Outcomes of Surgery for Chest Wall Sarcomas

Benign rib tumors: a case series from tertiary care Centre of Nepal and review of literature

Rib tumors are rare. They can present with wide varieties of symptoms and differentiating benign from malignant lesions is challenging. A careful history and supporting investigations can help to reach the definite diagnosis. Surgical resection is the treatment of choice with excellent prognosis. A total of four patients were operated for the management of rib tumors over a period of 5 years at our institution. All four were benign lesions and included simple bone cyst, fibrous dysplasia with aneurysmal bone cyst, aneurysmal bone cyst and enchondroma. There were three male and one female. None of them is having recurrence till now. Surgical resection is the treatment of choice for benign rib tumors as it provides diagnostic and curative treatment.

The accuracy and dosimetric analysis of 3D-printing non-coplanar template-assisted iodine-125 seed implantation for recurrent chest wall cancer

Purpose

To investigate the accuracy and dosimetry of 3D-printing non-coplanar template (3D-PNCT)-assisted computed tomography (CT)-guided iodine-125 seed implantation (¹²⁵I-SI) for recurrent chest wall cancer (rCWC).

Material and methods

This was a retrospective study of 19 patients with 22 rCWC treated with 3D-PNCT-assisted CT-guided ¹²⁵I-SI, from Mar 2017 to Mar 2020 in our institute.

Results

Mean needle entrance deviation was 4.50 ±2.70 mm, mean angular deviation was 3.40 ±3.10 degrees, and mean depth deviation was 5.20 ±5.20 mm. No significant difference was found for dosimetric parameters (except conformity index) between pre-plan and post-plan; D₉₀, D₁₀₀, V₁₀₀, V₁₅₀, and V₂₀₀ were 157.74 ±24.23 and 151.71 ±33.62 (p = 0.228), 85.36 ±34.09 and 70.46 ±23.48 (p = 0.067), 0.93 ±0.04 and 0.90 ±0.07 (p = 0.068), 0.64 ±0.16 and 0.64 ±0.16 (p = 0.984), and 0.35 ±0.17 and 0.37 ±0.18 (p = 0.382) for pre-plan and post-plan, respectively. Conformity index, external index, and homogeneity index were 0.57 ±0.16 and 0.52 ±0.15 (p = 0.007), 0.73 ±0.55 and 0.79 ±0.53 (p = 0.096), and 0.31 ±0.15 and 0.30 ±0.14 (p = 0.504) for pre-plan and post-plan, respectively. Median follow-up time was 8 months (range, 3-30 months). Complete response was observed in 4/22 (18.1%), partial response in 13/22 (59.1%), stable disease in 4/22 (18.1%), and progression disease in 1/22 (4.5%) of the cancers. Among patients with pain before ¹²⁵I-SI, pain relief rate was 87.5% (7/8). No peri-operative complications of more than grade 2 were observed.

Conclusions

3D-PNCT-assisted CT-guided ¹²⁵I-SI may be safe and feasible as palliative therapy for non-surgical candidates and painful patients with rCWC.

R0 resection and reconstruction for a large, rapidly progressive chest wall sarcoma

Background

Chest wall sarcomas are a rare group of soft tissue malignancies with variable presentations. Here we describe the definitive management of a large, rapidly progressing chest wall sarcoma arising from the pectoralis major muscle.

Case report

An obese 42-year-old African American male with multiple medical comorbidities presented with new onset right-sided chest pain and a palpable right chest mass. Initial CT chest demonstrated a 9x9x9cm necrotic mass arising from the pectoralis major. CT-guided core biopsy was positive for high-grade spindle cell neoplasm (positive for smooth muscle actin, desmin, S100, and CD31; negative for CD34, PAX8, and beta-catenin). Staging imaging 2 months later demonstrated growth of the mass to 21.4 × 17.8 × 13.7 cm. The patient underwent neoadjuvant chemoradiation with surveillance CT imaging demonstrating a stable tumor. Then he underwent wide local excision of the mass followed by delayed local myocutaneous flap reconstruction and skin grafting. Final pathology was R0 resection, 38x20x18 cm tumor with 70% gross necrosis. Microscopic examination confirmed high-grade sarcoma with smooth muscle differentiation. Final pathologic staging was Stage III G3 pT2bNxMx.

Conclusions

This patient presented with a rare, rapidly enlarging high-grade leiomyosarcoma of the chest wall without metastases or violation of the thorax. We describe the definitive management including a multidisciplinary team to manage a complex and rapidly progressive sarcoma of the chest wall.

Rib tumors: a 15-year experience

OBJECTIVE

A retrospective study of rib tumors was conducted to review their clinical, radiological, and pathological features, the difficulties in differentiating benign from malignant tumors, as well as the early and long-term results of surgical management.

METHODS

All patients with rib lesions evaluated by the Thoracic Surgery Department from 1998 to 2012 were studied. The patient's age, sex, symptoms, radiologic evaluation, surgical procedure, pathologic diagnosis and follow-up were assessed.

RESULTS

Ninety-one patients (81 male, 10 female, age range 16-80) with rib tumors underwent surgery in a period of 15 years (1998-2012). 64 patients (70.33 %) had benign lesions and 27 patients (29.67 %) had malignant tumors. In the group with malignant tumors, the main symptom was pain, and in the group with benign tumors the main symptom was swelling. Ten patients with benign rib tumor and two with malignant tumor were detected during routine chest radiograph. All patients were treated surgically with wide excision of the tumor and the diagnosis was established histologically. In the benign cohort, osteochondromas, fibrous dysplasia, enchondroma, eosinophilic granuloma and posttraumatic fibro-osseous lesion/dysplasia were among the most customary diagnoses. In the malignant cohort, 13 patients (48.15 %) had metastatic lesions, with the remaining 14 patients having primary malignant rib tumor.

CONCLUSIONS

Although radiographic imaging has evolved, all rib lesions must be considered as potentially malignant until proven otherwise. Prompt intervention is necessary and surgery must consist of wide resection with tumor-free margins to provide the best chance for cure in both benign and malignant lesions.