Single-institution, multidisciplinary experience with surgical resection of primary chest wall sarcomas.

INTRODUCTION: Primary chest wall sarcomas are rare mesenchymal tumors and their mainstay of therapy is wide surgical resection. We report our single-institution, multidisciplinary experience with full-thickness resection for primary chest wall sarcomas. METHODS: A retrospective review of our prospectively maintained databases revealed that 51 patients were referred for primary chest wall sarcomas from 1990 to 2009. RESULTS: All patients required resections that included rib and/or sternum. Twenty-nine patients (57%) had extended resections beyond the chest wall. Forty-two patients (82%) required prosthetic reconstruction and 17 patients (33%) had muscle flap coverage. Overall, 51% (26/51) of patients received neoadjuvant therapy. Seventy-three percent (11/15) of high-grade soft tissue sarcomas, 77% (10/13) of high-risk bony sarcomas, and 67% (4/6) of desmoid tumors were treated with induction therapy. Negative margins were obtained in 46 patients (90%). There were no perioperative mortalities. Eight patients (16%) experienced complications. Local recurrence and metastasis was detected in 14 and 23%. Five-year overall and disease-free survivals were 66% and 47%, respectively. Favorable prognostic variables for survival included age ≤50 years, tumor volume ≤200 cm, desmoid tumor, bony tumor, chondrosarcoma, and low-grade soft tissue sarcoma. CONCLUSIONS: We report our multidisciplinary experience with primary chest wall sarcomas that included induction therapy in the majority of high-risk soft tissue and bony sarcomas and desmoid tumors. Despite aggressive preoperative treatments, acceptable surgical results with low morbidity and mortality can be achieved. Neoadjuvant systemic therapy may reduce local and distant recurrence and improve overall survival.

Pneumoperitoneum after sexual assault in a patient who had hysterectomy 30 years ago: case report.

BACKGROUND: A non-surgical etiology accounts for approximately 10% of cases of pneumoperitoneum. However, in the patient with pneumoperitoneum, one must be suspicious of the less common non-surgical etiologies, including coitus, to avoid unnecessary laparotomy. OBJECTIVES: To report a case of pneumoperitoneum caused by coitus during sexual assault in a patient who had a hysterectomy 30 years ago. CASE REPORT: The authors present a case of non-surgical pneumoperitoneum after sexual assault occurring over 30 years after abdominal hysterectomy. CONCLUSION: This case is an important reminder that a thorough sexual and gynecologic/obstetrical history is an essential tool in identifying the patient who does not require laparotomy.

Chest wall sarcomas are accurately diagnosed by image-guided core needle biopsy.

OBJECTIVE: Sarcomas are rare mesenchymal malignancies. Accurate preoperative diagnosis is a prerequisite in considering investigational or institutional management algorithms that include neoadjuvant treatment. We reviewed our experience using core needle biopsy for chest wall sarcomas. METHODS: A retrospective review of our sarcoma databases revealed that 40 core needle biopsies and 35 tumor resections were performed in 34 patients, with chest wall musculoskeletal tumors, referred to the University of California, Los Angeles from 1991 to 2010. Primary, metastatic, or recurrent sarcomas involving the sternum, ribs, and soft tissues of the chest wall were evaluated for (1) adequacy of tissue from image-guided core needle biopsies and (2) accuracy in determining malignancy, histological subtype, and sarcoma grade. RESULTS: Twenty-eight of the 40 needle biopsy samples (70%) were adequate for histopathological analysis. Forty-two percent of nondiagnostic findings occurred due to insufficient tissue, whereas the remainder had sufficient tissue, but the pathologist was unable to determine specific histology. Excluding the nondiagnostic samples, the accuracy in determining malignancy, histological subtype, and grade in sarcomas was 100, 92, and 87%, respectively. The sensitivity and specificity of determining malignancy and high-grade sarcomas were 100, 100, 77, and 100%, respectively. There were no complications from the image-guided biopsies. CONCLUSIONS: We demonstrated that image-guided core needle biopsy when performed and reviewed by experienced radiologists and musculoskeletal pathologists is a safe and accurate diagnostic technique for chest wall sarcomas. Core needle biopsy should be considered in the multidisciplinary approach to chest wall musculoskeletal tumors, especially when induction therapy is considered.

PGE(2) contributes to TGF-beta induced T regulatory cell function in human non-small cell lung cancer.

CD4(+)CD25(bright) regulatory T cells (T(reg)) play an important role in cancer-mediated immunosuppression. We and others have previously shown that prostaglandin E2 (PGE(2)) and transforming growth factor beta (TGF-beta) induce CD4(+)CD25(bright)FOXP3(+)T(reg). Based on these studies, we investigated the requirement for PGE(2) in Treg induction by TGF-beta. TGF-beta stimulation of human CD4(+) T cells induced COX-2-dependent production of PGE(2). PGE(2)-neutralizing antibody treatment significantly reduced the suppressive function of TGF-beta-induced T(reg) (TGF-beta-T(reg)) in vitro. TGF-beta concentration measured in the plasma of non-small cell lung cancer (NSCLC) patients directly correlated with the frequency of circulating CD4(+)CD25(bright)FOXP3(+)T cells. Flow cytometry analysis showed increased FOXP3 expression in circulating CD4(+)CD25(+)HLA-DR- cells of lung cancer patients compared to control subjects. Immunohistochemical analysis revealed co-expression of TGF-beta, COX-2, and FOXP3 in serial sections from resected lung tumor tissues. All together these observations suggest interplay between TGF-beta and COX-2 in the induction of T(reg) activities. Interrupting TGF-beta and PGE(2) signaling may be important in therapeutic interventions that aim to limit T(reg)function in lung cancer.

Surgical management of endobronchial solitary fibrous tumors.

Solitary fibrous tumors of the pleura are rare neoplasms with both benign and malignant behaviors that are not reliably predicted by histologic findings. We report the case of a 55-year-old woman with recurrent pneumonias whose left mainstem bronchus was occluded by a 2.1- x 1.4-cm endobronchial mass that extended extraluminally into the subcarina. The mass was tissue diagnosed to be a solitary fibrous tumor preoperatively, and was completely resected by sleeve resection of the left mainstem bronchus with lung preservation. This report describes the challenging surgical management of an infrequently encountered tumor in a unique location.