Tumores primarios benignos de la pared torácica: resultados del tratamiento quirúrgico / Primary benign chest wall tumors: results of surgical treatment

BACKGROUND: We undertook this study to describe the clinical characteristics of primary benign chest wall tumors and to evaluate the results of surgical treatment. METHODS: We included patients with primary benign chest wall tumors who underwent surgical resection at the Instituto Nacional de Cancerología from January 1990 to December 2002. All patients had histological confirmation of benign tumor. Descriptive analysis was carried out. RESULTS: There were 17 patients, nine women (53%), with an average age of 35.1 years (interval 16-66 years). The most frequent tumor was chondroma in seven cases (41%), followed by aponeurotic-muscle fibromatosis in five (30%) and the remaining five patients had other tumor types. All patients were subject to thoracic wall resection, including at least one rib in each patient. In three patients the sternum was resected (17.6%), the clavicle in two (11.7%), thoracic vertebrae in one (5.9%) and associated structures in four patients (23.5%). In eight patients (47%) the thoracic wall was reconstructed with marlex mesh, whereas the remaining patients required no reconstruction. Of the 17 patients, 16 are alive without disease and one presented delayed recurrence with an aponeurotic-muscle fibromatosis requiring a new thoracic wall resection. One patient presented with respiratory complications and died after 42 days due to thoracic wall instability. Average follow-up time was 103 months. CONCLUSIONS: Primary benign chest wall tumors are locally aggressive and must be treated with wide resection of the thoracic wall. In addition, surgical reconstruction with prosthetic materials and/or myocutaneous flaps is done prior to resection, for stability of the thorax when the localization is anterior or lateral.

Schwannomas medaastinales: comunicación de casos y revisión de la literatura

Introducción: Los tumores del mediastino comprenden un grupo heterogéneo de neoplasias raras con comportamiento biológico muy variable. En México, las estadísticas reportan que corresponde al 0.88% de todas las neoplasias. En general, del 30 al 76% de todos estos tumores son malignos. De éstos el 53% corresponden a tumores neurógenos. Objetivo del estudio: Conocer la frecuencia del Schwannoma mediastinal, en el Instituto Nacional de Cancerología (INCan), así como el manejo de esta patología. Material y métodos: Se revisaron expedientes del archivo clínico de 1980 a 2003 con diagnóstico de tumor mediastinal. Se registraron edad, sexo, presentación clínica, presentación radiológica, métodos diagnósticos, tratamientos previos, histología, tratamiento y resultados. Resultados: 109 pacientes con diagnóstico de tumor mediastinal fueron tratados en el INCan entre 1980 al 2003; 9 casos correspondían a tumores de origen neuroepitelial; 4 pacientes fueron llevados a cirugía. Se realizaron 3 resecciones y una tumorectomía. La histología y el tamaño son factores que influyen en el resultado. La resección completa es curativa y la adyuvancia con radioterapia posoperatoria puede ser útil.

Introduction: Mediastinal tumors include an heterogenous group of neoplasms with variable biological behavior. In Mexico they represent 0.88% of all neoplasms. Thirty to 76% of these tumors are malignant; of these, 53% are neurogenic. Objectives: To study the frequency of mediastinal Schwannomas at our institute. Material and methods: A chart review of mediastinal tumors from 1980 to 2003 was done. Age, sex, clinical presentation, radiological features, previous diagnoses and treatments, histology, treatment and results were recorded. Results: 109 patients with mediastinal tumors were treated in the National Institute of Cancer from 1980 to 2003; 9 cases were tumors of neuroepithelial origin, 4 patients were taken to surgery. Histology and size were factors that influenced the result. Complete resection is the standard of care; adjuvant radiotherapy is useful.