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Autops. Case Rep ; 10(3): e2020166, 2020. graf
Article in English | LILACS | ID: biblio-1131826


The chest wall chondrosarcoma (CWC) is a rare slowly growing primary tumor of the chest wall with an incidence of <0.5 per million person-years. We present the case of a giant CWC that caused a mass effect on the mediastinum, heart, and lung. Large tumors with thoracic structures compression may be life threatening, and its resection and subsequent chest wall reconstruction represent a significant multidisciplinary surgical challenge. In this case, despite the large tumor dimensions, the preoperative planning—sparing key reconstructive options without compromising the tumor resection—allowed a complete en bloc tumor excision of a grade III chondrosarcoma with negative histologic margins. Successful reconstruction of the large full-thickness chest wall defect, with a latissimus dorsi muscle flap and methyl methacrylate incorporated into a polypropylene mesh in a sandwich fashion, was accomplished. Patient recovery was uneventful with good functional and aesthetic outcomes, and no evidence of recurrence at 1.5 years follow-up. This case report illustrates the main clinical, radiological, and histologic features of a CWC while discussing the surgical goals and highlighting the principles for chest wall reconstruction following extensive resection of a large and rare entity.

Humans , Male , Middle Aged , Bone Neoplasms/surgery , Chondrosarcoma/surgery , Reconstructive Surgical Procedures , Thoracic Wall/pathology , Heart , Lung , Mediastinum
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 225-233, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013295


ABSTRACT Objective: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. Methods: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). Results: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). Conclusions: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

RESUMO Objetivo: Avaliar o formato da caixa torácica em pacientes com escoliose idiopática do adolescente (EIA), comparando-os com indivíduos saudáveis e analisar a associação do formato da caixa torácica com a deformidade da coluna vertebral e função pulmonar em pacientes com EIA. Métodos: Estudo transversal que avaliou 30 pacientes com EIA e 20 indivíduos saudáveis com idade entre 11 e 18 anos. O ângulo de Cobb foi avaliado em pacientes com EIA. O formato da caixa torácica foi analisado pelo método da fotogrametria, utilizando o Software para Avaliação Postural (SAPO). Foram criados marcadores torácicos descritos como ângulos (A)e distâncias (D): A2 (acrômio direito/processo xifoide/acrômio esquerdo), A4E (ângulo formado entre o ponto externo da menor circunferência da cintura e suas bordas superior e inferior do lado esquerdo), A7 (ângulo formado pela interseção das retas tangentes aos ângulos superior e inferior das escápulas), D1D/D1E [distância entre o processo xifoide e a última costela falsa nos lados direito (D) e esquerdo (E)] e D3 (distância entre o processo xifoide e a espinha ilíaca anterossuperior). Resultados: Os marcadores torácicos A2 e A7 foram significativamente maiores, enquanto o A4E e o D1D/D1E foram significativamente menores no grupo EIA em relação ao controle. Foram encontradas correlações moderadas entre: A2 e os ângulos de Cobb torácico principal e proximal (r=0,50 e r=0,47, respectivamente); D1D/D1E e o ângulo de Cobb torácico principal (r=-0,40); e o volume expiratório forçado no primeiro segundo (VEF1) e D3D (r=0,47). Conclusões: O método da fotogrametria detectou alterações na caixa torácica de pacientes com EIA, além de apresentar correlações significativas entre os ângulos de Cobb e a função pulmonar.

Humans , Male , Female , Child , Adolescent , Scapula , Thoracic Vertebrae , Photogrammetry/methods , Respiratory Function Tests/methods , Scoliosis/diagnosis , Scoliosis/physiopathology , Scoliosis/pathology , Brazil , Anthropometry/methods , Cross-Sectional Studies , Reproducibility of Results , Thoracic Wall/physiopathology , Thoracic Wall/pathology
Autops. Case Rep ; 9(2): e20180780, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-994674


Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.

Humans , Female , Middle Aged , Lymphangioma, Cystic/diagnosis , Thoracic Wall/pathology , Muscular Diseases/diagnosis , Diagnosis, Differential , Echinococcosis/diagnosis
Rev. chil. pediatr ; 89(2): 231-235, abr. 2018. graf
Article in Spanish | LILACS | ID: biblio-900091


INTRODUCCIÓN: El blastema pleuropulmonar (BPP) es la neoplasia primaria maligna más común de los pulmones en la infancia. Se presenta con mayor frecuencia en niños entre 1 y 4 años, con sínto mas respiratorios. Han sido definidos tres tipos por histopatología (tipo I, II y III), relacionados con sobrevida y pronóstico. OBJETIVO: Reportar el primer caso de un paciente con un BPP que se presentó como una deformación de la pared torácica. CASO CLÍNICO: Paciente de un año de vida que se presentó con una deformidad de la pared torácica a los 10 meses de edad. El estudio imagenológico reveló una gran masa quística en el hemitórax derecho. No desarrolló sintomatología respiratoria hasta el ingreso hospitalario. Se realizó una lobectomía superior derecha y la biopsia confirmó un BPP tipo I. Se trató con resección quirúrgica y realización periódica de imágenes torácicas como seguimiento. CONCLUSIONES: Se reporta el caso de un BPP que se manifestó con deformidad torácica, forma de presentación no descrita previamente en la literatura. El BPP es un cáncer poco frecuente que debe ser considerado en el diagnóstico diferencial de lesiones quísticas pulmonares, sobre todo en la edad pediátrica. Reconocerlo como un tumor maligno en vez de una anomalía del desarrollo, es determinante para que el paciente sea sometido a resección quirúrgica, terapia adyuvante y seguimiento apropiado.

INTRODUCTION: Pleuropulmonary blastema (PPB) is the most common primary malignancy of the lungs in childhood. It occurs more frequently in children between one and four years of age, and respiratory symptoms are a common manifestation. Three types have been defined (type I, II and III), which are related to survival and prognosis. OBJECTIVE: To report the first case of a patient with a PPB who presented with a chest wall deformity. CASE REPORT: One year old male patient who had a chest wall deformity at ten months of age. Imaging revealed a giant cyst in the right hemithorax. He did not develop respiratory symptoms until hospital admission. A right upper lobectomy was perfor med and the biopsy confirmed a type I pleuropulmonary blastoma. He was considered successfully treated with complete surgical excision and routine follow-up with thoracic imaging is conducted. CONCLUSIONS: PPB is a very rare cancer that needs to be considered in the differential diagnosis of cystic lung diseases in children. The recognition of this lesion as a malignant tumour rather than a developmental cystic malformation is vital so the child can receive complete excision and appropriate follow-up care.

Humans , Male , Infant , Pulmonary Blastoma/diagnosis , Thoracic Wall/pathology , Pulmonary Blastoma/pathology
Rev. bras. cir. plást ; 31(2): 252-256, 2016. ilus
Article in English, Portuguese | LILACS | ID: biblio-1570


As opções reconstrutivas para defeitos da parede anterior do tórax podem ser desafiadoras especialmente quando o defeito é extenso e sujeito a radioterapia pré-operatória. Apresenta-se caso de paciente com carcinoma ductal invasivo de mama não tratado que realizou radioterapia e quimioterapia incompleta no pré-operatória. O exame patológico revelou carcinoma ductal invasivo de 11,5 cm, grau III, com invasão linfovascular e linfonodos axilares positivos (20/20). Após a mastectomia, defeitos estendidos seguido de longa excisão de pele mediram 25 x 20 cm, sendo esses cobertos imediatamente com retalhos em abdominoplastia reversa tensionada. Trata-se do primeiro caso relatado de excisão larga de mastectomia reconstruída exclusivamente com retalhos avançados em abdominoplastia reversa e alta tensão progressiva de pontos de adesão demostrando que nos pacientes selecionados, a pele abdominal pode ser avançada superiormente com segurança e facilidade para atingir a área superior do tórax e cobrir a área com defeito significante.

Reconstructive options for anterior chest wall defects can be challenging especially when the defect is large and has been subject for preoperative radiotherapy. We report a case of a patient with a neglected large invasive ductal carcinoma of the breast who had received incomplete preoperative radiotherapy and chemotherapy. The pathology examination revealed an 11.5 cm invasive ductal carcinoma, grade III, with lymphovascular invasion and positive axillary lymph nodes (20/20). The post mastectomy large defect following wide skin excision measured 25 x 20 cm and it was immediately covered with a tensioned reverse abdominoplasty flap. To our knowledge, this is the first case reported of a wide skin excision mastectomy reconstructed solely with a reverse abdominoplasty advancement flap and progressive high-tension with quilting sutures demonstrating that, in the selected patients, abdominal skin can be safely and easily advanced superiorly to reach the upper chest area and cover an area of significant defect.

Humans , Female , Middle Aged , History, 21st Century , Surgical Flaps , Abdominal Muscles , Reconstructive Surgical Procedures , Thoracic Wall , Carcinoma, Ductal , Diffusion of Innovation , Abdomen , Mastectomy , Surgical Flaps/surgery , Abdominal Muscles/surgery , Abdominal Muscles/pathology , Reconstructive Surgical Procedures/methods , Thoracic Wall/surgery , Thoracic Wall/pathology , Carcinoma, Ductal/surgery , Carcinoma, Ductal/pathology , Abdomen/surgery , Abdomen/pathology , Abdominal Neoplasms , Mastectomy/methods , Abdominal Neoplasms/surgery , Abdominal Neoplasms/complications
Rev. bras. cir. plást ; 30(2): 282-287, 2015. ilus
Article in English, Portuguese | LILACS | ID: biblio-1012


INTRODUÇÃO: A braquioplastia trata as deformidades dos membros superiores. A toracoplastia lateral visa o tratamento do torso superior. As braquioplastias, toracoplastias e também as braquiotoracoplastias em Z têm sido utilizadas no Hospital Estadual de Sapopemba no tratamento das deformidades dos membros superiores e terço superior do tórax. Objetivo: Propõe-se descrever as modificações na técnica cirúrgica resultando na braquiotoracoplastia em Z e analisar a casuística e os resultados obtidos, no tratamento das deformidades da região lateral do tórax. MÉTODO: Foram submetidos à braquiotoracoplastia e toracoplastia lateral 31 pacientes. A demarcação foi feita em posição ortostática, e os membros superiores abduzidos em 90o. Iniciou-se pela demarcação da braquioplastia, em duplo fuso, prolongando-se de maneira modificada a demarcação, seguindo pela linha axilar anterior em direção ao sulco inframamário em forma de Z. RESULTADOS: Todos os pacientes referiram melhora do contorno da região e não houve queixas quanto ao posicionamento da cicatriz. DISCUSSÃO: O procedimento da braquiotoracoplastia em Z atual consiste em estender a linha de incisão da face medial do braço, passando proximalmente à axila e continuando pela linha axilar média até o sulco mamário. Ocorreu a melhora do contorno da região dorsal e das dobras cutâneas da região torácica lateral. CONCLUSÃO: A braquiotoracoplastia em Z e a toracoplastia lateral têm a grande vantagem de eliminar a cicatriz circunferencial no torso superior, promovendo a melhoria do contorno dessa região por meio da ressecção cutânea tanto no sentido craniocaudal, como anteroposterior.

INTRODUCTION: Brachioplasty treats deformities of the upper limbs. Lateral thoracoplasty treats the upper torso. Brachioplasties, thoracoplasties, and brachiothoracoplasties have been performed with Z-plasty for deformities of the upper limbs and upper third of the chest, in the Sapopemba State Hospital. Objective: We describe modifications of surgical technique for the performance of Z brachiothoracoplasty, and evaluate the results of treatment of deformities of the lateral chest. METHOD: Thirty-one Patients underwent brachiothoracoplasty and lateral thoracoplasty. The demarcation was made with the patient upright, and the upper limbs abducted at 90º. Marking for brachioplasty was performed using a double-ellipse, to lengthen the modified demarcation along the anterior axillary line toward the inframammary crease in a Z shape. RESULTS: All patients reported an improvement in the contour of the region, and there were no complaints regarding the positioning of the scar. DISCUSSION: Z brachiothoracoplasty consists of extending the incision line on the medial aspect of the arm, passing proximally to the axilla, and continuing through the midaxillary line to the inframammary crease. There was an improvement in the contour of the dorsal region and the skin folds of the lateral thoracic region. CONCLUSION: Z brachiothoracoplasty and lateral thoracoplasty have the great advantage of eliminating a circumferential scar on the upper torso, thereby improving the contour of the region through skin resection in both the craniocaudal and anteroposterior directions.

Humans , Male , Female , Adult , Middle Aged , Aged , History, 21st Century , Thoracoplasty , Weight Loss , Upper Extremity , Thoracic Wall , Upper Extremity Deformities, Congenital , Diffusion of Innovation , Bariatric Surgery , Obesity , Thoracoplasty/methods , Upper Extremity/surgery , Thoracic Wall/surgery , Thoracic Wall/pathology , Upper Extremity Deformities, Congenital/surgery , Upper Extremity Deformities, Congenital/pathology , Bariatric Surgery/methods , Obesity/surgery
Professional Medical Journal-Quarterly [The]. 2015; 22 (9): 1176-1180
in English | IMEMR | ID: emr-173769


Introduction: Chest wall neoplasms are rare and represent only about 5% of all thoracic neoplasm. We present our 2 years analysis of the clinical features, presentation, diagnosis and treatment of chest wall neoplasms

Study design: Case series study

Place and duration of study: Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi, Pakistan from Nov 2012- Oct 2014

Methodology: Between 2012 and 2014, 39 patients with solid chest wall masses were enrolled in the study. Tumors were categorized as benign and malignant, including primary and secondary, after histopathological diagnosis with tissue biopsy. Data on patients' characteristics, symptoms, tumor type and management was recorded and analysed

Results: The study included 39 patients [20 males and 19 females] with age range 18-71years [mean 36.3]. 21[53.8%] patients had benign chest wall tumors while 18[46.1%] patients had malignant tumors. Among malignant tumors, 14[77%] patients had primary malignancy where as 4[22%] patients had chest wall tumor secondary to primary tumor elsewhere. Among these 4, the primary tumor remained unknown in 1 patient. The most common benign solid lesion was chest wal lesion lipoma in 8/21 patients [38%]. Among malignant tumors, chondrosarcoma [4/14, 29%] was the most common

Conclusion: Preoperative needs careful assessment of the patient, radiological imaging and histopathological examination for diagnosis of the tumor in the chest wall. Using a multidisciplinary team approach, excellent results can be available with complete surgical resection, reconstruction of the chest wall and appropriate or neo adjuvant treatment where necessary

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Thoracic Neoplasms/diagnosis , Thoracic Wall/pathology , Disease Management , Lipoma , Chondrosarcoma
Article in English | WPRIM | ID: wpr-22479


OBJECTIVE: To evaluate spine magnetic resonance imaging (MRI) inter-reader and intra-reader reliabilities using the thoracolumbar injury classification system and severity score (TLICS) and to analyze the effects of reader experience on reliability and the possible reasons for discordant interpretations. MATERIALS AND METHODS: Six radiologists (two senior, two junior radiologists, and two residents) independently scored 100 MRI examinations of thoracolumbar spine injuries to assess injury morphology and posterior ligamentous complex (PLC) integrity according to the TLICS. Inter-reader and intra-reader agreements were determined and analyzed according to the number of years of radiologist experience. RESULTS: Inter-reader agreement between the six readers was moderate (k = 0.538 for the first and 0.537 for the second review) for injury morphology and fair to moderate (k = 0.440 for the first and 0.389 for the second review) for PLC integrity. No significant difference in inter-reader agreement was observed according to the number of years of radiologist experience. Intra-reader agreements showed a wide range (k = 0.538-0.822 for injury morphology and 0.423-0.616 for PLC integrity). Agreement was achieved in 44 for the first and 45 for the second review about injury morphology, as well as in 41 for the first and 38 for the second review of PLC integrity. A positive correlation was detected between injury morphology score and PLC integrity. CONCLUSION: The reliability of MRI for assessing thoracolumbar spinal injuries according to the TLICS was moderate for injury morphology and fair to moderate for PLC integrity, which may not be influenced by radiologist' experience.

Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Injury Severity Score , Ligamentum Flavum/pathology , Lumbar Vertebrae/injuries , Magnetic Resonance Imaging/methods , Male , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective Studies , Spinal Injuries/classification , Thoracic Vertebrae/injuries , Thoracic Wall/pathology , Young Adult
Rev. bras. cir. plást ; 29(4): 550-556, 2014. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-849


INTRODUÇÃO: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. MÉTODO: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. RESULTADOS: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . CONCLUSÃO: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

INTRODUCTION: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. METHOD: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. RESULTS: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. CONCLUSION: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

Humans , Male , Female , Child , Adolescent , Adult , History, 21st Century , Polypropylenes , Thoracic Neoplasms , Thoracic Surgery , Thoracoplasty , Thorax , Medical Records , Review , Polymethyl Methacrylate , Reconstructive Surgical Procedures , Evaluation Study , Thoracic Wall , Polypropylenes/therapeutic use , Polypropylenes/chemistry , Thoracic Neoplasms/surgery , Thoracic Neoplasms/physiopathology , Thoracic Neoplasms/therapy , Thoracic Surgery/methods , Thoracoplasty/methods , Thorax/physiology , Thorax/pathology , Medical Records/standards , Polymethyl Methacrylate/therapeutic use , Polymethyl Methacrylate/chemistry , Reconstructive Surgical Procedures/methods , Thoracic Wall/surgery , Thoracic Wall/physiopathology , Thoracic Wall/pathology
Article in English | IMSEAR | ID: sea-154391


Askin tumour, a primitive neuroectodermal tumour of the thoracopulmonary region, is a rare tumour presenting in childhood. Its presentation in adults is rare. We report a case of an Askin tumour in an adult patient who presented to us with worsening breathlessness and vague chest pain. Investigations including immunohistochemistry confirmed the diagnosis of Askin tumour.

Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Biopsy , Bone Neoplasms/drug therapy , Bone Neoplasms/pathology , Bone Neoplasms/physiopathology , Disease Progression , Humans , Lung/pathology , Lung Neoplasms/pathology , Lymphatic Metastasis , Male , Neuroectodermal Tumors, Primitive, Peripheral/pathology , /secondary , Pleura/pathology , Pleural Neoplasms/pathology , Pleural Neoplasms/secondary , Sarcoma, Ewing/drug therapy , Sarcoma, Ewing/pathology , Sarcoma, Ewing/physiopathology , Thoracic Wall/pathology , Tomography, X-Ray Computed/methods , Treatment Outcome
Article in English | IMSEAR | ID: sea-154384


Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.

Adult , Chondrosarcoma/pathology , Chondrosarcoma/physiopathology , Chondrosarcoma/surgery , Humans , Male , Myocutaneous Flap , Reconstructive Surgical Procedures/methods , Surgical Mesh , Thoracic Neoplasms/pathology , Thoracic Neoplasms/physiopathology , Thoracic Neoplasms/surgery , Thoracic Wall/pathology , Thoracic Wall/surgery , Treatment Outcome
Saudi Medical Journal. 2012; 33 (8): 901-903
in English | IMEMR | ID: emr-155785


Liposarcoma is the second most common soft tissue sarcoma after malignant fibrous histiocytoma in adults. It is frequently found in the extremities and retroperitoneum; rarely it can be seen in the chest wall. We report a rare case of giant liposarcoma originating from the chest wall representing a transformation of a relapsing lipoma in the same region. We performed chest wall resection, reconstruction with latissimus dorsi muscle transposition via posterolateral thoracotomy. The patient received 4 series of adjuvant chemotherapy after the postoperative diagnosis of dedifferentiated liposarcoma. The patient had no postoperative complication and has remained disease-free for 30 months

Humans , Male , Aged , Thoracic Wall/pathology , Lipoma , Recurrence
Article in English | WPRIM | ID: wpr-89580


We report on a 41-year-old woman with a chest wall desmoid tumour who was successfully treated with a computed tomography (CT)-guided steroid injection. She presented with a palpable mass in the right upper chest wall and was treated by surgical excision and postoperative radiation therapy due to recurrence of the mass at the surgical site. At 20 months after the second operation, a recurrent mass was again detected in the anterosuperior portion of the previous surgical site on CT. We performed a CT-guided steroid injection weekly for 4 weeks by applying a mixture of 3 mL of triamcinolone acetonide (40 mg/mL) and 3 mL of 1% Lidocaine, administering 4-6 mL of the mixture, to the lesion. Six months later, CT showed a marked decrease in the size of the mass.

Adult , Female , Fibromatosis, Aggressive/drug therapy , Glucocorticoids/therapeutic use , Humans , Lidocaine/therapeutic use , Radiography, Interventional , Recurrence , Thoracic Wall/pathology , Tomography, X-Ray Computed , Triamcinolone/therapeutic use
Indian J Pathol Microbiol ; 2011 Oct-Dec 54(4): 803-805
Article in English | IMSEAR | ID: sea-142117


Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.

Bone Neoplasms/diagnosis , Bone Neoplasms/pathology , Fatal Outcome , Female , Fetus , Humans , Infant, Newborn , Pregnancy , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/pathology , Thoracic Wall/pathology , Young Adult
Article in English | IMSEAR | ID: sea-138662


Distant metastases in squamous cell carcinoma of head and neck are most often to the lung, liver and bone. They rarely metastasise to chest wall. We report a 60-year-old male patient who initially presented with an abscess over the anterior chest wall that was initially treated for infective pathology. Due to lack of response, cytological examination was performed that turned out to be metastasis from carcinoma larynx.

Biopsy, Fine-Needle , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/secondary , Humans , Laryngeal Neoplasms/drug therapy , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/radiotherapy , Male , Middle Aged , Thoracic Neoplasms/pathology , Thoracic Neoplasms/secondary , Thoracic Wall/pathology , Thoracic Wall/diagnostic imaging
Annals of Saudi Medicine. 2011; 31 (3): 311-313
in English | IMEMR | ID: emr-122625


We report the case of a child who presented with a subcutaneous mass on the left side of the chest wall of one month's duration. The mass was painful and increasing in size over time. He had a history of weight loss and a decrease in appetite, but no history of fever or trauma. He had ingested raw camel milk, but had no history of contact with animals. He was diagnosed by the standard tube agglutination titer and tissue culture for brucellosis, treated with surgery and three months of antibrucella antibiotics. The report includes a brief review of the current pediatric literature to familiarize pediatricians with this uncommon presentation

Humans , Animals , Male , Child , Brucellosis/diagnosis , Thoracic Wall/pathology , Milk/microbiology , Anti-Bacterial Agents , Agglutination Tests , Weight Loss , Camelus
Article in English | WPRIM | ID: wpr-21025


OBJECTIVE: We wanted to determine the clinical feasibility of using non-breath-hold real-time MR-echo imaging for the evaluation of mediastinal and chest wall tumor invasion. MATERIALS AND METHODS: MR-echo imaging was prospectively applied to 45 structures in 22 patients who had non-small cell lung cancer when the tumor invasion was indeterminate on CT. The static MR imaging alone, and the static MR imaging combined with MR-echo examinations were analyzed. The surgical and pathological findings were compared with using the Wilcoxon-signed rank test and McNemar's test. RESULTS: The accuracy, sensitivity and specificity of the combined MR-echo examination and static MR imaging for determining the presence of invasion were 84%, 83% and 85%, respectively, for the first reading session and they were 87%, 83% and 87%, respectively, for the second reading session (there was substantial interobserver agreement, k = 0.74). For the static MR imaging alone, these values were 62%, 83% and 59%, respectively, for the first reader and they were 69%, 67% and 74%, respectively, for the second reader (there was moderate interobserver agreement, k = 0.49). The diagnostic confidence for tumor invasion was also higher for the combined MR-echo examination and static MR imaging than that for the static MR imaging alone (p < 0.05). CONCLUSION: The combined reading of a non-breath-hold real-time MR-echo examination and static MR imaging provides higher specificity and diagnostic confidence than those for the static MR imaging reading alone to determine the presence of mediastinal or chest wall tumor invasion when this was indeterminate on CT scanning.

Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Echo-Planar Imaging , Female , Humans , Lung Neoplasms/pathology , Male , Mediastinum/pathology , Middle Aged , Neoplasm Invasiveness , Predictive Value of Tests , Sensitivity and Specificity , Thoracic Wall/pathology
Rev. bras. ortop ; 44(3): 191-198, maio-jun. 2009. ilus, tab
Article in Portuguese | LILACS | ID: lil-524566


Os autores resumem experiência de 32 anos no estudo e na abordagem não cirúrgica das deformidades pectus carinatum e pectus excavatum. Dados de 4.012 pacientes portadores de deformidades pectus foram coletados de 1977 a janeiro de 2009, permitindo avaliar sua etiologia, patogênese e tratamento. Distúrbios de crescimento dos ossos e cartilagens da parede torácica anterior foram detectados em exames de imagem. A hereditariedade e fatores biomecânicos, como distúrbios respiratórios e escolioses, mostraram-se presentes em mais de 40 por cento dos pacientes. O método dinâmico de remodelação do tórax - órteses compressivas simultaneamente à prática de exercícios - foi indicado em 2.453 pacientes. Tratamento concomitante com colete inclinado foi instituído em 11 portadores de escoliose entre 20º e 52º. Dos portadores de pectus que tiveram o tratamento indicado, 1.717 retornaram para reavaliação: 1.632 crianças e adolescentes e 85 adultos. Bons resultados foram observados em 60,6 por cento das crianças e adolescentes e em 27 por cento dos adultos tratados. Nenhum caso de escoliose apresentou piora da curva e um caso de 52º teve melhora de 20º com o tratamento. Distúrbios no crescimento do esterno e arcos costais, bem como os fatores biomecânicos que compõem a patogênese das deformidades pectus, demonstram como essas deformidades estão correlacionadas com a ortopedia. Avaliação apropriada da parede torácica anterior e tratamento concomitante com colete inclinado são recomendados na presença de escoliose. O método dinâmico de remodelação do tórax exige um protocolo de condutas médicas para que o tratamento tenha êxito.

The authors summarize a 32-year experience in the study and in the non-operative approach of pectus carinatum and pectus excavatum. Data of 4,012 patients with pectus deformities were collected from 1977 to January 2009, allowing evaluation on the etiology, pathogenesis and treatment of these deformities. Growth disturbances of anterior chest wall bones and cartilages were detected in imaging studies. Heredity, and biomechanical factors, like respiratory disturbances and scoliosis were noticed in more than 40 percent of the patients. The method of dynamic remodeling of the thorax - compressive orthoses simultaneously to exercises practice - was indicated in 2453 patients. Concomitant treatment with bending brace was provided in patients with 20º to 52º scoliosis. Of pectus patients with treatment indication, 1717 returned for re-evaluation: 1632 children and adolescents and 85 adults. Good results were seen in 60.6 percent of children and adolescents and in 27 percent of adults treated. No scoliosis patient presented curve worsening, and a case of 52º presented an improvement of 20º in the scoliosis with the treatment. Disturbances in the growth of the sternum and costal arches, as well as biomechanical factors related to the pathogenesis of pectus deformities, demonstrate how these deformities are correlated to orthopaedics. Appropriate evaluation of the anterior chest wall and concomitant treatment with bending brace are recommended in the presence of scoliosis. The dynamic remodeling method of the thorax requires a protocol of medical actions for a successful treatment.

Humans , Bone Remodeling , Funnel Chest , Orthotic Devices , Thoracic Wall/pathology