Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses:A case report and review of literature

BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones.Chest wall lesions may represent a challenge,particularly in pediatric patients.Pain is a common manifestation.However,life-threatening complications can result from direct involvement of adjacent structures.Surgical resection with appropriate reconstruction is often required.CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion.After appropriate preoperative investigations,he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.CONCLUSION Resection of chest wall lesions in children represents a challenge.Preoperative planning to determine the appropriate reconstruction strategy is essential.

Individual with concurrent chest wall tuberculosis and triplenegative essential thrombocythemia:A case report

BACKGROUND Chest wall tuberculosis(TB)and triple-negative essential thrombocythemia(TNET)are rare medical conditions,and their combination is extremely rare globally.Only one case of TB peritonitis with thrombocytosis has been reported,which was identified in 1974.CASE SUMMARY Herein,we report the case of a 23-year-old man with concurrent chest wall mass and TN-ET.The patient presented to a local hospital due to having a headache and low-grade fever for 2 d,with their bodily temperature fluctuating at around 36.8°C.Hematological analysis showed a high platelet count of 1503×109/L.Subsequently,the patient visited our hospital for further investigation.Computed tomography of the chest suggested a submural soft tissue density shadow in the left lower chest wall.After surgical resection,the pathological findings of the swelling were reported as TB with massive caseous necrosis.According to the World Health Organization diagnostic criteria,the patient was diagnosed with TN-ET,as they met the requirement of four main criteria or the first three main criteria and one secondary criterion.The patient was eventually diagnosed with chest wall TB with TN-ET,which is extremely rare.CONCLUSION Chest wall TB is rare.TN-ET diagnosis requires secondary factor exclusion and satisfaction of primary diagnostic criteria.miRNA,combined with the methylation process,could explain suppressor of cytokine signaling(SOCS)1 and SOCS3 downregulation in ET-JAK2V617F-negative patients.The miRNA could participate in JAK2 pathway activation.SOCS3 may be a novel MPN biomarker.

Value of ultrasound guided biopsy combined with Xpert Mycobacterium tuberculosis/resistance to rifampin assay in the diagnosis of chest wall tuberculosis

BACKGROUND The thoracic wall lesions,particularly chest wall tuberculosis,and chest wall tumors and other pyogenic wall and actinomycetes infections,almost always present as a diagnostic challenge.AIM To explore the value of ultrasound-guided biopsy combined with the Xpert Mycobacterium tuberculosis/resistance to rifampin(MTB/RIF)assay to diagnose chest wall tuberculosis.METHODS We performed a retrospective study of patients with chest wall lesions from March 2018 to March 2021.All patients received the ultrasound-guided biopsy for pathology examination,acid-fast Bacillus staining,mycobacterial culture,and Xpert MTB/RIF analysis.The sensitivity,specificity,and area under the curve(AUC)were calculated for these diagnostic tests,either individually or combined.Rifampicin resistance results were compared between the mycobacterial culture and the Xpert MTB/RIF assay.RESULTS In 31 patients with the chest wall lesion biopsy,22 patients were diagnosed with chest wall tuberculosis.Of them,3,6,and 21 patients tested positive for mycobacterial culture,acid-fast stain,and Xpert MTB/RIF assay,respectively.The rifampicin resistance results of the 3 culture-positive patients were consistent with their Xpert MTB/RIF assay results.When considering the sensitivity,specificity,and AUC value,the Xpert MTB/RIF assay(95.5%,88.9%,and 0.92,respectively)was a better choice than the acid-fast Bacillus stain(27.3%,100.0%,and 0.64,respectively)and mycobacterial culture(13.6%,100.0%,0.57,respectively).No complications were reported during the procedure.CONCLUSION Ultrasound guided biopsy combined with Xpert MTB/RIF has high value in the diagnosis of chest wall tuberculosis,and can also detect rifampicin resistance.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Local Recurrence of Low-Grade Myofibroblastic Sarcoma of the Chest Wall:Report of a Case and Literatures Review

Myofibroblastic sarcoma, composed primarily of myofibroblast, is a rare malignant tumor. Low-grade myofibroblastic sarcoma （LGMS） has been defined properly as a distinct entity in the 2002 WHO classification of soft tissue tumors. Primary sarcoma of the chest wall is also a rare disease. This article describes a case of locally recurrent LGMS of the chest wall.

Bronchogenic cysts with infection in the chest wall skin of a 64-yearold asymptomatic patient: A case report

BACKGROUND Skin bronchogenic cysts are extremely rare congenital bronchocystic changes caused by the abnormal development of the trachea,bronchial trees or lung buds during the embryonic period.The first case of skin bronchogenic cysts was reported in 1945.Since then,this disease has attracted increasing attention,but due to the low incidence,its pathogenesis is still not clear.CASE SUMMARY Here,we report another case of skin bronchogenic cysts with infection in a 64-year-old female patient.The patient had no symptoms for more than 60 years until her chest wall was recently found to be swollen,and she felt pain and discomfort.At the same time,secretions were found on the surface of the swelling.Color Doppler ultrasound examination showed abnormal echoes in the soft tissue under the frontal chest wall,suggesting the presence of cysts.Cytological puncture resulted in about 2 mL of pus and showed the presence of more acute inflammatory cells.The final clinical diagnosis was skin cyst with infection,and surgery was carried out.The pathological results obtained after surgery showed that the cystic wall was covered with column-like cilia epithelial cells,and the interstitial structure was partially inundated with inflammatory cells.After a variety of examinations and clinical diagnoses,we finally confirmed that the patient was suffering from bronchogenic cyst.CONCLUSION This article not only describes the case of an elderly patient with rare skin bronchogenic cysts with infection but also provides a detailed and correct diagnosis and a successful treatment process,which is of great value for the diagnosis and treatment of the disease.

Chest wall metastasis from unknown primary site of hepatocellular carcinoma

Previous reports of a solitary metastatic hepatocellular carcinoma have been rare. Because this tumor has a different treatment modality and prognosis, an accurate differential diagnosis is essential. Here we report a rare case of a solitary chest wall metastasis from unknown primary site of hepatocellular carcinoma. It involves a 51-year-old man who was admitted to our hospital because of a palpable left upper chest wall mass. The mass was resected and pathologic examination confirmed a diagnosis of metastatic hepatocellular carcinoma. Despite our investigation, no evidence was found that indicated the primary origin of the hepatocellular carcinoma. Four months later, the patient was admitted again because of spinal cord compression at the third and fourth thoracic vertebrae. Emergent decompressive laminectomy was performed and microscopic features revealed the same pathology as the initial chest wall mass resected 4 months earlier. After one year, a follow-up abdominal computed tomography （CT） still revealed no evidence of primary hepatocellular carcinoma.

Multicenter phaseⅡstudy of apatinib single or combination therapy in HER2-negative breast cancer involving chest wall metastasis

Objective:Breast cancer(BC)with chest wall metastasis(CWM)usually shows rich neovascularization.This trial explored the clinical effect of apatinib on human epidermal growth factor receptor 2(HER2)-negative advanced BC involving CWM.Methods:This trial involved four centers in China and was conducted from September 2016 to March 2020.Patients received apatinib 500 mg/d[either alone or with endocrine therapy if hormone receptor-positive(HR+)]until disease progression or unacceptable toxicity.Progression-free survival(PFS)was the primary endpoint.Results:We evaluated 26 patients for efficacy.The median PFS(mPFS)and median overall survival(mOS)were4.9[range:2.0-28.5;95%confidence interval(95%CI):2.1-8.3]months and 18(range:3-55;95%CI:12.9-23.1)months,respectively.The objective response rate(ORR)was 42.3%(11/26),and the disease-control rate was76.9%(20/26).In the subgroup analysis,HR+patients compared with HR-negative patients had significantly improved mPFS of 7.0(95%CI:2.2-11.8)months vs.2.3(95%CI:1.2-3.4)months,respectively(P=0.001);and mPFS in patients without or with chest wall radiotherapy was 6.4(95%CI:1.6-19.5)months vs.3.0(95%CI:1.3-4.6)months,respectively(P=0.041).In the multivariate analysis,HR+status was the only independent predictive factor for favorable PFS(P=0.014).Conclusions:Apatinib was highly effective for BC patients with CWM,especially when combined with endocrine therapy.PFS improved significantly in patients with HR+status who did not receive chest wall radiotherapy.However,adverse events were serious and should be carefully monitored from the beginning of apatinib treatment.

Intracranial malignant solitary fibrous tumor metastasized to the chest wall:A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is a rare fibroblastic mesenchymal neoplasm that affects spindle cell soft tissues with broad-spectrum biological behavior;it is predominantly benign,and rarely metastasizes.SFT occurs mainly in the tissue structure of the serosa in the pleura and the thorax,and can be found throughout the body,though extra-thoracic localization,including the cephalic region,is uncommon.We reported the first case of intracranial malignant SFT metastasized to the chest wall.CASE SUMMARY An 81-year-old Japanese man was referred to our hospital due to progressive gait disturbance and appetite loss.His medical history included partial resection due to brain tumor,four times,and 50-Gray radiation therapy at another hospital,starting when he was 74 years old.An unenhanced head computed tomography(CT)scan revealed an 8 cm×5.1 cm×6.5 cm mixed-density mass at the left frontal lobe,accompanying a midline shift,and an unenhanced chest-abdomen CT scan revealed a 6 cm×4.1 cm×6.5 cm low-density mass in the left chest wall.A CT-guided percutaneous lung biopsy was performed,and the pathological findings were SFT corresponding to brain tumor.Finally,the correct diagnosis of his brain tumor in history of past illness revealed to be SFT,and the unremovable tumor,namely present brain lesions enlarged and metastasized to the chest wall.We established a definitive diagnosis of intracranial malignant SFT metastasized to the chest wall.We notified him and his family of the disease,and offered palliative care.He passed away on the 29 th hospital day.CONCLUSION This case suggests the need for careful,detailed examination,and careful followup when encountering patients presenting with a mass.

Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report

BACKGROUND Chondrosarcoma,a cartilage matrix producing tumor,is the second most commonly observed primary bone tumor after osteosarcoma,accounting for 15%of all chest wall malignancies.We herein report the case of a patient with chondrosarcoma of the sternum and our management of the chest wall defects that presented following radical tumor resection.CASE SUMMARY A 31-year-old patient presented to our hospital with dull pain and a protruding mass overlying the chest for 3 mo.The presence of nocturnal pain and mass size progression was reported,as were overhead arm elevation-related limitations.Computed tomography showed a focal osteoblastic mass in the sternum with bony exostosis and adjacent soft tissue calcification.Positron emission tomography-computed tomography revealed hypermetabolic activity with a mass located over the upper sternum.Magnetic resonance imaging showed a focal illdefined bony mass of the sternum with cortical destruction and periosteal reaction.Preoperative biopsy showed a consistent result with chondrosarcoma with immunohistochemical positivity for S100 and focal positivity for IDH-1.The grade II chondrosarcoma diagnosis was confirmed by postoperative pathology.The patient underwent radical tumor resection and chest wall reconstruction with a locking plate and cement spacer.The patient was discharged 1 wk after surgery without any complications.At the 1-year follow-up,there was no local recurrence on imaging.The functional scores,including Constant Score,Nottingham Clavicle Score,and Oxford Shoulder Score,showed the absence of pain in the performance of daily activities or substantial functional disabilities.CONCLUSION The diagnosis of chondrosarcoma must be considered when chest wall tumors are encountered.The surgical reconstructive materials,with a locking plate and cement spacer,used in our study are cost-effective and readily-available for the sternum defect.

Reconstruction of complex chest wall defects:A case report

BACKGROUND Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy.If not treated early,then symptoms such as erosion,bleeding and infection will appear on the skin.In severe cases,ulcers invade the ribs and pleura,presenting a mortality risk.Small ulcers can be repaired with pedicle flaps.Because radioactive ulcers often invade the thorax,surgeons need to remove large areas of skin and muscle,and sometimes ribs.Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARY A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer.The patient was diagnosed with chronic radioactive ulceration.After multidisciplinary discussion,the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator(DIEP)flap combined with a high-density polyethylene(HDPE)patch.The patient was followed-up 6 mo after the operation.No pigmentation or edema was found in the flap.CONCLUSION DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

Reconstruction of the chest wall after resection of malignant peripheral nerve sheath tumor:A case report

BACKGROUND Malignant peripheral nerve sheath tumors(MPNSTs)are a group of rare and aggressive sarcomas that often arise from major peripheral nerves and represent a notable challenge to efficacious treatment.MPNSTs can occur in any body surface and visceral organs with nerve fiber distribution.The treatment options for MPNSTs include surgery,chemotherapy,and adjuvant radiotherapy.CASE SUMMARY A 26-year-old female cellist presented with chest pain on her left side when she squatted to lift the cello.One week later,a chest X-ray was performed and revealed fracture of the fourth rib on the left side.Three months later,the patient inadvertently touched a mass on the left side of the chest wall.Chest computed tomography(CT)three-dimensional reconstruction of the ribs revealed bone destruction of the fourth rib on the left side with a soft tissue mass shadow measuring 5.7 cm×3.7 cm.CT-guided puncture biopsy of the tumor showed that heterotypic cells(spindle cells)tended to be nonepithelial tumor lesions.PET-CT demonstrated bone destruction and a soft tissue mass with avid 18F-fluorodeoxyglucose activity(SUVmax7.5)in the left fourth rib.The tumor of the left chest wall was resected under general anesthesia,and reconstruction of the chest wall was performed.The postoperative pathological report exhibited an MPNST.CONCLUSION MPNSTs are relatively chemo-insensitive tumors.The mainstay of treatment for MPNSTs remains resection with tumor-free margins.

Recurrent and Invasive Primary Squamous Cell Carcinoma of the Chest Wall: A Case Report

Squamous cell carcinoma is a type of skin cancer with abnormal proliferation of keratinocytes. Its incidence reaches approximately 20% of cases of non-melanoma skin cancer, which has increased in recent decades due to growth in life expectancy, increased sun exposure, the use of tanning beds and improved detection of this type of tumors. We present a patient who was diagnosed with a squamous cell skin carcinoma in the chest wall, treated initially with surgical resection. A few years recurred in the same place, so the patient received radiotherapy with poor response. Ultimately a new surgical approach was performed with a wide margin resection by a multidisciplinary surgical team. Multidisciplinary management in this type of procedure is important so that the long-term result is optimal for the patient.

Diagnosis and Surgical Treatment of 105 Cases with a Tumor of the Chest Wall

OBJECTIVE To summarize the experience in diagnosis and surgical treatment of 105 cases with a tumor of the chest wall,and to investigate re-construction of a large chest-wall defect after resection of a chest wall tumor.METHODS Clinical data from 105 patients with a tumor of the chest wall were retrospectively analyzed.There were 78 males and 27 females with ages ranging from 6 to 70 years.Of the 105 cases,94 had a primary tumor,among which 75 were benign,19 malignant and the other 11 metastatic.After a resection of a chest-wall tumor in 19 patients,reconstruction of the large chest-wall defect was conducted.RESULTS All surgical operations were smoothly performed,without an intraoperative death.The results of postoperative follow-up were as follows:48 patients with a benign tumor were still living and well,16 patients with a benign tumor died of other diseases,13 with a malignant tumor survived for a period from 21 months to 8 years,and the others with a malignancy died of local recurrence or distant metastasis.All of the 11 patients with a metastatic tumor died of carcinomatous deseases during a period from 10 to 76 months.CONCLUSION With regard to a primary costal tumor without a patho-logical diagnosis,a restricted radical excision should be conducted first.Use of suitable repairing materials is very important for reconstruction of a mas-sive chest-wall defect.

Innovative combined therapy for multiple keloidal dermatofibromas of the chest wall: A novel case report

Dermatofibromas are benign soft tissue tumors that predominantly affect the limbs, and more rarely the chest.Keloidal dermatofibroma is a rare subtype with distinct clinicopathological features and an aggressive clinical course. By researching the evolution of the disease in this study, we aimed to summarize our experience of managing a rare patient who underwent five surgeries for keloidal dermatofibroma that developed sequentially in the upper arm and chest and propose a novel treatment for keloidal dermatofibroma. We concluded that keloidal dermatofibroma involving larger areas, high tension sites, and multiple localizations can be treated using the principles of pathological scar management.

A Rare Case of a Giant Cavernous Lymphangioma of the Chest Wall in a Child

Cavernous lymphangioma of the chest wall is a very rare disease entity, and only a few cases have ever been documented in the literature. Cases of recurrent cavernous lymphangioma after surgical excision of a cystic lymphangioma on the same side of the chest wall are quite uncommon. We report a case of a 10-year-old girl, with a giant cavernous lymphangioma of the left lateral chest wall extending into the axilla, who had undergone surgical excision of a cystic lymphangioma 9 years earlier.

Primary Chondrosarcoma of the Chest Wall— A Case Report

A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Initial work up of the finding included a CT scan of the chest which revealed a non-calcified, solid right anterior chest wall mass with invasion of the anterior fifth rib and intercostal space. The patient was presented at multidisciplinary conference with the patient’s primary physician, a medical oncologist, radiologist, pathologist and oncologic surgeon in attendance. The decision was to perform surgical resection of the mass to treat this primary mesenchymal malignancy. The anterior aspect of the fifth rib and intercostal muscles were resected with negative margins. Pathology confirmed the mass to be a low-grade chondrosarcoma. Due to the low-grade nature, low metastatic potential and negative margins of the tumor, the decision was made not to pursue adjuvant chemotherapy or radiation therapy. The patient made full recovery.

Melioidosis:a rare cause of anterior chest wall abscess

Melioidosis is an unusual tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei,which was formerly known as Pseudomonas pseudomallei. Melioidosis is characterized by abscess formation and it may manifest in any part of the human body,however,musculoskeletal melioidosis is uncommon and chest wall melioidosis is very rare. To determine the exact organism based solely on clinical presentation poses a great challenge to the physician.Yet,delay administration of antibiotic may be harmful.We describe a diabetic patient who had anterior chest wall melioidosis that mimics Staphylococcus aureus infection.A description of his presentation and management,along with a review of literature is presented.

Transcatheter arterial embolization for chest wall metastasis of hepatocellular carcinoma

Hemothorax due to rupture of metastatic hepatocellular carcinoma (HCC) is a very rare complication with high mortality because of uncontrollable hemorrhage. A 71-year-old man treated by transcatheter arterial embolization for HCC with massive bleeding from chest wall metastasis is reported. Enhanced computed tomography and selective intercostal angiogram showed a hypervascular mass in the right chest wall and extravasation of contrast agent. After successful transcatheter arterial embolization with gelatin sponge particles and metallic coils, the patient recovered from shock without major complication. To our knowledge, a successfully treated case of hemothorax due to rupture of metastatic HCC has not previously been described.

Chest Wall Reconstruction with Precontoured Locking Plate Proof of Concept

Complications after chest wall resection are common and are reported to occur in approximately 40% of patients. The most frequent complications are respiratory or wound complications. Restoring rib continuity after a resection is likely to prevent respiratory complications. However many patients remain painful after a reconstruction. This article describes a new technique using a titanium alloy precontoured locking plate and locking screws to reconstruct the chest wall after resection of the 7th rib on the left.