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PubMed2002

Hemithorax irradiation for Ewing tumors of the chest wall.

PURPOSE: In the Cooperative Ewing's Sarcoma Study 86 and the European Intergroup Cooperative Ewing's Sarcoma Study 92, hemithorax irradiation (RT) was performed in patients with Ewing tumors of the chest wall involving the pleura or contaminating the pleural cavity. In a retrospective analysis, the outcomes of these patients were evaluated and compared with those of patients with chest wall tumors who did not receive hemithorax RT. METHODS AND MATERIALS: Between 1985 and 1996, 138 patients presented with nonmetastatic Ewing tumors of the chest wall. They were treated in a multimodal treatment regimen that included polychemotherapy and local therapy depending on the tumor characteristics. Hemithorax RT was performed at a dose of 15 Gy for patients <14 years old and 20 Gy for patients >or=14 years old. Forty-two patients received hemithorax RT (Group 1) and 86 patients did not (Group 2). The data were insufficient for the other 10 patients. RESULTS: Comparing both groups, the initial pleural effusion, pleural infiltration, and intraoperative contamination of the pleural space were significantly more frequent in Group 1. The event-free survival rate after 7 years was 63% for patients in Group 1 and 46% for patients in Group 2 (not statistically significant). The 7-year local relapse rate (including combined local-systemic relapses) was 12% in Group 1 and 10% in Group 2; the corresponding systemic relapse rates were 22% and 39%. CONCLUSION: Patients with chest wall tumors who received hemithorax RT were negatively selected; yet the rate of event-free survival was better for patients who received hemithorax RT than for those who did not (although the difference was not statistically significant). This result was due to a reduction of metastases, mainly lung metastases. Local control was equivalent between the two groups. These favorable results have caused us to continue using hemithorax RT to treat high-risk patients with Ewing tumors of the chest wall.

Adolescent↗
PubMedDate not supplied

Radiology of the lymphomas.

Lymphomas are a group of diseases that provide the radiologist and clinician with unusual challenges. In most cases, an understanding of the histologic classification and staging is essential to design the imaging workup for the patient. Precise staging is critical, particularly for patients with HD and extranodal NHL. The malignant lymphomas share many similar radiographic features, yet have notable differences. An understanding of the pattern of extension of HD is useful in choosing an imaging modality for both staging and follow-up. Contiguous extension of HD follows lymphatic channels and is primarily limited to nodal compartments in the mediastinum and retroperitoneal lymph nodes. On the other hand, NHL may be either widespread or extranodal and localized. In the first instance, the histology will be low grade; in the second, intermediate or high grade. An understanding of these histologic clues is critical to the structuring of an efficient staging workup for the patient with NHL. Posttreatment follow-up imaging strategies should be governed by the fact that in both HD and NHL, recurrences are usually apparent within two years following initial treatment. Treatment complications must be separated from the manifestations of recurrent disease, a particularly important consideration in following up the patient with HD.

Abdominal Neoplasms↗
PubMedDate not supplied

A case of pyothorax-associated lymphoma simulating empyema necessitatis.

We describe a case of a diabetic man with a 40-year history of chronic tuberculous empyema presented with fever, chest pain and bulging soft tissue of the right chest wall. CT scan revealed a huge chest wall mass showing extensive necrosis with air-bubbles and destruction of the ribs. Decortication and extirpation of the chest wall mass were performed, and histopathologic examination confirmed diffused large cell type non-Hodgkin's lymphoma.

Chronic Disease↗
PubMed1989

Intrathoracic manifestations of disseminated prostatic adenocarcinoma.

Four cases of disseminated adenocarcinoma of the prostate illustrating the clinical spectrum of intrathoracic involvement in this disease are presented. In two cases the presenting features of prostatic cancer were with lymphangitis carcinomatosa and an isolated pleural effusion, whereas two other cases developed intrathoracic metastases in the setting of previously known locally advanced prostatic cancer. In one this took the form of hilar and mediastinal lymphadenopathy and in the other that of pulmonary nodules. An immuno-cytochemical marker for prostatic specific antigen, a highly sensitive and specific tool for identifying prostatic epithelium, identified the prostate as the primary site of malignancy in the first two cases. Symptomatic and radiological responses were noted in all four cases after bilateral orchidectomy. Pulmonary metastases are common in the advanced stages of prostatic cancer but may also be present at the initial presentation with the disease even when the primary tumour is not clinically apparent. We recommend that (i) immuno-cytochemical stains for prostatic specific antigen are applied to all lung, pleural and mediastinal biopsy specimens showing adenocarcinoma in male patients, and (ii) all males with intrathoracic adenocarcinoma have prostatic aspiration cytology performed if the prostatic specific antigen stain is positive.

Adenocarcinoma↗
PubMed2001

Primary chest wall tumors: early and long-term results of surgical treatment.

OBJECTIVES: A retrospective study of primary chest wall tumors (PCWTs/CWTs) was conducted to review their clinical, radiological and pathological features, as well as the early and long-term results of surgical management. MATERIALS AND METHODS: From 1986 through 1996, 41 patients (18/44% male, 23/56% female, aged 15-78 years) with PCWTs were treated in our department. RESULTS: Twenty-three patients (nine male, 14 female, mean age 36 years) had a benign CWT: enchondroma, five patients; fibrous dysplasia, four patients; neurilemmoma, three patients; osteochondroma, two patients; granular cell tumor, two patients; fibroma, two patients; lipoma, two patients; fibrolipoma, one patient; eosinophilic granuloma, one patient; aneurysmal bone cyst, one patient. Eighteen patients (nine male, nine female, mean age 59 years) had a malignant CWT: plasmacytoma, five patients; chondrosarcoma, two patients; osteosarcoma, two patients; fibrosarcoma, two patients; desmoid tumor, two patients; leiomyosarcoma, one patient; malignant fibrous histiocytoma, one patient; tendon sheath sarcoma, one patient; hemangiosarcoma, one patient; neurinosarcoma, one patient. The ribs were involved in 21 patients, the sternum in five patients, and the soft tissue in 17 patients. Distinction between benign and malignant CWT was not possible using radiographic criteria alone, and diagnosis was always confirmed histologically. Surgical treatment consisted of wide resection in 29 patients (15 benign/14 malignant CWTs), with the use of synthetic mesh in five cases, and excisional or incisional biopsy in 12 patients. There was no perioperative mortality. Two patients with a benign CWT (fibroma, one patient; neurilemmoma, one patient) had a local recurrence at 13 and 26 months after resection, respectively, and underwent wide resection (recurrence rate 8.7%). Follow-up at 3-13 years revealed one non-tumor-related death in patients with benign CWT (overall mortality rate 4.3%) and no other local recurrence. The overall 5- and 10-year survival in patients with malignant CWT was 33.3%. CONCLUSIONS: We believe that all CWTs should be considered malignant until proven otherwise. Wide resection with tumor-free margins is required in order to provide the best chance for cure in both benign and malignant lesions.

Adolescent↗
PubMed2001

Simultaneous operations in thoraco-abdominal clinical oncology.

OBJECTIVE: To increase radical operability of cases with synchronous multiple primary malignant tumours (SMPTM) of the thorax and abdomen, and of cancer patients with concomitant severe heart disease simultaneous operations are implemented in the clinical practice. METHODS: Twenty-seven simultaneous operations for SMPMT (17) and for cancers of different sites and concomitant cardiac disease (10) were performed at the Surgical Department of Thoraco-Abdominal Oncology, N.N. Blokhin Memorial Cancer Research Centre. All SMPMT cases had lung cancer. The second tumours were gastric cancer (6), oesophageal cancer (7), laryngeal cancer (3) and opposite lung cancer (1). Coronary artery bypass grafting for ischaemic heart disease was made in nine cases simultaneously with lung resection (4), tracheal resection (1), resection of the stomach or gastrectomy (4). Mitral valve commissurotomy and left pneumonectomy for lung cancer was made in one case. RESULTS: Two patients died from therapeutic complications early postoperatively. Median survival after simultaneous operations for SMPMT was 26 months. One patient undergoing simultaneous operation for cardiac disease and lung cancer died from cancer progression at 1 year following surgery. The remaining patients were followed up for 2 years free from evidence of cancer or heart disease. CONCLUSION: Simultaneous operations increase resectability, radicality and functional operability and therefore promise improvement of follow-up results in the most serious category of cancer patients in question.

Abdominal Neoplasms↗
PubMed2003

The role of radiation therapy and chemotherapy in the management of airway tumors other than small-cell carcinoma and non-small-cell carcinoma.

In rare pulmonary tumors, the choice of local and systemic therapy is frequently dictated by the histologic cell type and (generally) by extrapolation from the existing therapeutic literature for that cell type's more common presentation; however, this approach might change. We are in the midst of a new biological and technological era in how approach and treat cancer. In a phase I trial for non-small-cell lung cancer, Hayman et al safely treated with radiation doses as high as 102.9 Gy (to limited volumes) using three-dimensional, conformal radiation [100]. Such techniques facilitate radiation dose escalation for thoracic neoplasms while minimizing normal tissue toxicity, potentially enhancing the therapeutic ratio. Furthermore, the entire human genome has been sequenced recently, and scientists are now in the process of discovering the functions of previously unknown sequences and their protein products. DNA microarrays can be used to analyze small tissue samples for the presence of gene variations or mutations (genotyping), performing the equivalent of several thousand "Southern blot" experiments in only a few days. In the future, patients might receive individually tailored therapy based upon unique molecular-genetic alterations of the tumor.

Bronchial Neoplasms↗
PubMed1998

Dendritic fibromyxolipoma: clinicopathologic study of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma.

Twelve cases are described of a distinctive benign soft tissue lesion that may be mistaken for a sarcoma. The tumors occurred in 11 men and a woman aged 33 to 81 years (mean, 64 years), and measured from 2 to 11 cm in greatest diameter (mean, 6 cm). They were grossly described as soft, well-circumscribed, yellow-gray, with a mucoid cut surface. All cases were superficially located in the subcutis or muscular fascia of the head and neck region or the chest and back. Histologically, the tumors were characterized by a proliferation of spindle or stellate fibroblastic cells variably admixed with mature adipose tissue embedded in an abundant myxoid and collagenized stroma. The spindle and stellate fibroblastic cells were characterized by slender dendritic prolongations of their cytoplasm, which appeared to extend for short distances along connective tissue planes. Electron microscopy in two cases confirmed the dendritic nature of the fibroblastic cells, which showed elongated cytoplasmic processes lacking external lamina and displaying foci of pinocytotic activity. Immunohistochemical studies in 11 cases showed strong positivity of the spindle cells with vimentin, CD34 and bcl-2, and negative staining for smooth muscle actin, muscle-specific actin (HHF35), desmin, S-100 protein, keratin, and EMA. Because of their prominent myxoid stroma and relatively large size, some of these tumors were initially misinterpreted as low-grade sarcomas. Clinical follow-up in five cases, however, showed that the patients were alive and well without evidence of recurrence between 5 and 13 years (mean follow-up, 8 years) after simple local excision. The present cases appear to represent a distinctive form of benign soft tissue neoplasm that should be distinguished from myxoid liposarcoma and other benign and malignant myxoid tumors of superficial soft tissues.

Adult↗
PubMed2000

1. Positron Emission Tomography of Thoracic Malignancies. Reduction of Myocardial Fluorodeoxyglucose Uptake Artifacts With a Carbohydrate Restricted Diet.

Purpose: To reduce the artifact caused by cardiac uptake of F-18 fluorodeoxyglucose (FDG); we investigated the change in myocardial FDG uptake after placing a group of patients on a carbohydrate-restricted diet.Methods: Case control study involving 130 whole body FDG PET scans. 73 scans were of patients on carbohydrate-restriction; the remaining 57 were without dietary restrictions. Dietary intake for the last meal prior to scanning was recorded for both groups. Coronal and axial images were assessed and scored based on myocardial FDG uptake the presence of associated image artifacts.Results: Of the 73 patients on the diet, 50 did not consume carbohydrates, while of the 57 patients without dietary restriction, 13 did not consume carbohydrates. Of the 67 patients from both groups who consumed carbohydrates prior to their PET scan, 17 (25.4%) had a clinically significant image artifact versus only 6 (9.5%) of the 63 patients who did not consume carbohydrates (P = 0.018) in their meals prior to scanning. The odds ratio was calculated to be 3.23 (confidence interval 1.09-10.00), indicating that the risk a clinically significant image artifact will occur is 3.23 times higher for patients who consume carbohydrates in their last meal prior to scanning.Conclusion: A substantial reduction in the prevalence of myocardial FDG uptake image artifacts among patients who did not consume carbohydrates was observed. A carbohydrate dietary restriction prior to scanning may play a significant role in increasing lesion detectability and in preventing false negative scans when imaging for thoracic neoplasm.

Journal Article↗
PubMed2002

[Retropleural paraspinal approach in the treatment of anterolateral thoracic spinal diseases].

The personal experience in the treatment of the spinal and paraspinal thoracic pathology using the paraspinal retropleural approach is presented. A total of 18 patients with neoplastic, traumatic and discal lesions were operated on. Improvement of neurological disturbances and pain was noted in all patients. The surgical technique for spinal cord and root decompression and also for anterior and/or posterior stabilization of the spine is described. The paraspinal retropleural approach is compared with the anterior transthoracic approach. The advantages of the paraspinal retropleural approach are: low rate of complications; allows a very wide decompression of the neurological elements as well as an anterior and/or posterior stabilization of the spine by a single approach; and it can be easily tailored for each lesion. These advantages are enhanced in the management of lesions located in the upper thoracic or thoracocervical levels.

Adolescent↗
PubMed2000

Cutaneous metastasis of chordoma.

BACKGROUND: Chordomas are rare neoplasms that arise from the notochord remnant. They develop in the sacrococcygeal (50%) or cervical (15%) region and are generally regarded as a locally aggressive tumor with a slow progressive growth rate and a metastatic incidence ranging from 3 to 48%. Skin involvement by chordoma is rare, but can occur by direct extension, by local recurrence and by metastases. OBJECTIVE: To illustrate by a case report the clinical presentation and management of this disease. METHODS: We present a case of sacral chordoma with metastases over a 10-year period to the lungs, the soft tissue of the chest wall, the triceps tendon, and distant cutaneous metastases to the back and the nose. RESULTS: The cutaneous metastases were treated by excision. CONCLUSION: Chordoma is a slow growing tumor of the notochord remnant that may metastasize to the skin. Physicians and pathologists should be aware of this entity.

Chordoma↗
PubMed2002

A particular case with long-term follow-up of rare malignant hemangiopericytoma of the lung with metachronous diaphragmatic metastasis.

The authors report the case of a woman with a primary hemangiopericytoma of the lung and successive metachronous diaphragmatic metastasis treated with surgery only according to the patient's decision. The patient was first submitted to left lower lobectomy with resection of diaphragm and three ribs en-bloc for pulmonary sarcoma. One year later, a chest computed tomography (CT) scan showed a small lesion above the diaphragm on the left side. She refused the proposed operation and returned fifteen months later with a new thorax CT, and told us that she had in the meantime become pregnant and given birth. A rethoracotomy to remove the metastatic diaphragmatic tumor was performed. Chemotherapy with anthracycline and iphosphamide was proposed, but the patient again refused therapy for fear of side effects impairing another pregnancy. Currently, the patient is alive and disease-free, 68 months after the first treatment. The authors emphasize the long-term follow-up obtained with surgery alone in this kind of rare sarcoma.

Adult↗
PubMed2005

Thoracoscopic surgery in infants and children.

Numerous investigators have shown that video-assisted thoracoscopic surgery (VATS) can be safely used for specific conditions of newborns, infants, and children. The technique has been postulated to be associated with a lower morbidity, shorter hospital stay, lower costs, and clinical results similar to those achieved by open surgery. The present article reviews the state of the art of VATS for thoracic conditions in children. Most authors focus on the feasibility of single procedures, and only a small number of reports deals with the feasibility in series with multiple types of procedures and larger numbers of patients. Therefore, systematic research on the advantages and limits of VATS in children remains mandatory.

Adolescent↗
PubMed1985

[Ultrasound guided puncture of wall fixed intrathoracic processes].

To improve differentiation of intrathoracic lesions in the vicinity of the chest wall, 167 patients were investigated via sonography. In the case of an indication the lesions were punctured, assisted by sonography. Sonography proved helpful in differentiating between liquid and solid masses and in localising the spot for puncture resulting in the successful removal of material for cytologic analysis in all our cases without any complications. The results of the study are presented, and the sonographic morphology is shown.

Biopsy, Needle↗