guofei Zhang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chengxiao Liang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Shen
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenshan Li
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lijian Huang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Saibo Pan
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Chai
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Complex Repair of Pectus Excavatum Recurrence and Massive Chest Wall Defect and Lung Herniation After Prior Open Repair. Ann Thorac Surg 2013; 96:e29-31. [DOI: 10.1016/j.athoracsur.2013.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 12/17/2012] [Accepted: 02/20/2013] [Indexed: 11/18/2022]
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Fabre D, El Batti S, Singhal S, Mercier O, Mussot S, Fadel E, Kolb F, Dartevelle PG. A paradigm shift for sternal reconstruction using a novel titanium rib bridge system following oncological resections. Eur J Cardiothorac Surg 2012; 42:965-70. [DOI: 10.1093/ejcts/ezs211] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rocca M, Salone M, Galletti S, Balladelli A, Vanel D, Briccoli A. The role of imaging for the surgeon in primary malignant bone tumors of the chest wall. Eur J Radiol 2012; 82:2070-5. [PMID: 22209633 DOI: 10.1016/j.ejrad.2011.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections.
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Affiliation(s)
- M Rocca
- General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
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Park TH, Kim JK, Oh TY, Park YJ. Solitary Langerhans cell histiocytosis arising from sternum: a case report. J Pediatr Surg 2012; 47:e9-12. [PMID: 22244435 DOI: 10.1016/j.jpedsurg.2011.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 09/24/2011] [Accepted: 10/05/2011] [Indexed: 11/28/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare idiopathic benign disease characterized by proliferation of Langerhans cells, most commonly in the skull. In extremely rare cases, the tumor can occur in the sternum. A 4-year-old girl presented to our institution with a firm, nontender mass in her anterior chest that had indolently enlarged to approximately 2 cm in diameter over the previous several months. Computed tomography, magnetic resonance imaging, and F18-flurodeoxy-glucose positron emission tomography computed tomography were performed for preoperative diagnosis, but the findings were inconclusive. Therefore, we performed surgical excision under general anesthesia, followed by microscopic and immunohistochemical analysis of the excised specimen. The mass was eventually diagnosed as a LCH arising from the sternum. No postoperative oncological treatment was given, and follow-up has continued for 1 year until the time of writing without any tumor recurrence. To our knowledge, only 10 cases of LCH arising from the sternum have been reported in the medical literature. Among them, surgical approaches including curettage and partial sternotomy were performed in only 6 cases. Without exception, all patients experienced excellent clinical outcomes. Therefore, additional clinical experiences are required. No standard treatment of choice for this disease currently exists. In our experience, curettage of the involved soft tissue mass and bone followed by appropriate reconstruction of the defect is considered a good option for the treatment of solitary LCH of the sternum. In addition, LCH should be considered in the differential diagnoses when a sharp delineated osteolytic mass is detected in the sternum.
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Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea
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Koppert LB, van Geel AN, Lans TE, van der Pol C, van Coevorden F, Wouters MW. Sternal Resection for Sarcoma, Recurrent Breast Cancer, and Radiation-Induced Necrosis. Ann Thorac Surg 2010; 90:1102-1108.e2. [DOI: 10.1016/j.athoracsur.2010.06.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 06/04/2010] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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Luu TD, Kogon BE, Force SD, Mansour KA, Miller DL. Surgery for Recurrent Pectus Deformities. Ann Thorac Surg 2009; 88:1627-31. [DOI: 10.1016/j.athoracsur.2009.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Revised: 06/01/2009] [Accepted: 06/04/2009] [Indexed: 11/27/2022]
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Ashford RU, Stanton J, Khan F, Pringle JA, Cannon SR, Briggs TW. Surgical treatment of chondrosarcoma of the sternum. Sarcoma 2008; 5:209-13. [PMID: 18521316 PMCID: PMC2395459 DOI: 10.1080/13577140120099209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: We reviewed all tumours of the sternum referred to The London Bone and Soft Tissue Tumour Service between
1956 and 1997 inclusive. Patients and results: There were eight patients with this pathology, the male to female ratio was 3:1 and their mean age was
53 years. Of these patients, three are alive and disease free, one is alive with recurrence, and four have died, two of the consequences
of the disease and two of unrelated causes. Surgery is the principal treatment of these tumours both for excision and
subsequent reconstruction. Discussion: Extended disease-free survival is possible with correct diagnosis, complete excision at the first operation, appropriate
skeletal reconstruction, adequate skin cover and appropriate postoperative support and follow-up.
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Kim H, Huh SJ, Park W, Choi DH, Kang MK, Yang JH, Nam SJ, Im YH. Results of Three-Dimensional Conformal Radiation Therapy for the Treatment of a Solitary Sternal Relapse of Breast Cancer. THE JOURNAL OF THE KOREAN SOCIETY FOR THERAPEUTIC RADIOLOGY AND ONCOLOGY 2008; 26:91. [DOI: 10.3857/jkstro.2008.26.2.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Department of and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Briccoli A, Galletti S, Salone M, Morganti A, Pelotti P, Rocca M. Ultrasonography is superior to computed tomography and magnetic resonance imaging in determining superficial resection margins of malignant chest wall tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:157-62. [PMID: 17255176 DOI: 10.7863/jum.2007.26.2.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively analyze results obtained in 22 patients affected by malignant high-grade chest wall tumors evaluated preoperatively by ultrasonography as well as other imaging techniques. METHODS Twenty-two patients with chest wall high-grade sarcomas routinely underwent computed tomography, magnetic resonance imaging, total body scintigraphy, and ultrasonography. Ultrasonography was always performed by the same person using an ultrasonography system with a 5- to 13-MHz probe and with color Doppler evaluation of the lesion. Scans were done with the patient positioned as during surgery. Tumor lateral margins were identified, and a line was marked at 4 cm. In 8 patients with local recurrence, the presence of micronodules was also studied. Results of computed tomography, magnetic resonance imaging, and ultrasonography were compared with the surgical specimens. RESULTS Histologically, all surgical specimens excised according to ultrasonographic margins showed wide margins. Ultrasonography showed micronodules in 6 of 8 patients with local recurrence; histologically, they were all identified as sarcoma nodules. Ultrasonography failed in particular with cervical-mediastinal vessels. CONCLUSIONS Our results confirm that ultrasonography is feasible and reliable in the study of superficial margins and for detection of micronodules of less than 0.5 cm in diameter.
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Affiliation(s)
- Antonio Briccoli
- General Surgery Unit, Istituto Ortopedico Rizzoli, Via Pupilli 1, IT-40136 Bologna, Italy.
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Ogundiran TO, Ademola SA, Oluwatosin OM, Akang EE, Adebamowo CA. Primary osteogenic sarcoma of the breast. World J Surg Oncol 2006; 4:90. [PMID: 17156481 PMCID: PMC1702348 DOI: 10.1186/1477-7819-4-90] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 12/11/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast. CASE PRESENTATION A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy. CONCLUSION A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria.
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Affiliation(s)
- Temidayo O Ogundiran
- Division of Oncology, Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - Samuel A Ademola
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University, College Hospital, Ibadan, Nigeria
| | - Odunayo M Oluwatosin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University, College Hospital, Ibadan, Nigeria
| | - Effiong E Akang
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Clement A Adebamowo
- Division of Oncology, Department of Surgery, University College Hospital, Ibadan, Nigeria
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Haraguchi S, Hioki M, Hisayoshi T, Yamashita K, Yamashita Y, Kawamura J, Hirata T, Yamagishi S, Koizumi K, Shimizu K. Resection of sternal tumors and reconstruction of the thorax: a review of 15 patients. Surg Today 2006; 36:225-9. [PMID: 16493530 DOI: 10.1007/s00595-005-3134-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 07/12/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. METHODS Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. RESULTS All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. CONCLUSIONS Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.
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Affiliation(s)
- Shuji Haraguchi
- Department of Surgery, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
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Sharma RK, Mehrotra S, Dhaliwal RS. 'Extended deep inferior epigastric artery flaps' for reconstruction after excision of chondrosarcoma sternum. ACTA ACUST UNITED AC 2005; 58:1004-6. [PMID: 16039634 DOI: 10.1016/j.bjps.2005.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Revised: 12/20/2004] [Accepted: 04/19/2005] [Indexed: 10/25/2022]
Abstract
We describe a case of chondrosarcoma of the sternum requiring wide full thickness chest wall excision thereby creating a difficult defect for reconstruction. A mesh was used for support and two extended deep inferior epigastric artery fasciocutaneous flaps were mobilised medially into the defect.
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Affiliation(s)
- R K Sharma
- Department of Plastic and Reconstructive Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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22
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Wilson GJP, Versluys AB, Bax KNMA. Solitary Langerhans cell histiocytosis of the sternum in a 6-year-old girl: how should it be treated? J Pediatr Surg 2005; 40:e13-5. [PMID: 16034742 DOI: 10.1016/j.jpedsurg.2005.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a 6-year-old girl with Langerhans cell histiocytosis (LCH) of the sternum successfully managed with intralesional methylprednisolone. Sternal LCH is a rare condition with only 8 cases published to date. Management has included partial sternectomy, radiotherapy, and chemotherapy. Recent literature regarding the solitary osseous focus of LCH supports conservative management with excellent outcome after intralesional steroid administration and reports of spontaneous resolution of disease. We advocate that conservative management should also be applied to LCH of the sternum.
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Affiliation(s)
- Guin J P Wilson
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre, 3508 AB Utrecht, The Netherlands
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23
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Chapelier AR, Missana MC, Couturaud B, Fadel E, Fabre D, Mussot S, Pouillart P, Dartevelle PG. Sternal resection and reconstruction for primary malignant tumors. Ann Thorac Surg 2004; 77:1001-6; discussion 1006-7. [PMID: 14992915 DOI: 10.1016/j.athoracsur.2003.08.053] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary malignant sternal tumors (PMST) are locally aggressive and their optimal surgical management still continues to evolve. METHODS From 1986 to 2002, 38 patients (25 females/13 males) underwent radical resection of PMST. This series included 33 sarcomas, 17 of which had been radiation-induced, 3 hematologic tumors, and 2 carcinomas. Seventeen were high-grade tumors. Nine patients had received preoperative chemotherapy. Twelve patients required extensive skin excision. Eight total, seven subtotal, and 23 partial sternectomies were performed. Resection was extended to the anterior chest-wall in 4 patients, lung in 4, brachiocephalic vein in 3, superior vena cava in 2, and pericardium in 1. In 36 patients, chest wall stability was obtained by Marlex (n = 21) or Vicryl (n = 2) mesh and polytetrafluoroethylene patch (n = 13), with methylmethacrylate reinforcement in 12 patients. Soft tissue coverage was done by the pectoralis major muscles with skin advancement in 25 patients, a myocutaneous flap in 11, a breast transposition in 1, and a skin flap in 1. Omentoplasty was performed in 3 patients. RESULTS One patient died from pneumonia. Two patients needed a tracheostomy after total sternectomy. No flap-related complication was observed. Four local septic complications required removal of the composite prosthesis with reoperations. Local recurrence occurred in 9 patients, 7 patients having a repeat resection. Metastases developed in eight. The 5-year overall and disease-free survival was 66% and 53%, respectively. The histologic grade of sarcomas was a survival predictor (high grade versus others p = 0.035). CONCLUSIONS Wide resection of PMST is necessary to minimize local recurrence. Large sternal defects are safely reconstructed with a musculocutaneous flap. We suggest that the use of methylmethacrylate should be limited to reconstruction after total sternectomy.
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Affiliation(s)
- Alain R Chapelier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
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24
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Affiliation(s)
- Carolyn E Reed
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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25
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Abstract
The treatment of the chest wall tumors are based on the following principles. The surgery is the only curative treatment of the disease and the pain. The pre-operative assessment may find its beneficial only to eliminate the non surgical affections, to foresee the peroperative dangers and to prepare the reconstruction. The use of more adapted and better supported prosthesis has pushed back today the limits of the resections to the possibilities of covering. Finally the quality of the result depends more than one multidisciplinary work that technical prowess's of only one operator.
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26
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Abstract
Breast cancer surgery in the presence of previous reconstruction for pectus excavatum has not been reported. Such a case is described where simultaneous chest wall resection was undertaken because of fibrous tissue distortion mimicking malignant infiltration. Furthermore, postoperative adhesions necessitated opening the pleural lining during rib resection. This resulted in recurrent pleural effusion from axillary lymphatic leakage that required thoracocentesis. Breast surgery in these circumstances has to be performed with care.
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Affiliation(s)
- Kirsten S Hindle
- Department of Breast Surgery, The Luton and Dunstable Hospital NHS Trust, Luton, England.
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27
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Mansour KA, Thourani VH, Losken A, Reeves JG, Miller JI, Carlson GW, Jones GE. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73:1720-5; discussion 1725-6. [PMID: 12078759 DOI: 10.1016/s0003-4975(02)03527-0] [Citation(s) in RCA: 216] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chest wall defects continue to present a complicated treatment scenario for thoracic and reconstructive surgeons. The purpose of this study is to report our 25-year experience with chest wall resections and reconstructions. METHODS A retrospective review of 200 patients who had chest wall resections from 1975 to 2000 was performed. RESULTS Patient demographics included tobacco abuse, hypertension, diabetes mellitus, alcohol abuse, coronary artery disease, chronic obstructive pulmonary disease, and human immunodeficiency virus. Surgical indications included lung cancer, breast cancer, chest wall tumors, and severe pectus deformities. Twenty-nine patients had radiation necrosis and 31 patients had lung or chest wall infections. The mean number of ribs resected was 4 +/- 2 ribs. Fifty-six patients underwent sternal resections. In addition 14 patients underwent forequarter amputations. Immediate closure was performed in 195 patients whereas delayed closure was performed in 5 patients. Primary repair without the use of reconstructive techniques was possible in 43 patients. Synthetic chest wall reconstruction was performed using Prolene mesh, Marlex mesh, methyl methacrylate sandwich, Vicryl mesh, and polytetrafluoroethylene. Flaps utilized for soft tissue coverage were free flap (17 patients) and pedicled flap (96 patients). Mean postoperative length of stay was 14 +/- 14 days. Mean intensive care unit stay was 5 +/- 9 days. In-hospital and 30-day survival was 93%. CONCLUSIONS Chest wall resection with reconstruction utilizing synthetic mesh or local muscle flaps can be performed as a safe, effective one-stage surgical procedure for a variety of major chest wall defects.
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Affiliation(s)
- Kamal A Mansour
- Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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29
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Balakrishnan C, Bradt LM, Sylora RL. Metastatic synovial sarcoma of the sternum: A case report and review of the literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2001. [DOI: 10.1177/229255030100900605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Synovial sarcomas and metastasis of sarcomas to the sternum are a rare occurrence. Due to the rarity of occurrence, a case of synovial sarcoma metastasizing to the sternum with reconstruction is reported.
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Affiliation(s)
| | - Lisa M Bradt
- Wayne State School of Medicine, Detroit, Michigan, USA
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30
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Nahabedian MY, Riley LH, Greene PS, Yang SC, Vander Kolk CA. Sternal stabilization using allograft fibula following cardiac transplantation. Plast Reconstr Surg 2001; 108:1284-8. [PMID: 11604633 DOI: 10.1097/00006534-200110000-00029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Y Nahabedian
- Division of Plastic and Reconstructive Surgery, the Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Kowalewski J, Brocki M, Dryjanski T, Zolyński K, Koktysz R. Pectus excavatum: increase of right ventricular systolic, diastolic, and stroke volumes after surgical repair. J Thorac Cardiovasc Surg 1999; 118:87-92; discussion 92-3. [PMID: 10384189 DOI: 10.1016/s0022-5223(99)70145-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study was undertaken to assess how a surgical correction of funnel chest modifies right ventricular structure and function. METHODS Before and 6 months after surgery in 42 patients (27 male and 15 female patients, aged 5-31 years), a pectus index was calculated and echocardiographic examinations of the right ventricle were performed, with calculation of systolic, diastolic, and stroke volume indices. Right ventricular volume was estimated by subtracting the left ventricular volume from that of the entire heart. The values of the right ventricular volumes and the pectus index before and after the operation, as well as the changes in the indices, were compared. RESULTS Statistically significant changes in the pectus index and the right ventricular volume indices after surgery were noted. No correlation was observed between the changes in the pectus index and the changes in any right ventricular volume indices. CONCLUSION Surgical treatment of funnel chest causes an increase in right ventricular systolic, diastolic, and stroke volumes, although there is no correlation between these changes and the degree of sternocostal elevation.
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Affiliation(s)
- J Kowalewski
- First Department of General Surgery, Department of Cardiology, Department of Orthopedic and Field Surgery, and Patomorphology, The Military Medical Academy, Lodz, Poland
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Abstract
Resection of the sternum can be performed safely and offers the best choice for cure for a primary sternal malignancy. Survival after resection is dependent on the histology and grade of the tumor.
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Affiliation(s)
- R J Downey
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Katoh N, Hatano Y, Sasamoto S, Shimatani S, Okuyama N, Takagi K, Yamazaki S, Ohsaki M, Sawaizumi M, Maruyama Y. [Resection and reconstruction of sternum]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:338-43. [PMID: 9619032 DOI: 10.1007/bf03217752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In case of sternal resection, it is necessary to preserve bone material indispensable for the stability of the anterior chest wall and air tightness of the thoracic cavity, and the support of the chest wall integrity must be restored by some means. Various techniques have been applied to the reconstruction of the chest wall following resection. During the last 10 years, we have performed reconstructive operation for 6 cases of the chest wall following resection of the sternum in recurrent cases of breast cancer or invaded case of primary breast cancer. In these patients, the chest wall was reconstructed using a rib-latissimus dorsi osteomyocutaneolus flap or a latissimus dorsi myocutaneous flap. The sternum was totally resected in 3 cases, and in all 3 cases, reconstructed using a rib-latissimus dorsi osteomyocutaneous flap. Although postoperative pulmonary function decreased, all cases could be relieved from endotracheal intubation within 17 hours after operation, and had no problems in activities of daily living or occurrence of chest flailing or paradoxical movement of the chest. An artificial material (expanded polytetrafluoroethlene patch) was used in only one patient for the reconstruction of the osseous thorax, but this case developed infection during postoperative chemotherapy. After this experience, we used only biological materials for the reconstruction of the chest wall and postoperatively performed radiotherapy and/or chemotherapy on all cases. We have observed no flap infection or detachment since then. One characteristic of using the latissimus dorsi myocutaneous flap is that it is easily elevated and rarely causes serious postoperative esthetic or functional problems. The flap is also easily utilized to reinforce the osseous thorax because ribs immediately below the latissimus dorsi muscle are readily mobilized as a pedicle graft. Reconstruction of the chest wall following resection of the sternum, described in this report, allowed us to perform radiotherapy and/or chemotherapy without serious postoperative complications on the cases relapsing after treatment of breast cancer. The 2-year survival rate is 50% and one of these cases survived up to 10 years after resection of the sternum. Thus we prefer to perform resection of the sternum for sternal recurrence of breast cancer if there are no metastatic lesions in other organs.
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Affiliation(s)
- N Katoh
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Toho University, Tokyo, Japan
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Abstract
OBJECTIVE Primary malignant tumours of the bony chest wall are uncommon and data concerning treatment and results are sparse. METHODS To assess the results of surgical resection and chest wall reconstruction we reviewed our experience with primary malignant chest wall tumours treated since 1958. RESULTS Of the 49 lesions, 42 were found in the ribs and the remaining 7 in the sternum. These included chondrosarcomas [22], solitary plasmacytoma [18], Ewing's tumours [7], Askin's tumour [1] and Desmoid tumour [1]. Skeletal reconstruction was performed in 36 of the 49 patients. Marlex mesh alone was used in 17 patients. Since 1972, a sandwich of two layers of Marlex mesh with a filler of methyl methacrylate was utilised [19] successfully, producing better functional and cosmetic results. Primary soft tissue closure was possible in all but 8 cases in whom latissimus dorsi myocutaneous flaps were used. Bilaterally, partially transposed pectoralis major muscle was used to cover upper sternal defects in 4 cases. All but 1 patient had an uneventful post-operative recovery none requiring ventilatory support. SURVIVAL Overall survival at 5 and 10 years was 68%. The differential figures for 10-year survival were for chondrosarcoma 67%, Ewing's sarcoma 43%, and solitary plasmacytoma 59%. These were the results of radical en-bloc excisions. The patient with Desmoid tumour is alive at 5 years, following incomplete initial resection and the patient with Askin's tumour survived for 3 years. CONCLUSION Radical en-bloc excision remains the treatment of choice in all primary malignant chest wall neoplasms except large solitary plasmacytomas where incisional biopsy followed by irradiation appears to be the method of preference. In Ewing's and Askin's tumours, additional chemotherapy and radiotherapy have to be used. The extent of surgical excision should only be limited by the amount of tissue necessary to remove for adequate malignant tissue clearance, since even large defects can be reconstructed with little functional disturbance.
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Affiliation(s)
- S Sabanathan
- Department of Thoracic Surgery, Bradford Royal Infirmary, UK
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35
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González Muñoz JI, Córdoba Peláez M, Tebar Boti E, Téllez Cantero JC, Castedo Mejuto E, Varela de Ugarte A. [Thoracic reconstruction with polytetrafluoroethylene prosthesis]. Arch Bronconeumol 1997; 33:27-30. [PMID: 9072129 DOI: 10.1016/s0300-2896(15)30674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thoracic wall resections are performed to treat a wide variety of conditions. Reconstruction techniques have varied considerably since the introduction of synthetic prosthesis, the most recent of which are made of polytetrafluoroethylene (PTFE, or Gore-Tex). We describe our department's experience with PTFE prosthesis. PTFE was used in 21 patients treated for various diseases. Thirteen reconstructions were of the thoracic wall, 4 were of the diaphragm and 4 of the pericardium. Three of the 13 thoracic wall reconstructions involved bilateral myoplasty of the pectoralis major, 2 involved omentoplasty and 1 required use of a wide musculocutaneous flap. Complications included pneumonia in 2 cases and 1 seroma with chronic cutaneous fistula that required removal of the prosthesis after 9 months. Two patients died, 1 after 19 days and the other after 9 months, both as a result of causes unrelated to reconstruction. Follow-up of these patients ranged from 3 to 54 months. We recommend the prosthetic use of PTFE for thoracic wall reconstruction, along with plasty or musculocutaneous flaps when necessary.
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Affiliation(s)
- J I González Muñoz
- Servicio de Cirugía Torácica y Cardiovascular, Clínica Puerta de Hierro, Madrid
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36
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Soysal O, Walsh GL, Nesbitt JC, McMurtrey MJ, Roth JA, Putnam JB. Resection of sternal tumors: extent, reconstruction, and survival. Ann Thorac Surg 1995; 60:1353-8; discussion 1358-9. [PMID: 8526626 DOI: 10.1016/0003-4975(95)00641-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Resection of sternal tumors may be tailored to the patient and the location of the malignancy. METHODS We reviewed our results of sternectomy (typically 5-cm margins) performed in 30 patients over a 10-year period. RESULTS Thirteen patients had primary sternal sarcoma (six chondrosarcoma, five osteosarcoma, two other); 10 patients had local recurrence from breast cancer; 4 patients had metastases; 3 patients had other (two osteoradionecrosis, one malignant fibrous histiocytoma). Morbidity occurred in 8 patients (26.7%): wound dehiscence, 2; wound infection, 1; hemorrhage, 1; pneumonia, 1; prolonged air leak, 1; empyema, 1; and bronchopleural fistula, 1. One patient, with multiple metastases, died from adult respiratory distress syndrome on day 25 (overall mortality, 3.3%; 1 of 30). The area of reconstruction ranged from 35 to 264 cm2. The technique of reconstruction included muscle flap alone in 13 patients; muscle flap and mesh, 9; muscle flap and rigid prosthesis (Marlex methylmethacrylate), 7; or other, 1 patient. Nineteen patients (63%) were extubated within 24 hours after operation. Median intensive care unit stay was 2 days; median hospitalization, 6 days. Late local recurrence after resection occurred in 6 patients; 4 from breast cancer (3 patients had concurrent distant metastases). Five-year actuarial survival after primary tumor resection was 73% and 33% after resection of recurrent breast cancer (median, 21 months). CONCLUSIONS Partial sternectomy may be performed for primary sternal tumors with short hospitalization and good local control. Wider local excision or total sternectomy may minimize local re-recurrence of breast carcinoma to the sternum.
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Affiliation(s)
- O Soysal
- Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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37
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Graves TA, Bland KI. Comorbidity Risk Parameters Associated with Advanced Breast Cancer and Systemic Disease. Surg Oncol Clin N Am 1995. [DOI: 10.1016/s1055-3207(18)30421-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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Abstract
Surgical treatment of cancer has many advantages over other treatment modalities. The principles of defining the goal of surgery, surgical planning, surgical technique, surgical margins, and patient aftercare are reviewed. Special attention is devoted to tumor seeding and obtaining adequate margins. Incorporation of biologic behavior and stage of disease into the surgical plan are paramount to the successful implementation of surgery in cancer treatment.
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Affiliation(s)
- M J Soderstrom
- Sonora Veterinary Surgery and Oncology, Scottsdale, Arizona, USA
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