Histologic Types of Chest Wall Tumors—Nine Years’ Single Center Experience

Background: Chest wall tumors are rare and mostly malignant. More than half of the malignancies are primary and the remainder are metastatic. Many studies have reported that metastatic lesions occur with about the same frequency as primary tumor. We evaluate common histological types of chest wall tumors in a tertiary center for respiratory and thoracic diseases (National Research Institute of Tuberculosis and Lung Disease). Method: We performed a retrospective study of chest wall tumors at National Research Institute of Tuberculosis and Lung Disease (NRITLD) from April 2001 to March 2010. The pathology slides of patients were retrieved from the pathology archive of NRITLD and reviewed by two pathologists. The lesions were classified as primary or metastatic according to the relevant clinical data and imaging findings. Result: A total of 124 chest wall tumors were identified in patients with a mean age of 47.7 years (range 4-90 years). The male/female ratio was 2:1. The most commonly affected side was the right (42.7%). There were 105 malignant tumors (84.7%), out of which 49 (46.2%) were primary and 57 (53.8%) were metastatic in origin. The majority of the metastatic lesions were epithelial tumors (36/57) (63.1%). The metastatic origin was clear in 51 cases, mostly arising from the lungs (35.7%). The most common types of primary chest wall tumors were primitive neuroectodermal tumor (15/49, 30.6%), chondrosarcoma (7/49, 14.3%), and malignant fibrous histiocytoma, undifferentiated pleomorphic sarcoma (5/49, 10.2%). The most common benign tumor was lipoma (5/18, 35.7%). Conclusion: Most common tumors of chest wall in this study were malignant, mostly metastatic epithelial neoplasms.

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.

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.

HIGH-INTENSITY FOCUSED ULTRASOUND FOR TREATMENT OF UNRESECTABLE TUMORS LOCATED IN THE WALLS OF CHEST AND ABDOMEN IN 10 PATIENTS

Objective: To present our results of high-intensity focused ultrasound (HIFU) treatment in 10 patients with unresectable tumors involved in the walls of chest and abdomen. Methods: Tumors located in the walls of the chest and abdomen in 10 patients were treated by HIFU, including local recurrence of fibrosarcoma in 1 case and local invasion or metastases in 9 cases. All of the 10 patients had received anti-cancer treatments before HIFU, 3 patients were complicated with intercostal neuralgia. Results: Partial responses were obtained in 2 patients, minor response in 1 patient, stable disease in 4, progressive disease in 2 after HIFU treatments. All the intercostal neuralgia in 3 patients was disappeared after HIFU. Bone scan showed that site of rib metastasis before HIFU became normal after HIFU in one patient. Conclusion: Our preliminary results showed that HIFU could get good results for patients with malignant tumors located in the walls of chest and abdomen if they are focal tumors, even if they are complicated with rib metastasis.

A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach

A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.

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.

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.

动脉栓塞联合局部消融治疗复发性、难治性胸壁肿瘤

目的 初步探讨动脉栓塞联合局部消融治疗复发性、难治性胸壁肿瘤的安全性和疗效。方法 回顾性分析11例术后复发、治疗后进展的胸壁肿瘤患者,在原治疗方案的基础上联合DSA引导下动脉栓塞和CT引导下局部消融治疗,观察患者疼痛缓解情况(VAS评分)和术后并发症,并评价治疗疗效。结果 随访率100%,中位随访时间为18.5个月。所有患者均成功实施DSA引导下动脉栓塞术,7例患者9个病灶首程行CT引导下射频消融治疗,2例患者复发再次行射频消融治疗。4例患者5个病灶首程行CT引导下微波消融治疗,1例患者复发再次行微波消融治疗。根据mRECIST评价标准,6、12、18个月有效率(ORR)分别为72.7%(8/11)、45.5%(5/11)、18.2%(2/11),6、12、18个月总生存率分别为81.8%(9/11)、63.6%(7/11)、27.3%(3/11),中位生存期为13.2个月。术后1、3个月VAS评分分别为(2.42±1.25)分、(1.91±1.24)分,明显低于术前(6.78±1.13)分,差异有统计学意义,P<0.05。3例患者术后出现胸腔积液,给予穿刺引流后,胸腔积液消失;2例患者术后发热,对症治疗后发热好转;1例患者治疗后6个月因呼吸衰竭死亡。结论 动脉栓塞联合局部消融可改善胸壁肿瘤患者疼痛症状,延长生存期,而且创伤小、安全性好,可作为复发性、难治性胸壁肿瘤患者一种有效的治疗办法。

Traumatic giant cell tumor of rib: A case report

BACKGROUND Giant cell tumor(GCT)of the anterior rib origin is extremely rare.We report the first case of trauma-induced GCT of the rib.CASE SUMMARY A 22-year-old female developed a mass over the right anterior chest wall with pain 3 mo after a falling injury with blunt trauma of the right chest wall.Chest computed tomography(CT)showed a tumor originating from the right 6th rib with bony destruction,and a CT-guided needle biopsy revealed a GCT.We completely resected the tumor with chest wall and performed reconstruction.The pathological diagnosis was GCT of the bone.Twelve months after surgery,no signs of recurrence were observed.CONCLUSION GCT of the rib after trauma has not been reported.Meticulous history-taking and image evaluation are essential for the differential diagnosis of unusual chest wall tumors.

Infiltrating angiolipoma of the thoracic wall: A case report

We describe a case of infiltrating angiolipoma of the thoracic wall, which is an extremely unusual site for this tumor. Infiltrative angiolipoma is a rare benign soft tissue tumor that commonly affects the extremities and the trunk. This is the first report of infiltrative angiolipoma that affects this site. Magnetic resonance imaging (MRI) revealed a high intensity signal on T2-weighted images and contrast enhanced images showed moderate enhancement effect that mimicked tumors of neurogenic or vascular origin. Angiolipoma should be included in a differential diagnosis of the thoracic wall tumor with T2 high intensity signal and contrast enhancement that is not typical shape and signal for neurogenic tumor or hemangioma.

Askin Tumor in Egyptian Patients;5 Years Experience at the National Cancer Institute, Cairo University

Background: Askin tumor is a primitive neuroectodermal tumor of the Ewing sarcoma family arising from soft tissues of the chest wall. It is the commonest chest wall malignancy in children and adolescents. Its diagnosis is complex and management requires a multidisciplinary work including chemotherapy for systemic disease and radiation therapy to assist local control which is achieved through surgery with or without reconstruction. Objective: To analyze report and understand the clinicopathological features, results and outcome of this tumor with assessment of early and late postoperative complications following resection and chest wall reconstruction. Materials and Methods: This is a retrospective analysis of 30 cases with chest wall ES/PNET presented to the National Cancer Institute;Cairo University between January 2011 and December 2015. All patients’ records were revised for age, sex, clinical presentation, imaging, pathology, operative notes, different treatment modalities given, early and late postoperative complications following surgical resection or reconstruction, and outcome including overall survival (OS) and disease free survival (DFS). Results: Our cohort included 30 patients with chest wall ES. The median follow up period (n = 30) was 33.7 months (ranging from 3.7 to 69.3 months). The median OS was 54.2 months with cumulative OS at 60 months which was 45.6%. The median DFS was 27.9 months with cumulative DFS at 60 months which was 40.6%. All cases were below 18 years with a male predominance (n = 19). The commonest affected sites were ribs (n = 22, 73.3%), the scapula (n = 5, 16.6%), the clavicle (n = 2, 6.66%) and the sternum (n = 1, 3.33%). 23 patients (76.6%) were presented with localized disease, and 7 patients (23.4%) were metastatic from the start. All patients received neoadjuvant chemotherapy (4 cycles of VAC/IE) followed by local control: either surgery (26 cases, 86.6%) or radical radiotherapy (3 cases, 10%). A single case of a rib ES with initial bilateral lung deposited where no local control was done. After chest wall resection, closure of the defect was done by 1 ry closure with no reconstruction or double layer prolene mesh and bone cement that was covered by pedicled flap (latissimus dorsi, serratus anterior or pectoralis major muscle flap). Postoperative radiation therapy was given to 9 patients: 4 (13.3%) had postoperative poor chemotherapy effect (<90% tumor necrosis), 3 (10%) had +ve microscopic safety margin and 2 (6.6%) had pleural based nodules with malignant pleural effusion at initial presentation. Conclusion: Askin’s tumor shows a dramatic response to polychemotherapy. Treatment of such tumor should include multidisciplinary working groups for optimum results and better survival.

思维导图联合回授法健康教育模式在骨与软组织肿瘤病人胸壁输液港护理中的应用

目的:探讨思维导图联合回授法健康教育模式在骨与软组织肿瘤病人胸壁输液港护理中的应用效果。方法:便利选取2018年10月—2019年12月在河北省某三级甲等医院植入胸壁输液港的骨与软组织肿瘤病人35例为对照组,实施常规健康教育;选取2020年2月—2021年2月植入胸壁输液港的骨与软组织肿瘤病人35例为观察组,在常规健康教育基础上,于输液港植入当日及出院前采用思维导图联合回授法健康教育模式进行健康教育。比较两组病人胸壁输液港相关并发症发生率、维护依从性及胸壁输液港自我管理水平。结果:两组病人胸壁输液港相关并发症发生率、维护依从性及自我管理能力量表评分比较差异均有统计学意义(P<0.05)。结论:思维导图联合回授法健康教育模式可有效降低病人胸壁输液港相关并发症发生率,提高胸壁输液港维护依从性及自我管理水平。

乳腺癌改良根治术后胸壁复发结节的超声图像特征及预测模型构建

目的总结乳腺癌改良根治术后胸壁复发结节的超声图像特征,并构建预测模型,探讨其应用价值。方法选取我院102例乳腺癌改良根治术后胸壁结节患者,其中恶性结节57例(复发组),良性结节45例(良性组),比较两组超声图像特征;应用多因素Logistic回归分析筛选乳腺癌术后胸壁结节恶性风险预测因素,并建立预测模型,分析其预测胸壁结节恶性风险的诊断效能。结果两组结节最大径、数目、累及组织层次、边界、形态、钙化、周围组织回声变化、血流分级和间隔时间比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,胸壁结节最大径、数目、边界、血流分级、间隔时间是乳腺癌术后胸壁结节恶性风险的独立影响因素(均P<0.05)。建立预测模型为:Logit(P)=-5.126+0.086X1+2.315X2+2.549X3+1.874X4+1.945X5(X1:病灶最大径,X2:病灶数目,X3:边界,X4:血流分级,X5:间隔时间),其预测胸壁结节恶性风险的灵敏度、特异度、准确率、曲线下面积及95%可信区间分别为91.2%、82.2%、87.3%、0.935(0.890~0.979)。结论基于超声图像特征构建的预测模型能有效评估乳腺癌改良根治术后胸壁结节恶性风险。

开展胸腔镜经剑突下路径切除胸腺肿瘤的可行性分析

目的对比胸腔镜下经剑突下切口与经侧胸壁切口治疗胸腺肿瘤的临床效果,探讨胸外科开展经剑突下切口治疗胸腺肿瘤的安全性及可行性。方法选取我科自2017年1月-2023年1月采用胸腔镜手术治疗胸腺肿瘤患者的临床资料,共43例入组,其中经剑突下切口20例,经侧胸壁切口23例,分析两组的治疗效果。结果两组在手术时间,术后带管天数,术后住院天数,切除的瘤体大小及术后总体并发症上差异均无统计学意义(P>0.05),在术中出血量及住院费用方面剑突下三切口组较经侧胸壁组更低,两组有统计学差异(P<0.05)。结论胸外科医生开展胸腔镜经剑突下切口治疗胸腺肿瘤是安全的,可行的。

妇科恶性肿瘤患者应用完全植入式静脉输液港相关并发症规避方法分享

癌症是危害居民健康的重大公共卫生问题。周期性化疗是妇科恶性肿瘤患者的主要治疗方式之一。应用安全、价格低廉以及放置和维护周期长的静脉输液装置是化疗药物发挥作用的重要保障,也是提高患者治疗效果和生活质量的重要保障。目前,完全植入式静脉输液港是妇科恶性肿瘤化疗中最常用的静脉输液通路,其在临床应用中可能发生术中及术后并发症。本文通过检索国内外文献并总结临床工作经验,对妇科恶性肿瘤应用完全植入式静脉输液港相关并发症的预防及管理进行总结,以期为临床妇科医护人员提供参考,推动中心静脉通路应用与管理方法的健康可持续发展。

胸壁肿瘤切除后胸壁重建方法的探讨

目的：探讨胸壁肿瘤切除后胸壁重建的方法。方法：从1986－1998年对29例胸壁肿瘤切除后病人采用多种术式进行了胸壁重建，骨性胸壁的修复包括采用自体组织（阔筋膜、肌瓣、大网膜）及人工替代物（金属支架、钛合金片、Dacron、及Dacron十骨水泥十Dacron三文治式复合体）。皮肤软组织层的修复主要用岛状背阔肌皮瓣及乳房瓣。结果：无手术死亡及局部复发，无严重并发症，恶性肿瘤术后5年生存率为52％。结论：骨性胸壁缺损6cmX6cm以上需行胸壁重建，一般可用自体组织，必要时加用金属支架，大面积缺损（10cmx10cm以上）以三文治式修复法为理想，皮肤软组织缺损的修复可选用岛状背阔肌皮瓣及乳房劈裂瓣。

Askin瘤6例报告并文献复习

目的探讨Askin瘤的临床特点、影像学和病理特征、诊断、治疗及预后状况。方法复习国内发表的经病理证实的45例Askin瘤病例,结合该院近期收治的6例Askin瘤病例进行分析。结果 Askin瘤是发生于胸壁的原始神经外胚层肿瘤,临床特征不典型,特征性病理形态是镜下有典型的Homer-Wright菊形团结构,电镜检查显示的胞浆内神经内分泌颗粒为诊断本病的重要依据。免疫组化以CD99、S-100、NSE阳性表达为特征。治疗多采用以手术为主的综合治疗,治疗效果差,30例患者的平均生存期仅为7个月。结论 Askin瘤是一种发生于胸壁、罕见的神经内分泌瘤,高度恶性,易复发、转移,目前主张综合治疗,预后差。

胸部巨大肿瘤切除术后胸壁缺损的修复

目的：探讨胸壁肿瘤术后几种重建胸壁缺损方法的效果。方法：分析我院自１９６５年５月～１９９８年４月期间所行胸壁大块组织切除及重建７０例，良性肿瘤３８例，恶性肿瘤２３例，转移性肿瘤９例。所有肿瘤均切除３～５根肋骨。胸壁缺损面积８ｃｍ×１５ｃｍ × １９ｃｍ× ２３ｃｍ。１４例用克氏钢针，２５例用不锈钢丝，２６例用涤纶（Ｄｅｃｒｏｎ）网修复胸壁缺损。结果；全组无手术死亡，除３例伤口感染和２例呼吸困难外，其他病人恢复良好。术后分别有５例发生远处转移及局部复发。结论：胸壁缺损修复时，骨性支撑硬质材料以钢丝、软质材料以网状材料为最佳，前胸及侧胸壁的缺损应两种材料同时应用，以防止术后反常呼吸的发生，Ｄａｃｒｏｎ网具有组织相容性好、成本较低等优点，但其制作材料和工艺仍需改进。

胸壁大块缺损外科重建71例报告

目的探讨胸壁大块缺损后不同外科技术重建的效果。方法1995年9月至2005年9月对71例不同病因的胸壁大块缺损患者采用多种方法进行胸壁重建。骨性胸廓重建采用自体组织(肋骨条、阔筋膜、肌瓣)或人工材料(Dacron片、聚四氟乙烯网片+钛合金条、金属丝支架加大网膜片、Dacron和骨水泥构成的三明治式复合体)。皮下软组织修复主要应用转移皮瓣、肌皮瓣或大网膜瓣。结果全组无手术死亡和局部肿瘤复发,2例因感染摘除金属植入物。术后呼吸功能良好,无反常呼吸运动。结论背阔肌瓣和大网膜瓣修复软组织效果较好,后者对因感染引起的胸壁缺损效果更佳。Dacron片和骨水泥构成的三明治式复合体适用于大块骨性胸廓缺损的重建。

巨大原发性胸壁肿瘤的外科治疗

目的总结巨大原发性胸壁肿瘤的治疗经验。方法 23例巨大原发性胸壁肿瘤患者,根据病变部位选择不同的手术切口;有包膜者行瘤体包膜下分离,无包膜处及纵隔、胸壁浸润处则应在相应层次用锐性加钝性法进行分离,直至完整切除肿瘤。必要时切除被累及的心包、肺等组织,尽量保留未累及的胸壁软组织。胸壁缺损的修复材料包括大腿阔筋膜、Dacron补片与网格状钛合金钢板。结果切除瘤体最大直径（15.43±4.83）cm（10~26 cm）;恶性肿瘤18例,良性肿瘤5例,均被完整切除,其中12例行胸壁修复。无一例出现并发症。平均住院时间（9.91±2.56）d。结论术前正确评估肺功能、了解肿瘤与周围组织器官的关系,选择恰当的手术径路、准确的解剖层次及适宜的修复材料是手术成功的关键。