Management challenge in chest wall neoplasms; a 2 year experience

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

Outcome of mediastinal lypmh node biopsy by cervical mediastinoscopy

Objective: To analyze the outcome of mediastinal lypmh node biopsy by conventional mediastinoscopy for diagnostic purpose in patients with mediastinal lymph node enlargement

Study design: Descriptive case series

Place and Duration of study: The study was conducted at 2 private hospitals of Karachi, from July 2012 to June 2014

Methodology: Patients aged 12 year and above, of either sex, who presented with CT-proven mediastinal lymph node enlargement in whom diagnosis could not be confirmed via other investigations, were included. Patients underwent conventional mediastinoscopy under general anesthesia. Patients with previous history of thyroid or neck surgery, severe superior vena caval syndrome [SVC] or cervical spondylosis were excluded from the study. Multiple lymph node stations were biopsied and sent for histopathology. Biopsy reports were followed and results analyzed

Results: Out of 32 patients 19 were males and 13 females. Age range was from 25 to 55 year. The most common diagnosis was tuberculosis. The mean duration of the procedure was 40 minutes. Lymph node stations 2 and 4 were most commonly biopsied and an average of 4 biopsy samples were obtained per patient

Conclusion: Mediastinscopy is an invaluable and relatively cost effective procedure in the diagnosis of patients with mediastinal lymph node enlargement in whom the diagnosis could not be confirmed by other investigations