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.

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.

Histogram Matched Chest X-Rays Based Tuberculosis Detection Using CNN

Tuberculosis(TB)is a severe infection that mostly affects the lungs and kills millions of people’s lives every year.Tuberculosis can be diagnosed using chest X-rays(CXR)and data-driven deep learning(DL)approaches.Because of its better automated feature extraction capability,convolutional neural net-works(CNNs)trained on natural images are particularly effective in image cate-gorization.A combination of 3001 normal and 3001 TB CXR images was gathered for this study from different accessible public datasets.Ten different deep CNNs(Resnet50,Resnet101,Resnet152,InceptionV3,VGG16,VGG19,DenseNet121,DenseNet169,DenseNet201,MobileNet)are trained and tested for identifying TB and normal cases.This study presents a deep CNN approach based on histogram matched CXR images that does not require object segmenta-tion of interest,and this coupled methodology of histogram matching with the CXRs improves the accuracy and detection performance of CNN models for TB detection.Furthermore,this research contains two separate experiments that used CXR images with and without histogram matching to classify TB and non-TB CXRs using deep CNNs.It was able to accurately detect TB from CXR images using pre-processing,data augmentation,and deep CNN models.Without histogram matching the best accuracy,sensitivity,specificity,precision and F1-score in the detection of TB using CXR images among ten models are 99.25%,99.48%,99.52%,99.48%and 99.22%respectively.With histogram matching the best accuracy,sensitivity,specificity,precision and F1-score are 99.58%,99.82%,99.67%,99.65%and 99.56%respectively.The proposed meth-odology,which has cutting-edge performance,will be useful in computer-assisted TB diagnosis and aids in minimizing irregularities in TB detection in developing countries.

Tuberculosis Diagnosis and Visualization with a Large Vietnamese X-Ray Image Dataset

Tuberculosis is a dangerous disease to human life,and we need a lot of attempts to stop and reverse it.Significantly,in theCOVID-19 pandemic,access to medical services for tuberculosis has become very difficult.The late detection of tuberculosis could lead to danger to patient health,even death.Vietnamis one of the countries heavily affected by the COVID-19 pandemic,andmany residential areas as well as hospitals have to be isolated for a long time.Reality demands a fast and effective tuberculosis diagnosis solution to deal with the difficulty of accessingmedical services,such as an automatic tuberculosis diagnosis system.In our study,aiming to build that system,we were interested in the tuberculosis diagnosis problem from the chest X-ray images of Vietnamese patients.The chest X-ray image is an important data type to diagnose tuberculosis,and it has also received a lot of attention from deep learning researchers.This paper proposed a novel method for tuberculosis diagnosis and visualization using the deeplearning approach with a large Vietnamese X-ray image dataset.In detail,we designed our custom convolutional neural network for the X-ray image classification task and then analyzed the predicted result to provide visualization as a heat-map.To prove the performance of our network model,we conducted several experiments to compare it to another study and also to evaluate it with the dataset of this research.To support the implementation,we built a specific annotation system for tuberculosis under the requirements of radiologists in the Vietnam National Lung Hospital.A large experiment dataset was also from this hospital,and most of this data was for training the convolutional neural network model.The experiment results were evaluated regarding sensitivity,specificity,and accuracy.We achieved high scores with a training accuracy score of 0.99,and the testing specificity and sensitivity scores were over 0.9.Based on the X-ray image classification result,we visualize prediction results as heat-maps and also analyze them in comparison with annotated symptoms of radiologists.

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.

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.

Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult

Purpose: The complexity of chest radiography (CXR) is a source of variability in its interpretation. We assessed the effect of an interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis. Methods: The study was conducted in Yaounde (Cameroon). Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in medical imaging) interpreted 47 frontal CXR twice two months apart without (R1) and with (R2) the aid of an interpretation grid. We focused on the detection of micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n = 7). Results: The average score for accurate detection of elementary lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and 52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1) than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly variable with a modest improvement for the diagnosis of tuberculosis in R2. Conclusion: Standardized interpretation scheme improved the detection of CXR anomalies and diagnosis of tuberculosis. It significantly improved inter-observer’s agreement in diagnosing tuberculosis but not in detecting most lesions.

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Detecting Tuberculosis from Vietnamese X-Ray Imaging Using Transfer Learning Approach

Deep learning created a sharp rise in the development of autonomous image recognition systems,especially in the case of the medical field.Among lung problems,tuberculosis,caused by a bacterium called Mycobacterium tuberculosis,is a dangerous disease because of its infection and damage.When an infected person coughs or sneezes,tiny droplets can bring pathogens to others through inhaling.Tuberculosis mainly damages the lungs,but it also affects any part of the body.Moreover,during the period of the COVID-19(coronavirus disease 2019)pandemic,the access to tuberculosis diagnosis and treatment has become more difficult,so early and simple detection of tuberculosis has been more and more important.In our study,we focused on tuberculosis diagnosis by using the chestX-ray image,the essential input for the radiologist’s profession,and researched the effectiveness of the transfer learning approach in the case study of Vietnamese chest X-ray images.We proposed four strategies to clarify our hypothesis in different ways of applying transfer learning and different training set types.We also prepared a Vietnamese X-ray image dataset with the support of the VRPACS team to provide the basis for training and testing deep learning models.Our experiments were carried out by applying three different architectures,Alexnet,Resnet,and Densenet,on international,Vietnamese,and combined X-ray image datasets.After training,all models were verified on a pure Vietnamese X-rays set.The results show that transfer learning is suitable in the case study of Vietnamese chest X-ray images with high evaluating metrics in terms of AUC(Area under the Receiver Operating Characteristic Curve),sensitivity,specificity,and accuracy.In the best strategy,most of the scores were more than 0.93,and all AUCs were more than 0.98.

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.

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.

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.

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.

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.

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.

Titanium Rib Plate Technique for Huge Chest Wall Reconstruction

Chest wall reconstruction after en-bloc tumor resection is very important to preserve functional mobility and to enhance the cosmetic effect. Because they are flexible and pliable, titanium plates are proposed to reconstruct the chest wall, even though such chest wall reconstruction has been performed in only a few cases worldwide. We present a case of a 49-year-old man with a chondrosarcoma arising from the left 1st rib, invading the manubrium, clavicle, 2nd and 3rd ribs, and the anterior segment of the left upper lobe. After wide resection, the chest wall was reconstructed using titanium rib plates and Marlex mesh- the Bovine pericardium sandwich type. The patient tolerated the pain well, and fourteen months after surgery, the chest wall was well preserved function mobility and improved pulmonary function test.

Rare Occurrence of Primary Chest Wall Bone Tumours

Primary tumors involving the bony skeleton of the chest wall are uncommon. After a retrospective review of the histopathology archive at our institution from Oct 08 to Mar 09 we found three malignant neoplasms affecting the rib, clavicle and the costal cartilages, one mesenchymal chondrosarcoma, one case of clear cell chondrosarcoma and an aggressive osteoblastoma each having distinctive histological diagnosis. Our limited experience in the occurrence of primary chest wall tumors showed that there are occurrences of rare bony lesions. A strong clinical suspicion, clinico-radiological correlation and histopathological confirmation are required for proper evaluation.

Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm;she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.