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PubMed1985

Sarcomas arising after radiotherapy for peptic ulcer disease.

Therapeutic gastric irradiation has been used to reduce peptic juice secretion in patients with peptic ulcer disease. Between 1937 and 1968 a total of 2049 patients received such therapy at the University of Chicago. Three of these patients are known to have developed sarcomas in the field of radiation. Two gastric leiomyosarcomas of the stomach were diagnosed 26 and 14 years after treatment and a malignant fibrous histiocytoma of the anterior chest wall was removed six years after gastric irradiation. Of 743 peptic ulcer patients treated without irradiation and constituted as a control group for the study of therapeutic gastric radiation, none is known to have developed sarcoma. As the incidence of sarcoma in these patient groups is known only from the tumor registry of the University of Chicago, other cases of sarcoma may exist in the groups. While an increased incidence of sarcoma has not been proven to occur in patients who received therapeutic gastric irradiation for peptic ulcer disease, the possibility of such a risk should be borne in mind by physicians caring for such patients.

Adult↗
PubMed1994

Malignant melanoma incidence in Connecticut (United States): time trends and age-period-cohort modeling by anatomic site.

This study examined time trends and age-period-cohort patterns in the incidence of cutaneous malignant melanoma (CMM) by gender and anatomic site in Connecticut (United States) between 1950 and 1989, using data from the population-based Connecticut Tumor Registry. A total of 8,249 invasive CMM incident cases were included. Cases were grouped into melanomas of the head and neck, upper limb, lower limb, and trunk. Between 1950 and 1989, rates increased substantially for all sites. The largest relative increases occurred in melanoma of the upper limb for both males and females; the largest absolute increase occurred for melanoma of the trunk in males; and the smallest increase occurred in head and neck melanoma in females. Recent trends for time periods 1970-89 among birth cohorts 1930-69 indicated that the rate of increase of CMM is slowing substantially among males, but not among females. Nevertheless, continued overall increases in CMM incidence are likely in Connecticut in the 1990s in both genders, with a decrease in the male-female ratio. The age-period-cohort patterns were significantly different between the genders and among anatomic sites, suggesting different trends in carcinogenic exposures (mainly ultraviolet radiation from the sun) or etiologic distinctions between males and females and among the sites.

Adult↗
PubMed1981

Adjuvant CMF effect on site of first recurrence, and appropriate follow-up intervals, in operable breast cancer with positive axillary nodes.

From June 1973 to May 1978 a total of 845 patients with operable breast cancer were entered into different adjuvant programs. The medical records of the 278 patients showing relapse were carefully re-evaluated to assess the pattern(s) of first recurrence and the consistency of follow-up modulation. Ninety-one of 179 patients treated with surgery alone, 130 of 414 given 12 cycles of adjuvant CMF and 57 of 252 treated with 6 cycles of CMF showed treatment failure within 5 years from radical mastectomy. The frequency of new disease manifestations was significantly affected by primary treatment, since patients given adjuvant CMF showed a lower tendency to recur in local-regional area(s) and in bone(s). However, in relapsed patients, patterns of new lesions were not substantially altered by type of primary treatment. The most frequently involved sites were soft tissues (37.8%) and bones (37%) followed by viscera (34.2%). Retrospective evaluation of X-rays revealed that in 26.2% of osseous metastases, diagnosis could have been assessed earlier, with a median delay of 4 months (range 1-8). Present analysis also revealed that short-term repeated X-ray examinations yielded findings more controversial than reliable for assessing the exact time of relapse, thus preventing firm conclusions in the presence of suspicious recurrence. A new follow-up schedule after completion of adjuvant chemotherapy is proposed, since on the basis of our experience, in asymptomatic patients frequently repeated examinations are not necessary and some can safely be omitted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Contribution of videothoracoscopy to the management of the cancer patient.

BACKGROUND: Videothoracoscopy has rapidly become a popular procedure, but its technical feasibility has been emphasized without critically evaluating its role in the management of thoracic disease. To assess the value of videothoracoscopy in the diagnosis and staging of the cancer patient and to determine if it has added to our previous standard approach of thoracoscopy performed with a mediastinoscope without video, we established a prospective database when we initiated videothoracoscopy in January 1992. METHODS: Patients were offered videothoracoscopy as an alternative to thoracotomy only if other standard approaches (e.g., needle biopsy, mediastinoscopy) were inadequate to diagnose or stage cancer or to restage patients after therapy. Parameters entered and analyzed in a prospective database were patient name; age; sex; past history; indications for videothoracoscopy; procedure type; surgical technique; whether conversion to thoracotomy was necessary, and if so, why; complications; and pathology. A complete case list of thoracoscopies performed in 1991 before videothoracoscopy was available provided historical comparison. RESULTS: From January 1 to December 31, 1991, 82 patients underwent thoracoscopy using a mediastinoscope for diagnosis and therapy of pleural disease. From January 1 to July 31, 1992, 160 patients (male:female = 81:79; mean age 56 years) had videothoracoscopy; 72 of 160 patients (44%) had procedures that previously would have required thoracotomy: 69 lung wedge resections, one pericardial window, one pleurectomy, one mediastinal node sampling. No major resectional procedures (e.g., lobectomy, esophagectomy) were performed by videothoracoscopy. Twenty-two percent of all patients (35 of 160), and 23% of wedge resection patients (16 of 69) required conversion to thoracotomy because videothoracoscopy was inadequate for diagnosis or staging. Reasons for conversion (multiple reasons in five patients) included further resection required in 23 patients; inability to evaluate lesion in 11; adhesions in five; and inability to tolerate one lung ventilation in two. The chest tube was in place postoperatively for a mean of 2.3 days. Thirty-day postoperative complications included ventilation for > 48 h in one patient; prolonged air leak in one; pneumonia in one; arrhythmia in one; and death from progressive disease in two. CONCLUSIONS: Although the role of videothoracoscopy in the treatment of primary thoracic malignancies and pulmonary metastases is still undefined, this early experience indicates that videothoracoscopy often enhances the ability to diagnose and stage patients by obviating thoracotomy.

Adult↗
PubMed2005

[Oncoplastic surgery for thoracic wall tumours].

INTRODUCTION: Surgical treatment of tumours of the chest wall (primary or metastatic) requires special skills by the thoracic and the plastic surgeons, from the functional as well as the aesthetic perspective (oncoplastic surgery), when the treatment requires surgical reconstruction. MATERIAL AND METHODS: We present a series of 14 patients who needed extensive resection of the thoracic wall (external and/or 3 or more ribs) with disease-free margins and reconstruction with prostheses (7 with polytetrafluoroethylene [PTFE(R)] and 7 with the Sandwich Marlex-Methyl Metacrylate) technique with additional covering with muscle-skin flaps (6 pectoral, 5 recto-anterior, 3 dorsal) pedicled during the same surgical intervention. RESULTS: The aetiology of the extirpated tumours, following pathology assessment, were: 4 chondrosarcoma, 3 metastatic sternum, 2 breast cancer relapse, 1 desmoid tumour, 1 neurofibrosarcoma, 1 rhabdomiosarcoma, 1 malignant schwannoma and 1 radiation induced sarcoma. One patient died from complications and another 4 from disease progression before the conclusion of the study follow-up (3-22 months). CONCLUSIONS: Extensive resection of tumours of the chest wall with reconstruction using prostheses and muscle-skin flaps is a safe method that can be performed in the same surgical intervention period when combining the skills of the thoracic surgeon with that of the plastic surgeon.

Adult↗
PubMed2000

Elastofibroma dorsi.

It is often difficult to identify the characteristics of soft-tissue tumors of the chest wall. This paper describes the peculiarities of elastofibroma dorsi, a rare pseudotumor of this site, to exclude many dangerous misconceptions. During the period between 1987 and 1997, we treated nine patients with elastofibroma dorsi. In six patients, the lesion was unilateral and in three it was bilateral. All these lesions were excised and no evidence of local recurrence or shoulder disability was observed at the last clinical evaluation. Elastofibroma dorsi is a rare, slow-growing, pseudotumoral lesion of the soft tissues of the chest wall with a peculiar radiographic and histologic pattern.

Aged↗
PubMed2004

[Interdisciplinary surgery of the thorax-from the general surgeon's point of view].

Interdisciplinary professional management is the most important basic principle for successfully mastering thoracic operations including the thoracic wall and adjacent regions such as neck, axilla, mediastinal vessels, upper limb, and spine. Extended oncological resection in advanced malignant diseases, side-effects of radiotherapy and trauma explain the diversity of possible operative procedures. For technical success, the necessity of vascular grafting, reconstruction of the brachial plexus, spine surgery, cardiac surgery, plastic thoracic wall reconstruction, stabilization of the thoracic wall, modern equipment, and know-how are mandatory. We chose some show-cases which-in our opinion-might be appropriate for demonstrating interdisciplinary therapy management. Functional, oncological, and cosmetic/reconstructive aspects should be considered when approaching these cases.

Humans↗
PubMed2004

[Differential diagnosis of soft tissue sarcomas].

INTRODUCTION: Soft tissue sarcoma often goes undetected. PATIENTS AND METHODS: Over a 10-year period, the patients referred to us with a soft tissue tumor (STT) of the extremities and wall of the trunk were analyzed retrospectively. The aim of the present study was to investigate the differential diagnoses, the number of incompletely operated STS, and local recurrences together with their percentage fluctuations. RESULTS: A total of 490 patients with an STT were referred to our department, and of these patients 55% were diagnosed with an STS. In addition to STS, the differential diagnoses for STT included 2% lymphomas, 18% isolated carcinoma metastases, 18% benign mesenchymal tumors, 5% inflammatory processes, and 2% old hematomas. Only 45% of the STS had not undergone previous surgery. Of these, 15% had been incompletely resected, while 39% of the STS patients were admitted with a local recurrence. Within the 10-year period, referrals with STT and STS remained relatively constant, but referrals of patients with incompletely resected or recurrent STS doubled in the last 2 years under observation. DISCUSSION: In view of the numerous differential diagnoses of an STT, both the possibility of an STS and also carcinoma manifestations in the soft tissues should receive more attention. With the aim of reducing the relatively high number of STS re-resections and local recurrences, the treatment of patients with suspicious STT should be reserved for a specialized center.

Abdominal Neoplasms↗
PubMed2000

[Presternal verrucous carcinoma].

Verrucous carcinomas represent rare, highly differentiated variants of squamous cell carcinoma. They preferentially develop on the oropharyngeal mucosa (Ackerman tumor), the urogenital mucosa (Buschke-Loewenstein tumors), and the soles of the feet (epitheliomata cuniculata). Various synonyma have been coined for these tumors. We report the uncommon occurrence of a large verrucous carcinoma on apparently uninvolved chest skin of a 79-year old patient. The tumor was excised radically. Complete extirpation was confirmed histologically and there was no sign of recurrence during a 3 month observation period. The clinical appearance, histomorphological features, epidemiological aspects, differential diagnosis, therapy, and nomenclature of verrucous carcinomas are discussed.

Aged↗
PubMed2003

Pleuropulmonary blastoma with a large embolic cerebral infarct.

We report on a 3-year-old girl who developed a large embolic cerebral infarct 1 day after an uneventful thoracotomy to remove a large pleuropulmonary blastoma. The tumour had encased the heart and great vessels and ruptured into the left hemithorax. Pleuropulmonary blastoma is a rare, but unique, primary thoracic neoplasm in young children and, to our knowledge, the development of a secondary large embolic cerebral infarct is also uncommon and has not been reported in this tumour.

Cerebral Infarction↗
PubMed2006

An unusual case of grass inflorescence aspiration presenting as a chest wall tumour.

A 9-year-old boy was referred to the Oncology Department because of a thoracic soft-tissue mass thought to be a chest wall tumour. He had a history of grass inflorescence (Hordeum murinum) aspiration 2 weeks prior to this admission. On physical examination a tender soft-tissue mass under the right scapula and diminished breath sounds from the right lower lobe were detected. Thoracic CT confirmed soft-tissue swelling of the right posterior chest wall. There was a hypodense area within the soft-tissue mass suggesting a foreign body and also focal consolidation of the right lower lobe adjacent to the soft-tissue swelling. We report here unique CT findings of grass inflorescence aspiration before and after its migration through the airways.

Abscess↗
PubMedDate not supplied

Recurrent ovarian malignancy: patterns and spectrum of imaging findings.

Ovarian carcinoma is the most common cause of death from a gynecologic malignancy. The most important prognostic factors are the presence and magnitude of residual or recurrent disease after therapy. Recurrent ovarian malignancy usually manifests as pelvic masses in the surgical bed, peritoneal seeding, nodal recurrence and pleuropulmonary lesions, and liver metastasis. Pelvic recurrence involves the vaginal stump, parametria, urinary bladder, and/or bowel adjacent to the surgical bed. Peritoneal seeding presents as nodules on the peritoneal surface, most commonly around the liver or cul-de-sac, and mesenteric infiltration. Pseudomyxoma peritonei is the other form of peritoneal seeding. Nodal recurrence appears as enlarged paraaortic nodes, especially at the renal hilar level. Unusual manifestations include metastasis in the extrahepatic abdominal solid organs, bone metastasis, and abdominal wall lesion involving subcutaneous fat or muscle. Familiarity with the patterns and spectrum of imaging findings of recurrent ovarian malignancy will facilitate accurate diagnosis and prompt treatment.

Abdominal Neoplasms↗
PubMedDate not supplied

Endoscopic balloon dissection for removal of lipomas via transaxillary route.

Minimally invasive techniques and newer endoscopic surgical techniques are being introduced to aesthetic and reconstructive procedures at an accelerating pace. A new and modified technique of endoscopic excision of large encapsulated lipomas is presented and the versatility of creation of an optical cavity and incorporation of balloon dissection is discussed in two cases. Large encapsulated lipomas were removed endoscopically via transaxillary incisions and no immediate or late complication was observed. Endoscopic removal of lipomas offers several advantages over conventional direct excision and liposuction such as avoiding blind manipulation and fragmentation of lipoma mass, and unsightly scars. One drawback of this technique can be lengthy operation times, which have been near two hours for the presented cases. We conclude that endoscopic removal of tumors from a relatively remote site is beneficial in treating such encapsulated tumors and we speculate that endoscopy will prevent unsightly scarring in important areas while decreasing the operating time as experience is gained.

Adult↗
PubMed2005

The results of surgical treatment of chest wall tumors in childhood.

Chest wall tumors (CWT) are rarely seen in childhood and surgery constitutes a complementary part of the therapy. The early and late results of CWT resection and chest wall reconstruction were evaluated retrospectively. The children who underwent chest wall resection for CWT between January 1990 and November 2003 were evaluated retrospectively. Seventeen children (male/female = 12/5, mean age: 7.58 years) underwent chest wall resection for CWT. Fifteen patients underwent initial biopsy (tru-cut, n = 8 or open biopsy, n = 7) and two underwent initial resection. The diagnosis was malignant tumor in 12 (70%) and benign in 5 (30%). They were Ewing's sarcoma (ES) (n = 4), primitive neuroectodermal tumor (PNET) (n = 3), Askin's tumor (n = 1), rhabdomyosarcoma (RMS) (n = 2), neuroblastoma (n = 2), osteochondroma (n = 1), aneurysmal bone cyst (n = 2) and hamartoma (n = 2). Preoperative chemotherapy was given to most patients with malignant tumor. All patients had only local tumor at the time of resection. Thoracotomy was performed in all patients. All tumor tissues with the affected rib/ribs were resected en bloc with the adjacent tissues. The number of resected ribs was 1 (n = 6), 2 (n = 7) and 3 (n = 4). Chest wall defects were repaired primarily (n = 8) or with grafts (n = 9). Dura (n = 4), Neuro-patch (n = 3) and Goretex (n = 2) were used for closure. Wound infection and pleural fistula occurred in one patient. Patients with benign tumor were free of complaints or complications during follow up. All patients with malignant tumor received postoperative chemotherapy. Local recurrence did not occur in all patients. Five patients developed distant metastasis and two died. Scoliosis was encountered in one patient during follow-up. Since most of the CWT are malignant and not initially suitable for surgical excision, the management includes tissue diagnosis either by tru-cut or open biopsy. Determination of malignant condition should be followed by an intensive chemotherapy. Chest wall resection is planned to control local disease. Chest wall reconstruction may be needed for large defects following resection of CWT. Prosthetic materials can be used safely. Early complications of the surgery are limited. The patients should be closely followed up for late complications such as scoliosis, restrictive pulmonary disease and for the development of metastasis, which is a part of natural course of malignant CWT in children.

Adolescent↗
PubMed2006

Successful treatment of malignant fibrous histiocytoma originating in the chest wall: report of a case.

Malignant fibrous histiocytoma (MFH) rarely originates in the chest wall, so its clinical features are not well defined. We report a case of MFH that recurred locally 3 years after primary resection. The patient, a 59-year-old woman, underwent wide excision, and is alive without recurrence 7 months after the operation. We reviewed the clinical features and treatment strategies of the total 39 cases of MFH originating in the chest wall reported from Japan. The fact that all patients who underwent wide excision with negative margins at the primary operation were alive without recurrence at the time of each report, despite a local recurrence rate as high as 40%, shows the importance of this operative strategy. Thus, early diagnosis of MFH of the chest wall is essential for improving the outcome of these patients. Neoadjuvant chemotherapy plus radiation therapy may be worthwhile for patients with advanced disease.

Female↗
PubMed1998

Hodgkin's disease of the chest wall: report of a case.

Hodgkin's disease primarily originating from the chest wall is very rare. A 48-year-old man was admitted to our hospital because of an abnormal shadow on a chest X-ray. Radiographic examinations suggested a neurogenic tumor located in the right second-intercostal space, and it was thus extirpated thoracoscopically. The tumor was thought to have arisen from the subpleural space, probably from a lymph node of the chest wall. The resected specimen measured 5.5 x 2.0 cm in size, and the pathological diagnosis was Hodgkin's disease of the diffuse lymphocyte predominant type. A clinical examination showed no other lesions in any other part of the body, including the bone marrow. Following surgery, adjuvant chemotherapy (COPP-ABVD) was given because of the possible scattering of malignant cells during surgery. To the best of our knowledge, this is the first report of Hodgkin's disease originating in the chest wall.

Chemotherapy, Adjuvant↗
PubMed2000

Videothoracoscopic surgery for thoracic neurogenic tumors: a 7-year experience.

While videothoracoscopic surgery has rapidly become accepted as an effective method of performing minimally invasive surgery, the advantages and feasibility of using this surgical technique for the treatment of neurogenic tumors of the thorax are not yet well defined. Between August 1992 and May 1999, 15 solitary thoracic neurogenic tumors were surgically excised using videothoracoscopic surgery in our hospital. The patients comprised six women and nine men, with a mean age of 38.1 years. The mean tumor size was 3.5 cm, with a range of 1.5-6.5 cm and included 12 schwannomas, 2 ganglioneuromas, and 1 neurofibroma. Among the 15 patients, 4 were treated using videothoracoscopic surgery plus minithoracotomy. The only complication associated with videothoracoscopic surgery was hoarseness which developed in one patient. Our experience indicates that videothoracoscopic surgery is a useful alternative to facilitate the excision of small thoracic neurogenic tumors.

Adolescent↗