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Giaj Levra M, Novello S, Scagliotti GV, Papotti M, Le Cesne A. Primary pleuropulmonary sarcoma: a rare disease entity. Clin Lung Cancer 2012; 13:399-407. [PMID: 22673623 DOI: 10.1016/j.cllc.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Matteo Giaj Levra
- University of Torino, Department of Clinical and Biological Sciences, Division of Thoracic Oncology, S. Luigi Hospital, Orbassano, Italy.
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2
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Rocca M, Salone M, Galletti S, Balladelli A, Vanel D, Briccoli A. The role of imaging for the surgeon in primary malignant bone tumors of the chest wall. Eur J Radiol 2012; 82:2070-5. [PMID: 22209633 DOI: 10.1016/j.ejrad.2011.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections.
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Affiliation(s)
- M Rocca
- General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy.
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3
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Hashimoto N, Takenaka S, Akimoto Y, Tanaka H, Morii E, Minami M, Yoshikawa H. Capillary hemangioma in a rib presenting as large pleural effusion. Ann Thorac Surg 2011; 91:e59-61. [PMID: 21440110 DOI: 10.1016/j.athoracsur.2010.11.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/02/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
Intraosseous hemangioma in a rib is extremely rare, and most of the few reported cases are of the cavernous subtype. First we describe a capillary hemangioma arising from a rib in a 64-year-old woman that developed into a large, one-sided pleural effusion during the course of a 3-year follow-up. In addition to the life-threatening condition, the tumor demonstrated malignant imaging features such as a sunburst-like appearance or cortical disruption on plain roentgenogram and computed tomography. This case report adds to the literature on a serious complication and also discusses the diagnosis and management of this rare disease.
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Affiliation(s)
- Nobuyuki Hashimoto
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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4
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D’Aiuto M, Cicalese M, D’Aiuto G, Rocco G. Surgery of the Chest Wall for Involvement by Breast Cancer. Thorac Surg Clin 2010; 20:509-17. [DOI: 10.1016/j.thorsurg.2010.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nagayasu T, Yamasaki N, Tagawa T, Tsuchiya T, Miyazaki T, Nanashima A, Obatake M, Yano H. Long-term results of chest wall reconstruction with DualMesh. Interact Cardiovasc Thorac Surg 2010; 11:581-4. [PMID: 20724421 DOI: 10.1510/icvts.2010.242040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the clinical outcomes of chest wall reconstruction using a new, expanded polytetrafluoroethylene prosthesis, 'DualMesh'. Between December 2005 and March 2010, chest wall reconstruction using 2-mm DualMesh was performed in 11 patients. The indication for resection was primary lung cancer in six patients, malignant mesothelioma in one patient, recurrent lung cancer in one patient, recurrent invasive thymoma in one patient, postirradiated osteomyelitis in one patient, and chondro-hamartoma in one patient. The mean observation period was 23 months, and four cases were observed for more than three years. There were no operative deaths and no wound infections. There were two postoperative complications: prolonged air leakage occurred in a patient with pulmonary emphysema who underwent right lower lobectomy, and slight paradoxical respiration occurred in the patient who underwent resection of the entire sternal body for osteomyelitis. Follow-up chest computed tomography was performed routinely. No dehiscence occurred in any cases. Chest wall reconstruction using DualMesh demonstrated acceptable durability and biocompatibility, even after long-term follow-up. DualMesh has the potential to become an ideal prosthesis for the bony chest wall as an alternative to conventional polytetrafluoroethylene or polypropylene grafts.
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Affiliation(s)
- Takeshi Nagayasu
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Kocer B, Gulbahar G, Erdogan B, Budakoglu B, Erekul S, Dural K, Sakinci U. A case of radiation-induced sternal malignant fibrous histiocytoma treated with neoadjuvant chemotherapy and surgical resection. World J Surg Oncol 2008; 6:138. [PMID: 19116008 PMCID: PMC2628670 DOI: 10.1186/1477-7819-6-138] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 12/30/2008] [Indexed: 11/30/2022] Open
Abstract
Background Primary sternal malignant fibrous histiyocytoma (MFH) is highly rare. Effective treatment modality is surgical resection with wide margins. However, to date, the effects of radiotherapy or chemotherapy has not been clearly defined. Case presentation Herein, we aimed to present a 50-year old female patient with MFH occurred in the radiotherapy field who had had surgical procedure for breast cancer 19 years ago and had followed by radiotherapy. Neoadjuvant chemotherapy was applied for MFH due to cardiac and mediastinal vascular invasion. Wide resection was carried out for the mass after having been decreased in size following neoadjuvant chemotherapy. Conclusion Neoadjuvant chemotherapy was an effective method. In planning the surgical resection, the size of the tumor before chemotherapy should be considered as the initial size and surgical margins should be determined accordingly.
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Affiliation(s)
- Bulent Kocer
- Numune Education and Research Hospital, Thoracic Surgery Department, Ankara, Turkey.
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7
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Abstract
Chest wall tumors in childhood and adolescence can be very heterogeneous and may appear at any age from infancy to late adolescence. They can be benign or malignant and secondary or primary. A careful history and physical examination should be followed by adequate imaging studies to delineate the primary tumor and identify possible sites of dissemination. Diagnosis usually requires either a needle or open biopsy which minimizes dissection so that a complete resection can be done later. Most neoplastic lesions require a complete resection, whereas secondary and infectious processes are treated with chemotherapy or antibiotics. Rigid chest wall re-construction has the advantage of eliminating paradoxical respiration and obviating the need for postoperative ventilation. Another advantage is maintenance of chest wall contour.
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8
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Briccoli A, Galletti S, Salone M, Morganti A, Pelotti P, Rocca M. Ultrasonography is superior to computed tomography and magnetic resonance imaging in determining superficial resection margins of malignant chest wall tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:157-62. [PMID: 17255176 DOI: 10.7863/jum.2007.26.2.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively analyze results obtained in 22 patients affected by malignant high-grade chest wall tumors evaluated preoperatively by ultrasonography as well as other imaging techniques. METHODS Twenty-two patients with chest wall high-grade sarcomas routinely underwent computed tomography, magnetic resonance imaging, total body scintigraphy, and ultrasonography. Ultrasonography was always performed by the same person using an ultrasonography system with a 5- to 13-MHz probe and with color Doppler evaluation of the lesion. Scans were done with the patient positioned as during surgery. Tumor lateral margins were identified, and a line was marked at 4 cm. In 8 patients with local recurrence, the presence of micronodules was also studied. Results of computed tomography, magnetic resonance imaging, and ultrasonography were compared with the surgical specimens. RESULTS Histologically, all surgical specimens excised according to ultrasonographic margins showed wide margins. Ultrasonography showed micronodules in 6 of 8 patients with local recurrence; histologically, they were all identified as sarcoma nodules. Ultrasonography failed in particular with cervical-mediastinal vessels. CONCLUSIONS Our results confirm that ultrasonography is feasible and reliable in the study of superficial margins and for detection of micronodules of less than 0.5 cm in diameter.
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Affiliation(s)
- Antonio Briccoli
- General Surgery Unit, Istituto Ortopedico Rizzoli, Via Pupilli 1, IT-40136 Bologna, Italy.
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9
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Hsu PK, Hsu HS, Lee HC, Hsieh CC, Wu YC, Wang LS, Huang BS, Hsu WH, Huang MH. Management of primary chest wall tumors: 14 years' clinical experience. J Chin Med Assoc 2006; 69:377-82. [PMID: 16970274 DOI: 10.1016/s1726-4901(09)70276-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary chest wall tumor is rare but it encompasses tumors of various origins. We analyzed our experience with primary chest wall tumors with emphasis on its demographic presentation and management. METHODS From 1991 to 2004, 62 patients with the diagnosis of primary chest wall tumors were enrolled. Lipoma, chest wall metastasis, direct invasion from nearby malignancy, infection, and inflammation of chest wall were excluded. The clinical features, management, and the outcome of these patients were retrospectively reviewed. RESULTS There were 37 males and 25 females. Malignant and benign tumors were equally distributed. Chondrosarcoma and lymphoma were the 2 most common types of malignant chest wall tumors. The most common clinical symptoms were palpable mass (54.8%) and pain (40.3%). Nine of 31 patients (29.0%) with benign chest wall tumors were free of symptoms whereas patients with malignant chest wall tumors were all symptomatic (p = 0.002). A definite diagnosis was obtained in 21 of 26 patients (80.7%) who received nonexcision biopsy. All patients with primary chest wall tumors, except 6 who had medical treatment only, underwent surgical resection. Patients with malignant chest wall tumors were older than those with benign tumors (p < 0.001). The mean largest diameter of tumors was also larger in malignant tumors than in benign tumors (p = 0.04). CONCLUSION Patients with primary malignant chest wall neoplasm were older than those with benign tumors. The mean size of malignant tumors was larger than that of benign tumors. Adequate surgical resection remains the treatment of choice for patients with primary chest wall tumors. Nonexcision biopsy should be reserved for patients with a past history of malignancy, suspicion of hematologic disease, and with high operative risk. For patients with isolated chest wall lymphoma, surgical resection followed by chemotherapy can be considered to obtain a better outcome.
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Affiliation(s)
- Po-Kuci Hsu
- Divisions of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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10
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Hsu PK, Hsu HS, Li AFY, Wang LS, Huang BS, Huang MH, Hsu WH. Non-Hodgkin’s Lymphoma Presenting as a Large Chest Wall Mass. Ann Thorac Surg 2006; 81:1214-8. [PMID: 16564245 DOI: 10.1016/j.athoracsur.2005.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 11/10/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. METHODS From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. RESULTS There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. CONCLUSIONS Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
This article discusses the imaging evaluation of chest wall disorders in children.
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Affiliation(s)
- Nancy R Fefferman
- Division of Pediatric Radiology, Department of Radiology, New York University School of Medicine, 560 First Avenue, RIRM 234, New York, NY 10016, USA.
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Palliative Resektion eines Chondrosarkoms—Fallbeschreibung. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2004. [DOI: 10.1007/s00398-004-0465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Tohnosu N, Gunji H, Shimizu T, Natsume T, Matsuzaki H, Tanaka H, Maruyama T, Watanabe Y, Kato T, Uehara T, Ishii S. A case of neurilemmoma of the breast. Breast Cancer 2003; 9:257-60. [PMID: 12185339 DOI: 10.1007/bf02967599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neurilemmoma of the breast is rarely seen, although it is common at intracranial or peripheral sites. There have been only 14 cases described in the literature. We present the fifteenth case of a 64-year-old woman with neurilemmoma of the breast, the first to be diagnosed by fine needle aspiration cytology. Fibroadenoma must be distinguished from this tumor. Complete removal is the treatment of choice, considering the possibility of local recurrence and malignant change.
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Affiliation(s)
- Noriyuki Tohnosu
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi City, Chiba 273-8588, Japan
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Abstract
A 59-year-old man with an enlarged left chest wall mass that had been followed up for 3 years underwent surgical resection. The mass was pathologically diagnosed as cavernous hemangioma of the rib. This is the fourth case of this rare disease to be reported. However, it suggests that hemangioma of the rib should be considered in the differential diagnosis of rib tumors, especially in asymptomatic patients.
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Affiliation(s)
- Katsuhiko Shimizu
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
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15
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Abstract
Primary sarcomas of the thorax are rare. The diagnosis is established only after sarcomalike primary lung malignancies and metastatic disease have been excluded. Primary sarcomas of the thorax are classified according to their histologic features and constitute a large group of tumors that occur in the lung, mediastinum, pleura, and chest wall. Angiosarcoma, leiomyosarcoma, rhabdomyosarcoma, and mesothelioma (sarcomatoid variant) are the most common primary intrathoracic sarcomas. Ewing sarcoma, primitive neuroectodermal tumor, chondrosarcoma, malignant fibrous histiocytoma, osteosarcoma, synovial sarcoma, and fibrosarcoma usually arise in the chest wall. Although primary thoracic sarcomas commonly manifest as large, heterogeneous masses, they have a wide spectrum of radiologic manifestations, including solitary pulmonary nodules, central endobronchial tumors, and intraluminal masses within the pulmonary arteries. The different histologic types of sarcomas are frequently indistinguishable at radiologic analysis. However, differences in clinical presentation and the location of the tumor, as well as morphologic features such as calcification within the mass and rib involvement, can be useful in suggesting the appropriate diagnosis. For example, a large rib mass in a child with fever and malaise indicates a Ewing sarcoma, a mass with a calcified matrix is likely a chondrosarcoma or osteosarcoma, and a pulmonary artery mass is likely a leiomyosarcoma.
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Affiliation(s)
- Gregory W Gladish
- Department of Diagnostic Radiology, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030, USA.
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16
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Williamson BE, Stanton CA, Levine EA. Chest Wall Metastasis from Recurrent Meningioma. Am Surg 2001. [DOI: 10.1177/000313480106701011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Meningiomas are generally considered benign lesions. A minority, however, are capable of metastasis. The ones most likely to do so are commonly recurrent or frankly malignant in nature. The optimal management of such metastases is unclear. This is the first reported case of meningioma presenting as an isolated metastasis to the chest wall. This case involves a 64-year-old woman without significant medical or family history who underwent resection of a meningioma of the right cerebral hemisphere. She was treated 10 years later for recurrence by stereotactic radiosurgery. Three years after that, the patient's family noticed a mass on the left chest wall. A CT scan revealed destruction of the ninth rib laterally and subpleural extension. The patient subsequently underwent resection of full-thickness chest wall for a presumed soft-tissue sarcoma. Further pathologic evaluation including electron microscopy and immunohistochemistry revealed metastatic meningioma. The patient received adjuvant radiation to the chest wall and is currently free of disease at the chest wall one year after surgery. This case illustrates the difficulty in establishing an accurate diagnosis of metastatic meningioma. Consequently in selected patients with a history of the disease the diagnosis of metastatic meningioma must at least be considered. Resection of an isolated metastasis in this setting appears warranted.
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Affiliation(s)
| | - Constance A. Stanton
- Departments of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157
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Affiliation(s)
- B Karmazyn
- Department of Radiology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis 46202-5200, USA
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18
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Abstract
We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.
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Affiliation(s)
- B Ali Özuslu
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Onur Genç
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Sedat Gürkök
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
| | - Kunter Balkanli
- Department of Thoracic Surgery Gülhane Military Medical Academy Turkey
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Soysal O, Walsh GL, Nesbitt JC, McMurtrey MJ, Roth JA, Putnam JB. Resection of sternal tumors: extent, reconstruction, and survival. Ann Thorac Surg 1995; 60:1353-8; discussion 1358-9. [PMID: 8526626 DOI: 10.1016/0003-4975(95)00641-w] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Resection of sternal tumors may be tailored to the patient and the location of the malignancy. METHODS We reviewed our results of sternectomy (typically 5-cm margins) performed in 30 patients over a 10-year period. RESULTS Thirteen patients had primary sternal sarcoma (six chondrosarcoma, five osteosarcoma, two other); 10 patients had local recurrence from breast cancer; 4 patients had metastases; 3 patients had other (two osteoradionecrosis, one malignant fibrous histiocytoma). Morbidity occurred in 8 patients (26.7%): wound dehiscence, 2; wound infection, 1; hemorrhage, 1; pneumonia, 1; prolonged air leak, 1; empyema, 1; and bronchopleural fistula, 1. One patient, with multiple metastases, died from adult respiratory distress syndrome on day 25 (overall mortality, 3.3%; 1 of 30). The area of reconstruction ranged from 35 to 264 cm2. The technique of reconstruction included muscle flap alone in 13 patients; muscle flap and mesh, 9; muscle flap and rigid prosthesis (Marlex methylmethacrylate), 7; or other, 1 patient. Nineteen patients (63%) were extubated within 24 hours after operation. Median intensive care unit stay was 2 days; median hospitalization, 6 days. Late local recurrence after resection occurred in 6 patients; 4 from breast cancer (3 patients had concurrent distant metastases). Five-year actuarial survival after primary tumor resection was 73% and 33% after resection of recurrent breast cancer (median, 21 months). CONCLUSIONS Partial sternectomy may be performed for primary sternal tumors with short hospitalization and good local control. Wider local excision or total sternectomy may minimize local re-recurrence of breast carcinoma to the sternum.
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Affiliation(s)
- O Soysal
- Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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21
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Fernández-Trigo V, Sugarbaker PH. Sarcomas Involving the Head and Neck, Trunk and Breast. TUMORI JOURNAL 1994; 80:157-68. [PMID: 8053071 DOI: 10.1177/030089169408000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcomas of the head, neck, trunk and breast are biologically similar to and behave like the soft tissue tumors found in other anatomic areas. In the past and still today, radical surgical resection with negative margins is the only reliable treatment for these sarcomas. The opportunity to use chemotherapy, surgery, and radiation therapy in selected patients as a multi-modality approach may improve the likelihood of long-term, disease-free survival. Added experience with radiologic evaluation of patients to accurately define the anatomic location of the tumor, more definitive pathology to assess the biologic aggressiveness of the lesion, and more conservative wide excisions have allowed patients to retain function and cosmesis. In addition, the development of new surgical techniques has made it feasible to reconstruct large surgical defects.
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Fink G, Bergman M, Levy M, Avidor I, Spitzer S. Giant chondroma of the sternum mimicking a mediastinal mass. Thorax 1990; 45:643-4. [PMID: 2402733 PMCID: PMC462654 DOI: 10.1136/thx.45.8.643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 64 year old man with a giant benign sternal chondroma presented with cough as his sole complaint.
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Affiliation(s)
- G Fink
- Institute of Pulmonary Medicine, Beilinson Medical Center, Petach-Tikva, Israel
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24
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Abstract
Chest-wall resection can be performed with low morbidity and mortality rates and remains the primary treatment for most chest-wall tumors. However, some lesions are best treated with a multimodality approach including preoperative chemotherapy. Therefore, pretreatment tissue diagnosis is essential in planning. The biopsy should be done at the medical center where the definitive treatment will be undertaken, and frequently, a needle biopsy will be sufficient. Osteosarcoma, rhabdomyosarcoma, Ewing's sarcoma, and other small-cell sarcomas are sensitive to chemotherapy, which should be given preoperatively, continued postoperatively, and modified according to the tumor response. Chondrosarcomas and most adult soft-tissue sarcomas are well controlled by primary excision and selective use of adjuvant irradiation. Better systemic and local therapy is needed for the recurrent soft-tissue sarcomas and the aggressive unclassified sarcomas. Chest-wall resection continues to play a primary role in the management of locally and regionally recurrent breast cancer but is best combined with systemic chemotherapy. Chest-wall resection can provide a long disease-free survival in patients with isolated metastases from sarcomas or carcinomas. In addition, significant palliation can be afforded patients with symptomatic chest-wall metastases and a shortened life expectancy.
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Affiliation(s)
- M B Ryan
- Department of Thoracic Surgery, University of Texas M. D. Anderson Cancer Center, Houston
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25
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McCormack PM. Use of prosthetic materials in chest-wall reconstruction. Assets and liabilities. Surg Clin North Am 1989; 69:965-76. [PMID: 2675354 DOI: 10.1016/s0039-6109(16)44932-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sparked by the experience during war time, our knowledge of how to handle chest-wall defects has matured with the decades since the 1940s. Techniques are now available for reconstruction of large areas of the chest wall. The materials are readily available and can be adapted to fit any size and shape of defect. The disadvantages are few and correctable. This technique has been used to restore chest continuity in patients whose tumors were resected for cure. It has also been used palliatively for patients with bleeding, ulcerative, or infected tumors of the chest wall and in those with known metastases elsewhere. Removing the malodorous mass from the chest wall provides excellent palliation and should be offered to patients to improve their quality of survival.
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Affiliation(s)
- P M McCormack
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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26
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el-Tamer M, Chaglassian T, Martini N. Resection and debridement of chest-wall tumors and general aspects of reconstruction. Surg Clin North Am 1989; 69:947-64. [PMID: 2675353 DOI: 10.1016/s0039-6109(16)44931-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The main criterion for adequate local control of a chest-wall malignancy remains wide excision. With the available techniques of skeletal and soft-tissue reconstruction, even large lesions can be resected with safe margins. The primary purpose is to achieve a curative resection, although a significant number of symptomatic patients can benefit from palliative resection provided by such procedures. A key element in the success in treating chest-wall tumors is a multidisciplinary approach by all participating physicians, namely the thoracic surgeon, the plastic and reconstructive surgeon, the radiotherapist, and the medical oncologist.
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Affiliation(s)
- M el-Tamer
- Memorial Sloan-Kettering Cancer Center, New York, New York
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27
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Ala-Kulju K, Luosto R, Ketonen P, Salo J, Heikkinen L. Primary tumours of the sternum. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1989; 23:169-72. [PMID: 2665060 DOI: 10.3109/14017438909105988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In 1966-1986, two men and four women (mean age 47.5 years) underwent surgery for primary sternal tumour. Three of the tumours were benign (two condromata, one osteochondroma) and three were malignant (two chrondrosarcomata, one reticulum cell sarcoma). Inflammatory or degenerative lesions impeded differential diagnosis in three additional cases (without tumour). The tumours were treated with radical resection of the affected part of the sternum, including the relevant attached structures. Marlex-mesh reconstruction of the defect was necessary in four cases. There was no operative mortality. One Marlex graft became infected. At follow-up (average 11.1 years, range 9.0-14.7 years), five patients were alive without recurrence of tumour and the sixth had died of unrelated cause.
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Affiliation(s)
- K Ala-Kulju
- Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland
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28
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Eng J, Sabanathan S, Pradhan GN. Primary sternal tumours. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1989; 23:289-92. [PMID: 2617251 DOI: 10.3109/14017438909106012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nine cases of primary sternal tumour were retrospectively reviewed in regard to clinical, radiologic and surgical features. The tumours were chondrosarcoma (4), chondroma (3), solitary plasmacytoma (1) and osteochondroma (1). All the benign lesions were excised without complication or recurrence. Three chondrosarcomas were radically excised en bloc, and one was only locally excised because of gross involvement of underlying structures. The solitary plasmacytoma was treated with incisional biopsy and radiotherapy. Two of the three patients with radical excision of sternal chondrosarcoma were alive after 5 years. Careful preoperative assessment, including use of computed tomography, is important. Wide excision should be the procedure of choice for all sternal tumours, since differentiation between benign and malignant lesions may be difficult in cartilaginous tumours, which are the commonest types.
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Affiliation(s)
- J Eng
- Department of Cardiothoracic Surgery, Bradford Royal Infirmary, England
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29
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McKenna RJ, Mountain CF, McMurtrey MJ, Larson D, Stiles QR. Current techniques for chest wall reconstruction: expanded possibilities for treatment. Ann Thorac Surg 1988; 46:508-12. [PMID: 3190322 DOI: 10.1016/s0003-4975(10)64686-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Myocutaneous flaps and prosthetic materials have greatly facilitated reconstruction after massive chest wall resection. This series includes 112 such procedures. Latissimus dorsi, rectus abdominis, omental, pectoralis major, and contralateral breast flaps were used in 80 patients. Early in the series, 3 flaps were lost because of technical problems. Minor areas of incomplete healing that resolved completely with local wound care occurred in 16 of 80 flaps. Skeletal reconstruction was performed in 82 patients without complication. Marlex mesh was used for flat surfaces, and Marlex mesh with methyl methacrylate was used for the sternum and the curved surface of the lateral chest wall. These results have allowed an expansion of the indications for chest wall resection to include the curative treatment of primary chest wall tumors and palliative treatment for breast cancer patients with osteoradionecrosis, local recurrence (in select patients), chest wall infection, and tumors metastatic to the chest wall.
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Affiliation(s)
- R J McKenna
- Department of Thoracic Surgery, University of Texas M. D. Anderson Hospital and Tumor Institute, Houston 77030
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30
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Friedman B, Yellin A, Huszar M, Blankstein A, Lotan G. Aneurysmal bone cyst of the rib: a review and report of two cases. BRITISH JOURNAL OF DISEASES OF THE CHEST 1988; 82:179-85. [PMID: 3048366 DOI: 10.1016/0007-0971(88)90041-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aneurysmal bone cyst (ABC) is a benign lesion and generally occurs in the long bones and vertebral column. ABC of the rib is an uncommon entity. Two cases of ABC involving the rib are reported. Its occurrence in the eight decade of life as manifested in one of our patients is extremely rare. The aetiology, clinical manifestations, pathology and treatment are briefly discussed. En bloc resection of the lesion is curative, and offers a good cosmetic and functional result.
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Affiliation(s)
- B Friedman
- Department of Orthopaedic Surgery 'B', Chaim Sheba Medical Center, Tel Hashomer, Israel
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31
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Ala-Kulju K, Ketonen P, Järvinen A, Salo J, Luosto R. Primary tumours of the ribs. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1988; 22:97-100. [PMID: 3406697 DOI: 10.3109/14017438809105936] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Thirty-four primary rib tumours (24 benign, 10 malignant) were surgically treated in 1966-1985. The mean age was higher and the tumour diameter was greater in the patients with malignant, than in those with benign neoplasm. The benign tumours were excised without operative death. At follow-up after a mean of 12.3 years there was no recurrence of benign growth, but in two cases with initial diagnosis of chondroma a regrowth at the same site proved to be chondrosarcoma. Among the cases of malignant tumour there was one operative death from pulmonary embolism, after radical resection of sarcoma. None of the four patients with chondrosarcoma had recurrence 6-13 years after surgery. There was no long-term survival among the patients with other forms of sarcoma or malignant tumour of the reticuloendothelial system.
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Affiliation(s)
- K Ala-Kulju
- Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland
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32
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King RM, Pairolero PC, Trastek VF, Piehler JM, Payne WS, Bernatz PE. Primary chest wall tumors: factors affecting survival. Ann Thorac Surg 1986; 41:597-601. [PMID: 3013106 DOI: 10.1016/s0003-4975(10)63067-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Between 1955 and 1975, chest wall resection was done in 90 patients for primary chest wall tumors. Ages ranged from 8 to 96 years (mean, 44.3 years). A painful mass was the most common sign and symptom. Eighty-two tumors (91.1%) were located in the lateral chest wall and eight, in the anterior thorax. The tumor was malignant in 71 patients (78.9%) and benign in 19. All patients with benign tumors had complete excision and are currently free from disease. Malignant fibrous histiocytoma, chondrosarcoma, and rhabdomyosarcoma constituted 62% of the malignant neoplasms. Most malignancies were treated by wide resection. There were no thirty-day operative deaths. Overall 1-, 5-, and 10-year survival was 89%, 57%, and 49%, respectively. Recurrent tumor developed in 37 patients (52%); 5-year survival, however, was only 17% after recurrence. Cell type and extent of invasion significantly influenced survival. Both chondrosarcoma and rhabdomyosarcoma had a better prognosis than malignant fibrous histiocytoma (p less than 0.05). We conclude that early resection is the treatment of choice for primary malignant chest wall tumors and that development of recurrent disease is an ominous event.
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Abstract
Thirty chest wall tumors were evaluated over a 3-year period at two major medical centers; a nonradical excisional biopsy technique was used. The majority of the lesions were benign; the small number of malignancies consisted of either plasmacytomas or metastatic neoplasms. These findings support a limited excisional biopsy as the recommended initial diagnostic approach for all chest wall tumors.
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34
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Penkrot RJ, Bolden R. Thoracic neurilemmoma: case report and review of the world literature. THE JOURNAL OF COMPUTED TOMOGRAPHY 1985; 9:13-5. [PMID: 3971732 DOI: 10.1016/0149-936x(85)90044-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Thoracic tumors are unusual and tend to occur in the posterior mediastinum. A case of anterior thoracic neurilemmoma is presented, with plain film, computed tomographic, and pathologic correlation. Diagnosis of chest wall masses, including the role of computed tomography, is discussed, along with the significance of calcification in these lesions.
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Abstract
Two patients are presented who had a resection of a solitary expansile rib lesion. The radiologic features were nonspecific and the lesions were thought to represent either fibrous dysplasia, myeloma, or metastatic disease. Histologically, the lesion consisted of focal hyperplasia of the bone marrow involving all hematopoietic elements. The marrow expanded the rib, eroded the cortex, and extended into the adjacent soft tissue. Neither patient had any underlying hematologic abnormality. A search of the English language literature failed to discover a description of a similar lesion. From the clinical course and follow-up information, the process appears to be benign. The authors believe the lesion is a form of pseudotumor, and propose that it be designated as "focal hematopoietic hyperplasia of rib" or "hematopoietic pseudotumor."
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36
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Ramming KP, Holmes EC, Zarem HA, Lesavoy MA, Morton DL. Surgical management and reconstruction of extensive chest wall malignancies. Am J Surg 1982; 144:146-52. [PMID: 6953769 DOI: 10.1016/0002-9610(82)90616-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Seven patients aged 8 to 77 years underwent massive resection for chest wall malignancies. Two had chondrosarcoma, one recurrent breast cancer, one malignant hemangioepithelioma, one embryonal cell sarcoma, one metastatic osteogenic sarcoma, and one lymphangiosarcoma. The smallest surgical defect was 17 by 19 cm, the largest 35 by 45 cm. Closure was done with Marlex mesh, full-thickness muscle flaps, or free island pectoralis or latissimus dorsi flaps. The rotation of myocutaneous island flaps (bilateral in two patients) greatly facilitated reconstruction. No infection, pulmonary compromise, or operative morbidity or mortality was encountered. The age of the patients and the location or size of the lesions were not significant factors. Designing a surgical strategy which provides adequate full-thickness margins and immediate reconstruction is critically important. Massive chest wall resection for malignancy should be pursued aggressively whenever these lesions are encountered. The operations can be performed safely and can be curative, and the benefits to patients in terms of comfort and prolonged survival justify this extensive surgery.
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