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Katkov D. Challenges in Diagnosing Pleural Thickening: Primary Pleural Follicular Lymphoma. Cureus 2024; 16:e63018. [PMID: 39050296 PMCID: PMC11267589 DOI: 10.7759/cureus.63018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
This is the case of a 66-year-old male with a medical history of HIV infection on combination antiretroviral therapy (cART) who presented to the hospital with gradually worsening chronic right-sided chest and abdominal pain over the past three months. Computed tomography (CT) with contrast showed new mass-like pleural thickening in the right lower lobe posteriorly with an associated small loculated right pleural effusion. A core needle pleural biopsy was performed, and the results were consistent with primary pleural malignant lymphoma. Histopathological and immunohistochemical examinations revealed CD10-positive, low-grade B-cell lymphoma. This case is considered a rare occurrence of primary malignant lymphoma developing in the pleura.
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Affiliation(s)
- Daniil Katkov
- Department of Internal Medicine, Waterbury Hospital, Yale-Waterbury Internal Medicine Residency Program, Waterbury, USA
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2
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Akbari M, Alter A, Kuenzler KA. Spindle cell sarcoma of the chest wall: a pediatric case report. J Surg Case Rep 2024; 2024:rjae431. [PMID: 38933828 PMCID: PMC11200180 DOI: 10.1093/jscr/rjae431] [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: 04/26/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Chest wall sarcomas are reported to be infrequent among thoracic tumors. The spindle cell subtype makes up a small percentage of this group. These tumors can be asymptomatic or cause symptoms of chest pain and shortness of breath due to the mass effect, which can lead to a delay in diagnosis. A 10-year-old female with a persistent cough, shortness of breath on exertion, and left-sided chest pain presented to the ED. Imaging indicated a chest wall mass filling the left hemithorax with a rightward mediastinal shift. During surgical resection, two tumors were removed, with resection of parts of the latissimus dorsi and serratus anterior. A diagnosis of MGA:NUTM1 spindle cell sarcoma was made pathologically. The patient was successfully treated with surgery and adjuvant chemoradiotherapy. We hope to add to our academic knowledge by presenting the presentation and treatment of SCS in a pediatric patient.
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Affiliation(s)
- Masoud Akbari
- Department of Pediatric General Surgery, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, United States
| | - Avram Alter
- Department of Clinical Education, Touro College of Osteopathic Medicine, 230 West 125th Street, New York, NY 10027, United States
| | - Keith A Kuenzler
- Department of Pediatric General Surgery, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, United States
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Sharma J, Deo SVS, Kumar S, Bhoriwal S, Gupta N, Saikia J, Bhatnagar S, Mishra S, Bharti S, Thulkar S, Bakhshi S, Sharma DN. Malignant Chest Wall Tumors: Complex Defects and Their Management-A Review of 181 Cases. Ann Surg Oncol 2024; 31:3675-3683. [PMID: 38153642 DOI: 10.1245/s10434-023-14765-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Chest wall tumors are a heterogeneous group of tumors that are managed by surgeons from diverse specialties. Due to their rarity, there is no consensus on their diagnosis and management. MATERIALS This retrospective, descriptive analysis includes patients with malignant chest wall tumors undergoing chest wall resection. Tumors were classified as primary, secondary, and metastatic tumors. The analysis includes clinicopathological characteristics, resection-reconstruction profile, and relapse patterns. RESULTS A total of 181 patients underwent chest wall resection between 1999 and 2020. In primary tumors (69%), the majority were soft tissue tumors (59%). In secondary tumors, the majority were from the breast (45%) and lung (42%). Twenty-five percent of patients received neoadjuvant chemotherapy, and 98% of patients underwent R0 resection. Soft tissue, skeletal + soft tissue, and extended resections were performed in 45%, 70%, and 28% of patients, respectively. The majority of patients (60%) underwent rib resections, and a median of 3.5 ribs were resected. The mean defect size was 24 cm2. Soft tissue reconstruction was performed in 40% of patients, mostly with latissimus dorsi flaps. Rigid reconstruction was performed in 57% of patients, and 18% underwent mesh-bone cement sandwich technique reconstruction. Adjuvant radiotherapy and chemotherapy were given to 29% and 39% of patients, respectively. CONCLUSIONS This is one of the largest single-institutional experiences on malignant chest wall tumors. The results highlight varied tumor spectra and multimodality approaches for optimal functional and survival outcomes. In limited resource setting, surgery, including reconstructive expertise, is very crucial.
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Affiliation(s)
- Jyoti Sharma
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Gupta
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoutishman Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Bharti
- Department of Onco-Anesthesia, Pain and Palliative Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Pikin OV, Ryabov AB, Alexandrov OA, Kolbanov KI, Rudenko MS, Topilin OG, Hayrapetyan MI, Chernusov VA. [Chest wall reconstruction with a non-rigid synthetic rib prosthesis: a multicenter study]. Khirurgiia (Mosk) 2024:41-51. [PMID: 39140942 DOI: 10.17116/hirurgia202408141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Chest wall resection is performed for a variety of diseases, for primary rib and soft tissue tumors, metastatic lesions, or locally invasive growth of lung and mediastinal tumors being the most common indications. Following the resection phase, it is essential to determine the method of chest wall reconstruction that will restore the structural function, preserve pulmonary biomechanics, reduce the likelihood of residual pleural space, pulmonary hernia, and protect intrathoracic organs. The main objective of this study is to investigate the outcomes of chest wall resection with reconstruction using Codubix material. MATERIAL AND METHODS This retrospective multicenter study included 22 patients who underwent chest wall tumor resection with subsequent Codubix rib endoprosthesis reconstruction from 2019 to 2023. Four medical institutions participated in the study: P.A. Herzen Moscow Cancer Research Institute, Sverdlovsk Regional Oncology Hospital, Morozov Children's City Clinical Hospital and Kaluga Regional Oncology Hospital. Inclusion criteria were the presence of chest wall tumors, both primary and secondary, removal of more than 2 ribs, resection of the rib arch and the sternum. RESULTS The median age was 60 years (48-66), 11 (50%) patients were females and 11 (50%) males. Operations for chest wall sarcoma, metastatic lesions, and lung cancer were performed in 9 (40.9%), 4 (18.2%), and 3 (13.6%) patients, respectively. The median number of removed ribs was 3 (2-4), with a maximum of 7. Sternotomy was performed in 9 (40.9%) patients, and subtotal resection of the body or handle of the sternum was carried out in 77.7%. Combined resections were performed in 14 (63.6%) patients. Radical tumor removal (R0) was achieved in 21 (95.5%) patients. Complications were observed in 9 (40.9%) patients, with intermuscular seroma being the most common in three (33.3%), followed by hydrothorax in 2 (22.2%), bilateral pneumonia, acute respiratory failure, and postoperative delirium in 1 (11.1%) patient each. One patient had the Codubix plate removed due to postoperative wound infection. The median overall and recurrence-free survival was not reached, and the 1-year recurrence-free survival was 63.9%, with an overall survival of 86.8%. CONCLUSION Reconstruction with Codubix material allows for satisfactory functional and cosmetic results, characterized by a low complication rate and good adaptive properties.
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Affiliation(s)
- O V Pikin
- Moscow Research Oncology Institute named after. P.A. Herzen - branch of the National Medical Research Center for Radiology, Moscow, Russia
| | - A B Ryabov
- Moscow Research Oncology Institute named after. P.A. Herzen - branch of the National Medical Research Center for Radiology, Moscow, Russia
| | - O A Alexandrov
- Moscow Research Oncology Institute named after. P.A. Herzen - branch of the National Medical Research Center for Radiology, Moscow, Russia
| | - K I Kolbanov
- Moscow Research Oncology Institute named after. P.A. Herzen - branch of the National Medical Research Center for Radiology, Moscow, Russia
| | - M S Rudenko
- Sverdlovsk Regional Oncology Dispensary, Yekaterinburg, Russia
| | - O G Topilin
- Morozov Children's City Clinical Hospital, Moscow, Russia
| | - M I Hayrapetyan
- First Moscow State Medical University named after. THEM. Sechenov, Moscow, Russia
| | - V A Chernusov
- Kaluga Regional Clinical Oncology Dispensary, Kaluga, Russia
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Yoshino R, Nakatsubo M, Ujiie N, Yoshida N, Yuzawa S, Kitada M. Primary Chondrosarcoma of the Right Fourth Rib Resected at the Marginal Margin: A Case Report. Cureus 2023; 15:e51251. [PMID: 38288168 PMCID: PMC10823202 DOI: 10.7759/cureus.51251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Primary chondrosarcoma of the ribs is relatively rare, and its basic treatment is surgical resection. In cases with positive resection margins, additional resection is considered, but its indications are unclear. However, reported cases with positive resection margins have been limited. We report a 71-year-old man whose medical checkup revealed an abnormal shadow in the chest. The findings from chest computed tomography, axial T2-weighted magnetic resonance imaging (MRI), and contrast-enhanced MRI led to a diagnosis of chondrosarcoma of the right fourth rib, and surgical resection was performed. The chest wall defect was reconstructed with a Marlex mesh. Postoperative histopathologic diagnosis was grade 2 chondrosarcoma. Gross resection margins, which were marginal, were negative, and the resection margin was grade 1. The patient was followed up without adjuvant therapy and did not undergo additional surgery. For chondrosarcomas with negative gross margins but a marginal margin, additional resection should be considered depending on the histologic grade of the margins. In cases with extensive resection of the chest wall, it is useful to reconstruct the chest wall while paying careful attention to infection control.
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Affiliation(s)
- Ryusei Yoshino
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masaki Nakatsubo
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nanami Ujiie
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nana Yoshida
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Sayaka Yuzawa
- Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masahiro Kitada
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
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Sarvan M, Etienne H, Bankel L, Brown ML, Schneiter D, Opitz I. Outcome Analysis of Treatment Modalities for Thoracic Sarcomas. Cancers (Basel) 2023; 15:5154. [PMID: 37958328 PMCID: PMC10649966 DOI: 10.3390/cancers15215154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Primary chest wall sarcomas are a rare and heterogeneous group of chest wall tumors that require multimodal oncologic and surgical therapy. The aim of this study was to review our experience regarding the surgical treatment of chest wall sarcomas, evaluating the short- and long-term results. METHODS In this retrospective single-center study, patients who underwent surgery for soft tissue and bone sarcoma of the chest wall between 1999 and 2018 were included. We analyzed the oncologic and surgical outcomes of chest wall resections and reconstructions, assessing overall and recurrence-free survival and the associated clinical factors. RESULTS In total, 44 patients underwent chest wall resection for primary chest wall sarcoma, of which 18 (41%) received surgery only, 10 (23%) received additional chemoradiotherapy, 7% (3) received surgery with chemotherapy, and 30% (13) received radiotherapy in addition to surgery. No perioperative mortality occurred. Five-year overall survival was 51.5% (CI 95%: 36.1-73.4%), and median overall survival was 1973 days (CI 95% 1461; -). As determined in the univariate analysis, the presence of metastasis upon admission and tumor grade were significantly associated with shorter survival (p = 0.037 and p < 0.01, respectively). Five-year recurrence-free survival was 71.5% (95% CI 57.6%; 88.7%). Tumor resection margins and metastatic disease upon diagnosis were significantly associated with recurrence-free survival (p < 0.01 and p < 0.01, respectively). CONCLUSION Surgical therapy is the cornerstone of the treatment of chest wall sarcomas and can be performed safely. Metastasis and high tumor grade have a negative influence on overall survival, while tumor margins and metastasis have a negative influence on local recurrence.
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Affiliation(s)
- Milos Sarvan
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Lorenz Bankel
- Department of Medical Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Michelle L. Brown
- Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (H.E.); (D.S.)
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Khamitov K, Dudek W, Arkudas A, Haj Khalaf M, Parjiea C, Higaze M, Horch RE, Sirbu H. Interdisciplinary Treatment of Malignant Chest Wall Tumors. J Pers Med 2023; 13:1405. [PMID: 37763172 PMCID: PMC10532685 DOI: 10.3390/jpm13091405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest wall resections for malignant chest wall tumors (MCWTs), particularly those with full-thickness chest wall involvement requiring reconstruction, present a therapeutic challenge for thoracic and plastic reconstructive surgeons. The purpose of this study was to review our experience with chest wall resection for primary and metastatic MCWTs, with a focus on perioperative outcomes and postoperative overall survival (OS). METHODS All patients who underwent surgical resection for primary and secondary MCWTs at our single institution between 2000 and 2019 were retrospectively analyzed. RESULTS A total of 42 patients (25 male, median age 60 years) operated upon with curative (n = 37, 88.1%) or palliative (n = 5, 11.9%) intent were reviewed. Some 33 (78%) MCWTs were of secondary origin. Chest wall reconstruction was required in 40 (95%) cases. A total of 13 (31%) patients had postoperative complications and one (2.3%) died perioperatively. The 5-year postoperative overall survival rate was 51.9%. The postoperative 5-year survival rate of 42.6% in patients with secondary MCWTs was significantly lower compared to the figure of 87.5% in patients with primary MCWTs. CONCLUSIONS In well-selected patients, chest wall resections for primary and secondary MCWTs are feasible and associated with good perioperative outcomes. For secondary MCWTs, surgery can also be performed with palliative intent.
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Affiliation(s)
- Koblandy Khamitov
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Wojciech Dudek
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Andreas Arkudas
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Mohamed Haj Khalaf
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Chirag Parjiea
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Mostafa Higaze
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
| | - Raymund E. Horch
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Plastic and Hand Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Horia Sirbu
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Thoracic Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054 Erlangen, Germany
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Lo Iacono G, Mazzella A, Mohamed S, Petrella F, Sedda G, Casiraghi M, Girelli L, Bertolaccini L, Spaggiari L. The Role of Surgery in Primary Chest Wall Tumors: Over 20 Years’ Experience in Resection and Reconstruction. Cancers (Basel) 2023; 15:cancers15072153. [PMID: 37046813 PMCID: PMC10093177 DOI: 10.3390/cancers15072153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Primary chest wall tumors comprise a heterogeneous group of neoplasms arising from soft tissues and bones. While surgical excision is the standard of care for benign tumors, the management of malignant tumors requires multimodal treatment. We conducted a predictive analysis of outcome, recurrence-free and overall survival. Methods: We retrospectively reviewed the clinical and pathological records of all patients treated in our center between 1998 and 2020. Results: 53 patients (15–85 years) were treated in our department. The average tumor diameter was 65 ± 35 mm (10–160 mm). Negative margins were obtained in 48 patients (90.6%), whereas in the remaining 5, R1 resection was accomplished. Median overall survival was 63,03 months (1–282 months). Overall survival was 90% at 1 year, 78% at 2 years, and 61% at 5 years. Our analysis identified tumor diameter, postoperative complications, and high grade of malignancy as factors that can influence prognosis. Conclusions: The treatment of primary chest wall tumors remains a very challenging process. Different histological types preclude definition of an unequivocal approach. Complete resection with healthy margins remains a definitive cornerstone in the treatment of these cancers as part of a more comprehensive approach.
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Affiliation(s)
- Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Lara Girelli
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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9
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Primary pleural lymphoma - A rare diagnosis. Pulmonology 2023; 29:94-96. [PMID: 36115824 DOI: 10.1016/j.pulmoe.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 01/28/2023] Open
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Chest-Wall Tumors and Surgical Techniques: State-of-the-Art and Our Institutional Experience. J Clin Med 2022; 11:jcm11195516. [PMID: 36233384 PMCID: PMC9573184 DOI: 10.3390/jcm11195516] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
The chest wall can be involved in both primary and secondary tumors, and even today, their management and treatment continue to be a challenge for surgeons. Primary chest-wall tumors are relatively rare and include a large group of neoplasms that can arise from not only bone or cartilage of the chest wall but also from associated subcutaneous tissue from muscle and blood vessels. Secondary tumors refer to a direct invasion of the chest wall by neoplasms located elsewhere in the body, mainly metastases from breast cancer and lung cancer. En-bloc surgical excision of the lesion should ensure adequate negative margins to avoid local recurrence, and a full thickness surgical resection is often required, and it can result in important chest-wall defects such as skeletal instability or impaired breathing dynamics. The reconstruction of large defects of the chest wall can be complex and often requires the use of prosthetic and biologic mesh materials. This article aims to review the literature on these tumor entities, focusing on the main surgical techniques and the most recent advances in chest-wall resection and reconstruction. We also report on the institutional experience our center.
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Tanaka M, Fujimoto D, Akamatsu H, Sumikawa H, Yamamoto N. Radiographic findings useful for diagnosis of primary chest wall lymphoma without preceding pleural disease: A case report. Respirol Case Rep 2022; 10:e01019. [PMID: 35992553 PMCID: PMC9379257 DOI: 10.1002/rcr2.1019] [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: 05/22/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
A 70-year-old man with no history of pleural diseases had a dumbbell-shaped chest wall mass extending from the thoracic cavity to the spinal canal at the intervertebral foramen without bone destruction. Computed tomography revealed a positive a 'pleural sandwich sign', where the intercostal artery was enveloped by the mass. A high maximum standard uptake value was noted on fluorodeoxyglucose-positron emission tomography. No lesions were found in areas other than the chest wall. CT-guided biopsy was performed and he was diagnosed with primary chest wall lymphoma. This case report suggests that these radiographic findings may be helpful for diagnosing chest wall lymphomas even in patients without prior pleural disease.
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Affiliation(s)
- Masanori Tanaka
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Daichi Fujimoto
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Hiroaki Akamatsu
- Internal Medicine III Wakayama Medical University Wakayama Japan
| | - Hiromitsu Sumikawa
- Department of Radiology National Hospital Organization Kinki-Chuo Chest Medical Center Osaka Japan
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Sonavane SN, Basu S. Chest Wall Mass as the Dominant Presentation of Low-Grade B-Cell Non-Hodgkin's Lymphoma: A Case Report. World J Nucl Med 2022; 21:169-172. [PMID: 35865162 PMCID: PMC9296237 DOI: 10.1055/s-0042-1750344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Low-grade B cell non-Hodgkin's lymphoma with dominant presentation of chest wall mass is presented in this report. The patient, a 65-year-old woman, presented with pain, rising skin temperature and redness, and swelling on the right lower chest wall. The histopathological examination revealed non-Hodgkin's lymphoma; the staging fluorodeoxyglucose-positron emission tomography/computed tomography demonstrated stage IVE disease, with hypermetabolic active disease in the right anterolateral chest wall in the form of large soft tissue mass and subcutaneous tissue with underlying bony erosion with extension into right anterior cardiophrenic space and superiorly up to right second costosternal region along the right internal mammary vessels. This was along with hypermetabolic active right axillary, right supraclavicular and left inguinal lymphadenopathy, and thickened hypermetabolic posterior right pleura with ametabolic right-sided pleural effusion. Bone marrow biopsy revealed uninvolved bone marrow. On follow-up after eight cycles of R-CHOP chemotherapy, the mass had completely resolved on contrast-enhanced computed tomography.
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Affiliation(s)
- Sunita Nitin Sonavane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Yamamoto S, Hirose M, Oyaizu T, Muramatsu A, Suzuki M, Ohta S. Leiomyosarcoma of the chest wall mimicking schwannoma resected by a video-assisted thoracoscopic approach: a case report. J Surg Case Rep 2022; 2022:rjab563. [PMID: 35070261 PMCID: PMC8776346 DOI: 10.1093/jscr/rjab563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 12/04/2022] Open
Abstract
Chest wall sarcomas account for <20% of all soft tissue sarcomas of which leiomyosarcomas represent only 1–4%. We report a case of thoracic leiomyosarcoma that resembled schwannoma in preoperative image studies. A 79-year-old man presented to our hospital with a chest wall tumor that increased in size over 3 months. Computed tomography of the chest revealed a 3-cm mass arising from the chest wall. Thoracic magnetic resonance imaging showed a solid tumor that was hypo-intense on T1-weighted imaging and iso-intense on T2-weighted imaging. Chest wall resection was performed using a video-assisted thoracoscopic approach after a frozen section examination revealed sarcoma. The histological diagnosis was leiomyosarcoma. Liver and multiple lung metastases were detected 5 years after surgery. Malignant tumors should be considered in any patient with chest wall tumors. The thoracoscopic approach could be an optimal treatment for chest wall tumor.
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Affiliation(s)
- Saki Yamamoto
- Correspondence address. Department of Thoracic Surgery, Shizuoka General Hospital, Shizuoka 420-8527, Japan. Tel: +81-54-247-6111; Fax: +81-54-247-6140; E-mail:
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14
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Wang L, Yan X, Zhao J, Chen C, Chen C, Chen J, Chen KN, Cao T, Chen MW, Duan H, Fan J, Fu J, Gao S, Guo H, Guo S, Guo W, Han Y, Jiang GN, Jiang H, Jiao WJ, Kang M, Leng X, Li HC, Li J, Li J, Li SM, Li S, Li Z, Li Z, Liang C, Mao NQ, Mei H, Sun D, Wang D, Wang L, Wang Q, Wang S, Wang T, Liu L, Xiao G, Xu S, Yang J, Ye T, Zhang G, Zhang L, Zhao G, Zhao J, Zhong WZ, Zhu Y, Hulsewé KWE, Vissers YLJ, de Loos ER, Jeong JY, Marulli G, Sandri A, Sziklavari Z, Vannucci J, Ampollini L, Ueda Y, Liu C, Bille A, Hamaji M, Aramini B, Inci I, Pompili C, Van Veer H, Fiorelli A, Sara R, Sarkaria IS, Davoli F, Kuroda H, Bölükbas S, Li XF, Huang L, Jiang T. Expert consensus on resection of chest wall tumors and chest wall reconstruction. Transl Lung Cancer Res 2022; 10:4057-4083. [PMID: 35004239 PMCID: PMC8674598 DOI: 10.21037/tlcr-21-935] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023]
Abstract
Chest wall tumors are a relatively uncommon disease in clinical practice. Most of the published studies about chest wall tumors are usually single-center retrospective studies, involving few patients. Therefore, evidences regarding clinical conclusions about chest wall tumors are lacking, and some controversial issues have still to be agreed upon. In January 2019, 73 experts in thoracic surgery, plastic surgery, science, and engineering jointly released the Chinese Expert Consensus on Chest Wall Tumor Resection and Chest Wall Reconstruction (2018 edition). After that, numerous experts put forward new perspectives on some academic issues in this version of the consensus, pointing out the necessity to further discuss the points of contention. Thus, we conducted a survey through the administration of a questionnaire among 85 experts in the world. Consensus has been reached on some major points as follows. (I) Wide excision should be performed for desmoid tumor (DT) of chest wall. After excluding the distant metastasis by multi-disciplinary team, solitary sternal plasmacytoma can be treated with extensive resection and adjuvant radiotherapy. (II) Wide excision with above 2 cm margin distance should be attempted to obtain R0 resection margin for chest wall tumor unless the tumor involves vital organs or structures, including the great vessels, heart, trachea, joints, and spine. (III) For patients with chest wall tumors undergoing unplanned excision (UE) for the first time, it is necessary to carry out wide excision as soon as possible within 1–3 months following the previous surgery. (IV) Current Tumor Node Metastasis staging criteria (American Joint Committee on Cancer) of bone tumor and soft tissue sarcoma are not suitable for chest wall sarcomas. (V) It is necessary to use rigid implants for chest wall reconstruction once the maximum diameter of the chest wall defect exceeds 5 cm in adults and adolescents. (VI) For non-small cell lung cancer (NSCLC) invading the chest wall, wide excision with neoadjuvant and/or adjuvant therapy are recommended for patients with stage T3-4N0-1M0. As clear guidelines are lacking, these consensus statements on controversial issues on chest wall tumors and resection could possibly serve as further guidance in clinical practice during the upcoming years.
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Affiliation(s)
- Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Tiesheng Cao
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Ming-Wu Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongbin Duan
- Department of Thoracic Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junke Fu
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Wei Guo
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Ge-Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophageal Surgery, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wen-Jie Jiao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - He-Cheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Li
- Department of Plastic and Burn Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing, China
| | - Shao-Min Li
- Department of Thoracic Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuben Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongcheng Li
- Department of Thoracic and Cadiovascular Surgery, Affiliated Hospital of Qinghai University, Xining, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Nai-Quan Mao
- Department of Thoracic Surgery, Tumor Hospital Affiliated to Guangxi Medical University, Nanning, China
| | - Hong Mei
- Department of Thoracic Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Dong Wang
- Department of Cardiothoracic Surgery, Affiliated Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang, China
| | - Tianhu Wang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gaoming Xiao
- Department of Thoracic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Shidong Xu
- Department of Thoracic Surgery and Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jinliang Yang
- Department of Thoracic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Ye
- Department of Thoracic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guofang Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital (Ningbo No. 2 Hospital), University of Chinese Academy of Sciences, Ningbo, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Zhao Zhong
- Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jin Yong Jeong
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Giuseppe Marulli
- Department of Emergency and Organ Transplantation, Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Alberto Sandri
- Thoracic Surgery Division, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano (To), Italy
| | - Zsolt Sziklavari
- Department of Thoracic Surgery, Klinikum Coburg, Coburg, Germany.,Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Yuichiro Ueda
- Department of General Thoracic, Breast and Pediatric Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, UK
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital, Raemistrasse, Zurich, Switzerland
| | | | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ricciardi Sara
- Division of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Inderpal S Sarkaria
- Department of Thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Servet Bölükbas
- Department of Thoracic Surgery, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Xiao-Fei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lijun Huang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Tao Jiang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
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A rare giant sarcoma of the chest wall: Undifferentiated pleomorphic sarcoma. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:552-555. [PMID: 35096456 PMCID: PMC8762898 DOI: 10.5606/tgkdc.dergisi.2021.20061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
Undifferentiated pleomorphic sarcoma or, as formerly called, malignant fibrous histiocytoma is a type of sarcoma which originates from fibroblast and histiocytic cells. It is the most common type of sarcoma among all soft tissue sarcomas in adults. Its most common site is the lower limb, followed by the upper limb and the retroperitoneum. It is rarely encountered on chest wall. In the differential diagnosis of masses on chest wall, it is important to consider undifferentiated pleomorphic sarcoma in surgical planning. In this article, we report a male case with a giant undifferentiated pleomorphic sarcoma located above the right scapula.
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Schirren M, Jefferies B, Safi S, Wörtler K, Hoffmann H. [Surgical treatment of chest wall tumors]. Chirurg 2021; 93:623-632. [PMID: 34636942 DOI: 10.1007/s00104-021-01499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
The term chest wall tumor summarizes a heterogeneous group of malignant and benign tumors, whereby primary and secondary chest wall tumors are differentiated. The incidence of secondary chest wall tumors is higher than that of primary tumors. Primary chest wall tumors can arise from any anatomic structure of the chest wall. Surgical resection is usually the treatment of choice. Resection status and tumor differentiation are relevant prognostic factors. Treatment of secondary chest wall tumors is performed depending on the patient's symptoms and prognosis of the underlying disease. Lung carcinomas infiltrating the chest wall can be resected primarily or secondarily as part of multimodal therapeutic strategies. Anatomic lung resections combined with chest wall resection have a higher mortality than standard resections. Chest wall reconstruction after resection has the goal of reducing paradoxical respiratory motion, although not every chest wall defect requires reconstruction.
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Affiliation(s)
- Moritz Schirren
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - Benedikt Jefferies
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Seyer Safi
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Klaus Wörtler
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Hans Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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17
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"Multimodality imaging of the extrapleural space lesions". Clin Imaging 2021; 79:64-84. [PMID: 33892397 DOI: 10.1016/j.clinimag.2021.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.
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18
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Abstract
Reconstruction of soft tissue defects following tumor ablation procedures in the trunk and extremities can challenge the microsurgeon. The goal is not just to provide adequate soft tissue coverage but also to restore form and function and minimize donor site morbidity. Although the principles of the reconstructive ladder still apply in the trunk and extremities, free tissue transfer is used in many cases to optimally restore form and function. Microsurgery has changed the practice in soft tissue tumors, and amputation is less frequently necessary.
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Prisciandaro E, Hustache-Castaing R, Michot A, Jougon J, Thumerel M. Chest wall resection and reconstruction for primary and metastatic sarcomas: an 11-year retrospective cohort study. Interact Cardiovasc Thorac Surg 2021; 32:744-752. [PMID: 33532842 DOI: 10.1093/icvts/ivab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chest wall sarcomas are rare, aggressive malignancies, the management of which mainly revolves around surgery. Radical tumour excision with free margins represents the optimal treatment for loco-regional clinically resectable disease. The objective of this study was to review our 11-year experience with chest wall resection for primary and metastatic sarcomas, focusing on surgical techniques and strategies for reconstruction. METHODS Retrospective analysis of a comprehensive database of patients who underwent chest wall resection for primary or secondary sarcoma at our Institute from January 2009 to December 2019. RESULTS Out of 26 patients, 21 (81%) suffered from primary chest wall sarcoma, while 5 (19%) had recurring disease. The median number of resected ribs was 3. Sternal resection was performed in 6 cases (23%). Prosthetic thoracic reconstruction was deemed necessary in 24 cases (92%). Tumour recurrence was observed in 15 patients (58%). The median overall survival was 73.6 months. Primary and secondary tumours showed comparable survival (P = 0.49). At univariate analysis, disease recurrence and infiltrated margins on pathological specimens were associated with poorer survival (P = 0.014 and 0.022, respectively). In patients with primary sarcoma, the median progression-free survival was 13.3 months. Associated visceral resections were significantly associated to postoperative complications (P = 0.02). CONCLUSIONS Chest wall resection followed by prosthetic reconstruction is feasible in carefully selected patients and should be performed by experienced surgeons with the aim of achieving free resection margins, resulting in improved long-term outcomes.
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Affiliation(s)
- Elena Prisciandaro
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Romain Hustache-Castaing
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Audrey Michot
- Division of Surgery, Bergonié Institute, Bordeaux, France
| | - Jacques Jougon
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Matthieu Thumerel
- Division of Thoracic Surgery, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,Université de Bordeaux, Bordeaux, France
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20
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Alam NZ. Surgical Management of Chest Wall Sarcomas. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Abstract
Chest wall sarcoma is a rare and challenging pathology best managed by a multidisciplinary team experienced in the management of a multiple different pathologies. Knowledge of the management sequence is important for each sarcoma type in order to provide optimal treatment. Surgical resection of chest wall resections remains the primary treatment of disease isolated to the chest wall. Optimal margins of resection and reconstruction techniques have yet to be determined.
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Abstract
Chondrosarcoma is a unique kind of tumor that originates from the cartilage-producing neoplastic mesenchymal cells and appears in both the appendicular and atlantoaxial skeleton. It is the second most prevalent neoplastic bone tumor, with an occurrence of 0.79/100,000/year. The biological presentation of this cancer fluctuates extensively, depending on the grade and anatomical location. Since chondrosarcoma is predominantly resistant to conventional chemo- and radiation therapy, surgical resection remains the sole curative treatment, although at present new treatment modalities are under investigation.
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Affiliation(s)
- Muhammad Tahir
- Pathology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jawaria Rahman
- Pathology, City of Hope, Comprehensive Cancer Center, Monrovia, USA
| | - Hassan Arekemase
- Anatomical and Clinical Pathology, Saint Barnabas Medical Center, Livingston, USA
| | | | - Abdul Basit
- Internal Medicine, Coney Island Hospital, Brooklyn, USA
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Shah AC, Komperda KW, Mavanur AA, Thorpe SW, Weiss KR, Goodman MA. Overall survival and tumor recurrence after surgical resection for primary malignant chest wall tumors: a single-center, single-surgeon experience. J Orthop Surg (Hong Kong) 2020; 27:2309499019838296. [PMID: 30939982 DOI: 10.1177/2309499019838296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Malignant primary chest wall tumors (PCWTs) comprise a rare group of thoracic tumors with unique anatomical considerations, and experience with wide surgical resection is limited to specialty referral centers and specific diagnoses. We investigated the tumor recurrence and overall survival (OS) for patients with a variety of PCWTs diagnoses at our institution. METHODS From 1991 to 2010, patients with malignant PCWT undergoing wide surgical resection for curative intent under a single surgeon were reviewed. Diagnosis and grade (if applicable) of surgical pathology, along with patient demographics, neoadjuvant chemotherapy or radiation therapy, and outcomes (complications, recurrence, and OS) at follow-up were analyzed. RESULTS One hundred fifteen patients were included in the study. The most common tumor diagnoses included pleomorphic sarcoma and liposarcoma. Negative margins were achieved in 70 (74%) of cases. Postoperative complications were reported in 21 (20%) cases. The 5-year survival rate was 54%, while the 10-year survival rate was 29%. The local and distant recurrence rates were 50% and 38%, respectively. OS was significantly less in patients with any recurrence ( p < 0.001) but not significantly different between pathology grades ( p = 0.28). CONCLUSIONS Wide resection for malignant PCWT is feasible when undertaken for a heterogenous group of diagnoses.
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Affiliation(s)
- Aalap C Shah
- 1 Department of Anesthesiology, Perioperative and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kazimierz W Komperda
- 2 Department of Orthopedic Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Arun A Mavanur
- 3 Department of Surgical Oncology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Steven W Thorpe
- 4 Department of Orthopaedic Surgery and Musculoskeletal Oncology, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Kurt R Weiss
- 5 Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mark A Goodman
- 6 Department of Orthopedic Surgery and Musculoskeletal Oncology, University of Pittsburgh Medical Center and Hillman Cancer Institute, Pittsburgh, PA, USA
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24
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Binh NH, Bang HT, Hung NQ, Tien TQ. Chest wall reconstruction using a titanium plate sandwiched between two prolene meshes for large chest wall tumours: A single-centre case series study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Sandri A, Donati G, Blanc CD, Nigra VA, Gagliasso M, Barmasse R. Anterior chest wall resection and sternal body wedge for primary chest wall tumour: reconstruction technique with biological meshes and titanium plates. J Thorac Dis 2020; 12:17-21. [PMID: 32055419 DOI: 10.21037/jtd.2019.06.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chest wall tumours are heterogeneous neoplasms, either primary or metastatic, with a malignancy rate of 50%. Surgical resection is one of the mainstays of the treatment, however, chest wall resections can be particularly challenging depending onto the resection size, site and patient habitus. The surgical strategy should be carefully analysed preoperatively, keeping in mind the need of an oncological radical resection (R0) in accordance to the reconstruction principles elicited by le Roux and Sherma since 1983, which include restoring the chest wall rigidity, preserving pulmonary mechanics, protect the intrathoracic organs, avoiding paradox movements of the chest cavity and, possibly, to reduce the thoracic deformity. In this context, we herewith report our surgical reconstruction technique following an anterior chest wall resection and sternal body wedge for a primary chest wall tumour (chondrosarcoma).
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Affiliation(s)
- Alberto Sandri
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | - Victor Auguste Nigra
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Matteo Gagliasso
- Unit of Thoracic Surgery, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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26
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Adjuvant Radiation Therapy for Thoracic Soft Tissue Sarcomas: A Population-Based Analysis. Ann Thorac Surg 2020; 109:203-210. [DOI: 10.1016/j.athoracsur.2019.07.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/29/2019] [Accepted: 07/23/2019] [Indexed: 11/20/2022]
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27
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Park I, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Primary Chest Wall Sarcoma: Surgical Outcomes and Prognostic Factors. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:360-367. [PMID: 31624714 PMCID: PMC6785165 DOI: 10.5090/kjtcs.2019.52.5.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
Abstract
Background Primary chest wall sarcoma is a rare disease with limited reports of surgical resection. Methods This retrospective review included 41 patients with primary chest wall sarcoma who underwent chest wall resection and reconstruction from 2001 to 2015. The clinical, histologic, and surgical variables were collected and analyzed by univariate and multivariate Cox regression analyses for overall survival (OS) and recurrence-free survival (RFS). Results The OS rates at 5 and 10 years were 73% and 61%, respectively. The RFS rate at 10 years was 57.1%. Multivariate Cox regression analysis revealed old age (hazard ratio [HR], 5.16; 95% confidence interval [CI], 1.71–15.48) as a significant risk factor for death. A surgical resection margin distance of less than 1.5 cm (HR, 15.759; 95% CI, 1.78–139.46) and histologic grade III (HR, 28.36; 95% CI, 2.76–290.87) were independent risk factors for recurrence. Conclusion Long-term OS and RFS after the surgical resection of primary chest wall sarcoma were clinically acceptable.
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Affiliation(s)
- Ilkun Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gao H, Zhou Y, Wang Z, Zhao R, Qian S. Clinical features and prognostic analysis of patients with chest wall chondrosarcoma. Medicine (Baltimore) 2019; 98:e17025. [PMID: 31490388 PMCID: PMC6738982 DOI: 10.1097/md.0000000000017025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chest wall chondrosarcoma is a rare malignant tumor of the bone. This study is aimed to identify the prognostic determinants of chest wall chondrosarcoma. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with chest wall chondrosarcoma from 1973 to 2015. Statistical analyses were performed using Kaplan-Meier method and Cox regression proportional hazards. A total of 779 patients were identified from the SEER database. The overall survival (OS) and cancer-specific survival (CSS) rates of the entire group at 10 years were 66.2% and 77.2%, respectively. On multivariate Cox regression, age ≤40 years, localized tumor stage, low tumor grade, surgery, and no radiotherapy were significantly associated with improved both OS and CSS. This study may help clinicians to predict survival of patients with chest wall chondrosarcoma and to provide appropriate treatment recommendations.
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Affiliation(s)
- Hongliang Gao
- Department of Orthopaedics, Huzhou Central Hospital, Huzhou
| | - Yuanxi Zhou
- Department of Orthopaedics, Health Community Group of Yuhuan Second People's Hospital, Taizhou
| | - Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Renbo Zhao
- Department of Orthopaedics, Taizhou Tumor Hospital, Wenling, China
| | - Shengjun Qian
- Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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Sternectomy for Treating Advanced Non-Melanoma Skin Cancer. J Skin Cancer 2019; 2019:3948782. [PMID: 31275656 PMCID: PMC6582790 DOI: 10.1155/2019/3948782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Skin cancer is a rare indication of sternectomy. Our goal is to report the clinical course of seven patients who underwent sternectomy for skin cancer. Methods The survey data were collected from medical records of patients treated between 2008 and 2018 at Ceará Cancer Institute. Results All patients had prolonged sunlight exposure and average disease time of two years and age of 60 years. Most patients recovered favorably after treatment with prolonged survival. Conclusion Sternectomy remains an option with curative purposes for locally advanced skin cancer.
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Yoon SH, Jung JC, Park IK, Park S, Kang CH, Kim YT. Clinical Outcomes of Surgical Treatment for Primary Chest Wall Soft Tissue Sarcoma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:148-154. [PMID: 31236374 PMCID: PMC6559192 DOI: 10.5090/kjtcs.2019.52.3.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/16/2022]
Abstract
Background This study investigated the clinical outcomes of surgical treatment of primary chest wall soft tissue sarcoma (CW-STS). Methods Thirty-one patients who underwent surgery for CW-STS between 2000 and 2015 were retrospectively reviewed. The disease-free and overall survival rates were estimated using the Kaplan-Meier method, and prognostic factors were analyzed using a Cox proportional hazards model. Results The median follow-up duration was 65.6 months. The most common histologic type of tumor was malignant fibrous histiocytoma (29%). The resection extended to the soft tissue in 14 patients, while it reached full thickness in 17 patients. Complete resection was achieved in 27 patients (87.1%). There were 5 cases of local recurrence, 3 cases of distant metastasis, and 5 cases of combined recurrence. The 5-year disease-free rate was 49%. Univariate analysis indicated that incomplete resection (p<0.001) and stage (p=0.062) were possible risk factors for recurrence. Multivariate analysis determined that incomplete resection (p=0.013) and stage (p=0.05) were significantly associated with recurrence. The overall 5- and 10-year survival rates were 86.8% and 64.3%, respectively. No prognostic factor for survival was identified. Conclusion Long-term primary CW-STS surgery outcomes were found to be favorable. Incomplete microscopic resection and stage were risk factors for recurrence.
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Affiliation(s)
- Seung Hwan Yoon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Shin JW, Chang YJ, Cho DG, Choi SY. Long-Term Survival after Wide Resection of Malignant Fibrous Histiocytoma of the Chest Wall. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:36-39. [PMID: 30834216 PMCID: PMC6383847 DOI: 10.5090/kjtcs.2019.52.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 11/20/2022]
Abstract
Primary malignant fibrous histiocytoma (MFH) of the chest wall is extremely rare and is characterized by aggressive features, including a high incidence of local recurrence and distant metastasis. Surgical resection of the chest wall is the primary modality of management. However, surgical treatment is not generally recommended in patients with evidence of distant metastasis. Here, we present a case of chest wall MFH along with a schwannoma mimicking distant metastasis in the right upper arm. The patient was treated by radical en bloc resection and survived for more than 9 years without recurrence.
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Affiliation(s)
- Jin Won Shin
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Yong Jin Chang
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Si Young Choi
- Department of Thoracic and Cardiovascular Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea
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Ben Saad A, Fahem N, Khemakhem R, Abdeljelil NB, Migaou A, Njima M, Mhamed SC, Joobeur S, Rouatbi N. Rare case of primary extranodal marginal zone lymphoma of the thorax. Respir Med Case Rep 2019; 26:251-254. [PMID: 30788210 PMCID: PMC6369120 DOI: 10.1016/j.rmcr.2019.02.006] [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: 01/14/2019] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/26/2022] Open
Abstract
Primary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.
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Affiliation(s)
- Ahmed Ben Saad
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Nesrine Fahem
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Rim Khemakhem
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Asma Migaou
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Samah Joobeur
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Naceur Rouatbi
- Pulmonology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
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Abstract
RATIONALE Primary diffuse large B-cell lymphoma of the chest wall is extremely rare. A majority of the pleural lymphomas develop in patients with chronic tuberculous pyothorax. The underlying mechanism might be attributed to the sustained stimulation of chronic inflammation. Surgery followed by adjuvant chemotherapy can improve the outcome in some patients with lymphoma localized only in the chest wall. Thus, an early diagnosis of pyothorax-associated lymphoma is essential as it is a malignant, life-threatening condition. PATIENT CONCERNS A 79-year-old male complained of left-side chest pain for more than 2 months, which was not alleviated with nitrates and aspirin. The patient presented an intermittent low fever, anorexia, and marasmus, accompanied by tuberculosis 40 years ago and chronic left-side pyothorax. Also, ANCA (antineutrophil cytoplasmic autoantibody)-associated vasculitis occurred for >3years. DIAGNOSIS Computed tomography scan showed a solid mass in the left lateral chest wall. The patient underwent ultrasonic-guided biopsy of the lesion. A diagnosis of primary diffuse large B-cell lymphoma of the chest wall was established after histological examination. INTERVENTION Due to advanced age and poor physical condition, the patient received CHOP chemotherapy at a reduced dose. OUTCOMES The patient died 5 days after the first cycle of chemotherapy with severe dyspnea and high fever. LESSONS The chronic inflammation stimulation might result in the development of lymphoma in the chest wall of patients with long-term pyothorax, vasculitis, or other autoimmune diseases associated with malignancies. The fever, chest pain, or other nonspecific clinical symptoms in these patients should be under intensive focus as it might indicate the development of malignant lymphoma. Thus, histological examination in these patients is essential for accurate early diagnosis.
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Affiliation(s)
- Qianwen Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
- Department of Respiratory, Weihai Municipal Hospital, Weihai
| | - Yuanrong Ju
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | - Tao Qu
- Department of Respiratory, Weihai Municipal Hospital, Weihai
| | - Tao Wang
- Shandong Medical Imaging Research Institute Affiliated to Shandong University, Jinan
| | - Xiaoqin Liu
- Department of Pathology, Weihai Municipal Hospital, Weihai, Shandong, China
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Shewale JB, Mitchell KG, Nelson DB, Conley AP, Rice DC, Antonoff MB, Hofstetter WL, Walsh GL, Swisher SG, Roth JA, Mehran RJ, Vaporciyan AA, Weissferdt A, Sepesi B. Predictors of survival after resection of primary sarcomas of the chest wall-A large, single-institution series. J Surg Oncol 2018; 118:518-524. [PMID: 30109699 DOI: 10.1002/jso.25162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Chest wall sarcomas are rare and may demonstrate heterogeneous features. Surgery remains the mainstay of treatment with chemotherapy and radiotherapy used as adjuncts. Herein, we report outcomes of a large cohort of patients with primary chest wall sarcoma who underwent resection. METHODS Records of 121 patients who underwent resection for primary chest wall sarcoma between 1998 and 2013 were reviewed. A thoracic pathologist reexamined all tumors and categorized them according to grade. Univariable and multivariable Cox analyses were conducted to identify predictors of overall survival (OS). RESULTS The median age was 45.0 (range, 11-81) years, and most tumors (63.6%, 77) were high grade. The median tumor size was 7 cm (range, 1-21 cm). Fifty-nine (48.8%) patients received neoadjuvant chemotherapy and 12 (9.9%) received neoadjuvant radiotherapy. A complete resection was achieved in 103 (85.1%) patients. Neoadjuvant chemotherapy (P = 0.532) and radiation ( P = 1.000) were not associated with a complete resection. Five-year OS among patients undergoing R0 and R1 resections was 61.9% and 27.8%, respectively. Multivariable analysis identified high grade (HR, 15.21; CI, 3.57-64.87; P < 0.001), R1 (HR, 3.10; CI, 1.40-6.86; P = 0.005), R2 resection (HR, 5.18; CI, 1.91-14.01; P = 0.001), and age (HR, 1.02; CI, 1.01-1.03; P = 0.002) as predictors of OS. CONCLUSIONS In this series of resected chest wall sarcomas, complete resection and tumor grade remain the most important survival predictors. Individual decisions are required for the utilization of neoadjuvant therapy.
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Affiliation(s)
- Jitesh B Shewale
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center (UTHealth) School of Public Health, Houston, Texas
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David B Nelson
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Nakayama S, Matsuda M, Adachi T, Sueda S, Ueda K, Kawahara K, Ohashi Y, Awaji S, Hashimoto S, Matsumura I. Tumor necrosis factor- and interleukin-6-producing high-grade B-cell lymphoma, not otherwise specified in the pleura. Leuk Res Rep 2018; 10:1-3. [PMID: 29998057 PMCID: PMC6037664 DOI: 10.1016/j.lrr.2018.06.001] [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] [Received: 04/28/2018] [Revised: 06/01/2018] [Accepted: 06/14/2018] [Indexed: 12/01/2022] Open
Abstract
A 65-year-old man was admitted to our hospital with left-sided chest and back pain and dyspnea. Computed tomography demonstrated a marked circumferential left pleural thickening. A thoracoscopic pleural biopsy led to a diagnosis of high-grade B-cell lymphoma, not otherwise specified (HGBL, NOS). Lymphoma cells were positive for tumor necrosis factor (TNF) and interleukin-6. This is the first case report of TNF- and IL-6-producing aggressive HGBL, NOS in the pleura, in which radiological findings mimicked pleural mesothelioma. The aggressive tumor progression in the present case may have been caused by abnormal cytokine production from lymphoma cells.
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Affiliation(s)
- Shoko Nakayama
- Department of Hematology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Mitsuhiro Matsuda
- Department of Hematology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Tatsuya Adachi
- Department of Hematology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Sanae Sueda
- Department of Hematology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Kayo Ueda
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Osaka 583-8588, Japan
| | - Kunimitsu Kawahara
- Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Osaka 583-8588, Japan
| | - Yuka Ohashi
- Department of Pathology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Sumie Awaji
- Department of Pathology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Shigeo Hashimoto
- Department of Pathology, PL General Hospital, 2204, Shindo, Tondabayashi City, Osaka 584-8585, Japan
| | - Itaru Matsumura
- Division of Hematology and Rheumatology, Kinki University Faculty of Medicine, 377-2, Ono-Higashi, Osakasayama City, Osaka 589-8511, Japan
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37
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Cipriano A, Burfeind W. Management of Primary Soft Tissue Tumors of the Chest Wall. Thorac Surg Clin 2017; 27:139-147. [DOI: 10.1016/j.thorsurg.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Hussain ON, Sabbagh MD, Carlsen BT. Complex Microsurgical Reconstruction After Tumor Resection in the Trunk and Extremities. Clin Plast Surg 2017; 44:299-311. [PMID: 28340664 DOI: 10.1016/j.cps.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstruction of soft tissue defects following tumor ablation procedures in the trunk and extremities can challenge the microsurgeon. The goal is not just to provide adequate soft tissue coverage but also to restore form and function and minimize donor site morbidity. Although the principles of the reconstructive ladder still apply in the trunk and extremities, free tissue transfer is used in many cases to optimally restore form and function. Microsurgery has changed the practice in soft tissue tumors, and amputation is less frequently necessary.
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Affiliation(s)
- Omar N Hussain
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - M Diya Sabbagh
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
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39
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Shenoy R, Dewan RK, Saxena R, Ganapathi A. Giant cell tumor of rib presenting as intra-thoracic mass: a rare case report. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Mini review: surgical management of primary chest wall tumors. Gen Thorac Cardiovasc Surg 2016; 64:707-714. [PMID: 27778223 DOI: 10.1007/s11748-016-0719-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Primary chest wall tumors (PCWTs) are relatively rare entities, and their clinical characteristics as well as appropriate treatments are not fully known. Previously reported studies, including ours, are reviewed here, taking into account the clinical approach and findings in Japan for the diagnosis, distribution of histological types, surgical procedures, and prognosis of these entities. Surgery for PCWTs comprised that approximately 0.7 % of surgeries in 2012 in Japan and 28.3 % of PCWTs were malignant with an extremely low rate of mortality within 30 days from surgery. Surgical biopsy is recommended for the differential diagnosis of chest wall tumors to determine if they are primary, metastatic, benign, or malignant lesions. Of the 297 PCWT cases reported in nine published studies, neurogenic tumors were the most common benign PCWT, and chondrosarcoma was the most common malignant PCWT. Reconstruction of the resected chest wall was performed for 41.3 % of cases, and the materials used were e-PTFE or polypropylene. The prognosis of patients with benign tumors is usually good if complete resection is achieved; however, the 5-year recurrence rate and disease-related mortality were approximately 22.5 and 18.1 %, respectively, for patients with malignant tumors. Surgery for PCWTs is safe; however, surgical treatment for patients with malignant PCWTs remains challenging, and multimodal treatments for each histological tumor type should be considered.
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41
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Carter BW, Benveniste MF, Betancourt SL, de Groot PM, Lichtenberger JP, Amini B, Abbott GF. Imaging Evaluation of Malignant Chest Wall Neoplasms. Radiographics 2016; 36:1285-306. [PMID: 27494286 DOI: 10.1148/rg.2016150208] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neoplasms of the chest wall are uncommon lesions that represent approximately 5% of all thoracic malignancies. These tumors comprise a heterogeneous group of neoplasms that may arise from osseous structures or soft tissues, and they may be malignant or benign. More than 50% of chest wall neoplasms are malignancies and include tumors that may arise as primary malignancies or secondarily involve the chest wall by way of direct invasion or metastasis from intrathoracic or extrathoracic neoplasms. Although 20% of chest wall tumors may be detected at chest radiography, chest wall malignancies are best evaluated with cross-sectional imaging, principally multidetector computed tomography (CT) and magnetic resonance (MR) imaging, each of which has distinct strengths and limitations. Multidetector CT is optimal for depicting bone, muscle, and vascular structures, whereas MR imaging renders superior soft-tissue contrast and spatial resolution and is better for delineating the full extent of disease. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is not routinely performed to evaluate chest wall malignancies. The primary functions of PET/CT in this setting include staging of disease, evaluation of treatment response, and detection of recurrent disease. Ultrasonography has a limited role in the evaluation and characterization of superficial chest wall lesions; however, it can be used to guide biopsy and has been shown to depict chest wall invasion by lung cancer more accurately than CT. It is important that radiologists be able to identify the key multidetector CT and MR imaging features that can be used to differentiate malignant from benign chest lesions, suggest specific histologic tumor types, and ultimately guide patient treatment. (©)RSNA, 2016.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Sonia L Betancourt
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - John P Lichtenberger
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Behrang Amini
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Gerald F Abbott
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
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Patel R, Devgarha S, Mathur RM. Chondrosarcoma of right 1st rib presenting as neurogenic thoracic outlet syndrome; A 13th case report in world literature. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Momeni A, Kovach SJ. Important considerations in chest wall reconstruction. J Surg Oncol 2016; 113:913-22. [PMID: 26969557 DOI: 10.1002/jso.24216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022]
Abstract
Chest wall reconstruction represents one of the most challenging tasks in plastic surgery. Over the past several decades, a more profound understanding of surgical anatomy and physiology along with tremendous advances in surgical technique have resulted in substantial improvements in postoperative outcomes. Conceptually, the reconstructive goals include dead space obliteration, restoration of skeletal stability with protection of intrathoracic structures, and stable soft tissue coverage. Ideally, these goals are achieved with minimal aesthetic deformity. J. Surg. Oncol. 2016;113:913-922. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arash Momeni
- Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
| | - Stephen J Kovach
- Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania
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Ho AL, Lyonel Carre A, Patel KM. Oncologic reconstruction: General principles and techniques. J Surg Oncol 2016; 113:852-64. [PMID: 26939879 DOI: 10.1002/jso.24206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 02/06/2023]
Abstract
Halsted's principle of radical mastectomy influenced cancer treatment for decades. Randomized controlled trials resulted in a paradigm shift to less radical surgery and the use of adjuvant therapies. Oncologic reconstruction performed by plastic surgeons has evolved, ranging from skin grafts and local flaps for smaller defects to pedicled flaps and free flaps for larger and more complex defects. Immediate reconstruction facilitates resection is oncologically safe and contributes to meaningful improvements in quality of life. J. Surg. Oncol. 2016;113:852-864. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Adelyn L Ho
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Antoine Lyonel Carre
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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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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Abstract
Primitive neuro-ectodermal tumour of the lung is an extremely rare occurrence and we hereby report a case of a neuro-ectodermal tumour of the lung which was proved by immuno-histochemical examination of the resected specimen, and he had a very aggressive pattern of behavior.
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Affiliation(s)
- Gajanan S Gaude
- 1 Department of Pulmonary Medicine, 2 Department of Radiodiagnosis, 3 Department of Pathology, 4 Department of Cardio-thoracic Surgery, Jawaharlal Nehru Medical College, Belgaum, India
| | - Pradeep Patil
- 1 Department of Pulmonary Medicine, 2 Department of Radiodiagnosis, 3 Department of Pathology, 4 Department of Cardio-thoracic Surgery, Jawaharlal Nehru Medical College, Belgaum, India
| | - Prakash Malur
- 1 Department of Pulmonary Medicine, 2 Department of Radiodiagnosis, 3 Department of Pathology, 4 Department of Cardio-thoracic Surgery, Jawaharlal Nehru Medical College, Belgaum, India
| | - Shivappa Annurshetru
- 1 Department of Pulmonary Medicine, 2 Department of Radiodiagnosis, 3 Department of Pathology, 4 Department of Cardio-thoracic Surgery, Jawaharlal Nehru Medical College, Belgaum, India
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Yang H, Tantai J, Zhao H. Clinical experience with titanium mesh in reconstruction of massive chest wall defects following oncological resection. J Thorac Dis 2015; 7:1227-34. [PMID: 26380739 DOI: 10.3978/j.issn.2072-1439.2015.05.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/06/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To present our experience of reconstructing wide defects with porously titanium mesh after radical resection of malignant chest wall tumors. METHODS A retrospective review of surgical reconstruction for large chest wall resections with titanium mesh was conducted from January 2009 to August 2014 in Shanghai Chest Hospital. RESULTS A total of 27 patients underwent major chest wall reconstructions with titanium mesh, following oncological resections. Chest wall sarcomas were the most frequent (63.0%). The mean tumor size was 72.4 (range, 36-140) cm(2). The average size of the applied porously titanium mesh was 140.9 (range, 80-225) cm(2). Mean postoperative length of stay was 7.1 (range, 4-14) days. There were no perioperative mortalities. Four (14.8%) patients experienced treatable complications. All had a resection of at least 3 ribs (median 3, mean 3.5 ribs). A total of 22 patients underwent ribs without sternal resections, and five patients underwent partial sternal resections with adjacent costal cartilage. Anterior chest wall resections were performed in 13 patients while lateral chest wall resections were performed in 9 patients. Three patients had extended resections beyond the chest wall in patients with primary chest wall malignancies, including two with wedge resections of lung and one with partial resection of pericardium. No patient was lost to follow-up. Mean follow-up was 30.7 months. Neither chest wall instability nor wound infection/necrosis was observed. Of these, 23 patients (85.2%) were alive at the last follow-up. Local recurrence was detected in three cases. The 5-year disease-free and overall survivals of primary chest tumors were 72.1% and 80.8%, respectively. CONCLUSIONS Our results showed that chest wall reconstruction utilizing synthetic titanium meshes following extensive resections of the chest wall malignant tumors allowed adequate resection size, with acceptable complications and survival benefits.
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Affiliation(s)
- Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Jicheng Tantai
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
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Lau MC, Mhandu P, Parissis H, McGuigan J. Primary diffuse B-cell lymphoma presenting as a solitary chest-wall lesion. J Surg Case Rep 2015; 2015:rjv069. [PMID: 26088055 PMCID: PMC4471484 DOI: 10.1093/jscr/rjv069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary lymphoma presenting as a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumours arise from metastasis. We demonstrate a case report of a 67-year-old male who underwent investigations for a chronic left-sided pleural effusion. A computed tomography scan demonstrated a large chest-wall lesion, without rib destruction. He subsequently underwent fine needle aspirations and excisional biopsy for a histological diagnosis.
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Affiliation(s)
- Man-Chi Lau
- General and Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Peter Mhandu
- Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
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Sangma MMB, Dasiah S. Chondrosarcoma of a rib. Int J Surg Case Rep 2015; 10:126-8. [PMID: 25841154 PMCID: PMC4430221 DOI: 10.1016/j.ijscr.2015.03.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 11/04/2022] Open
Abstract
Chondrosarcoma of a rib is a very rare malignant tumor of the bone. Most patients were present with an enlarging painful anterior chest wall tumor. We present a case of an asymptomatic 29-years old female with a tumor size of 10 cm × 12 cm on the left anterior chest wall involving the 8th rib. CT scan with intravenous contrast is the gold standard for radiological imaging and planning for surgery. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment.
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Affiliation(s)
- Mima Maychet B Sangma
- Department of General Surgery, Indira Gandhi Medical College & Research Institute, Pondicherry 605009, India.
| | - Simon Dasiah
- Department of General Surgery, Indira Gandhi Medical College & Research Institute, Pondicherry 605009, India.
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