Ultrasonography-guided Transthoracic Cutting Biopsy of Pulmonary Lesion: Diagnostic Benefits and Safety

PURPOSE: To assess the safety and usefulness of ultrasonography-guided transthoracic cutting biopsy for lung lesions. MATERIALS AND METHODS: Eighty-eight patients (66 men, 22 women, mean age 59 years) with lung lesions underwent an ultrasonography(USG)-guided transthoracic cutting biopsy. The final diagnosis was based on the findings of surgery and clinical and radiological follow-ups. The histopathologic results and diagnostic accuracy of cutting biopsy were determined. Also, the complication rate was statistically evaluated according to the mass size, number of biopsies, and the presence or absence of pleural effusion. RESULTS: Biopsy specimens were successfully obtained in all patients. 79 of 88 lesions (89.8%) were established by histopathology. The final diagnosis was malignant in 58 and benign in 28. The remaining 2 patients were lost to follow-up. Diagnostic sensitivity for malignant lesions was 89.6% (52/58) and that for benign lesions was 96.4% (27/28). Procedure-related complications occurred in 9 patients (10.2%) including pneumothorax (n = 2) and hemoptysis (n = 7). And there was no significant difference according to mass size, number of biopsies, or presence of pleural effusion. CONCLUSION: USG-guided transthoracic cutting biopsy is a useful and safe method for technically-feasible lung lesions.

Granulocytic Sarcoma Involving the Pectoralis Muscle in a Patient with Chronic Myelogenous Leukemia / 대한흉부외과학회지

We report here on a very rare case of granulocytic sarcoma of the pectoralis muscle on the left chest wall of a patient with chronic myelogenous leukemia, and this malady presented as a very rapidly growing hematoma-like mass.

Xanthoma of the Rib without Hyperlipoproteinemia: A case report / 대한흉부외과학회지

Primary xanthoma of the bone is a rare benign neoplasm, and it is extremely rare to find this in the ribs. It is most commonly reported in soft tissue and it associated with hyperlipoproteinemia. A 54-years-old male who complained of left chest pain had an X-ray taken. It revealed a left 3rd rib tumor. The blood examinations for lipid and protein were normal. A resection was done for tissue examination. The mass was histolopathologically diagnosed as a xanthoma.

Elastofibroma Dorsi in the Right Chest Wall / 대한흉부외과학회지

A 71-year-old woman visited our hospital with the chief complain of a mass in her infrascapular region. We performed tumor excision and we diagnosed it as elastofibroma dorsi. Elastofibromas are benign soft tissue tumors that mostly arise in the infrascapular lesion; it is a slowly growing lesion that's characterized by the proliferation of fibrous tissue with elastin. Its incidence is very low and its pathogenesis remains unclear. We report here on this case, and we include a review of the relevant literature.

A Metastatic Giant Cell Tumor of the Soft Tissue of the Thoracic Wall: A case report / 대한흉부외과학회지

A giant cell tumor of bone is a benign bone tumor, but has very high local recurrence rate and, very rarely metastasizes to the lung or a distant area. We report a case of a 29-year-old male patient presenting with a metastatic giant cell tumor of the soft tissue of the chest wall, who underwent a total resection of the radius for recurrence of the giant cell tumor. The tumor was not related to any bony structure of the thorax. We resected the tumor with a wide surgical margin. No evidence of malignancy was seen in the frozen and permanent pathological report.

Myxofibrosarcoma Originating from Chest Wall / 대한흉부외과학회지

Myxofibrosarcoma represents one of the most common soft tissue sarcomas of the extremities in adult and elderly patients. However, it only rarely occurs in the chest wall. A 58 years old woman presented with a huge painless lump (8x6.5 cm) in the right lower parasternal area which recurred a few months following excision from General surgery of our hospital. Histology showed an infiltrative deep seated dermal and subcutaneous tumor. It had a distinctive lobular growth pattern with prominent myxoid change and moderate cellularity. Tumor cells were spindle-shaped with varying degrees of pleomorphism and frequent mitotic figures. Numerous blood vessels with curvilinear growth pattern were also seen. Immunostains for S-100, CD68, Mac 387, and FX IIIa were all negative, but positive for Vimentin. The histologic feature was of an intermediate grade myxofibrosarcoma. Wide excision was performed and recovered in good condition without any physical disabilities and was discharged at one month later. Currently she is waiting for the skin graft without chemotherapy and radiotherapy.

Treatment of Tumor Involving Thoracic Inlet by Using Transmanubrial Osteomuscular Sparing Approach: One case report / 대한흉부외과학회지

The operative case of transmanubrial osteomuscular sparing approach for the tumor involving thoracic inlet is reported. A 69-year-old man visited the hospital due to right upper extremity weakness. Chest roentgenogram showed bronchiectasis, chronic pulmonary tuberculosis, and fungal ball in right upper lobe. On computed tomogram, tumor was located in epidural space of the 6th, the 7th cervical, and the 1st thoracic spine and extended to the apex of the right thorax. A neurosurgeon performed laminectomy and removed the tumor located in the spinal canal. A thoracic surgeon performed a transmanubrial osteomuscular sparing approach and removed the tumor involving thoracic inlet. The tumor was diagnosed as hemangiopericytoma. The patient recovered without complication.

Parachordoma of the Chest Wall: 1 case report / 대한흉부외과학회지

Parachordoma is a very rare, slow-growing, and low-grade malignant tumor that occurs in the extremities and trunk. The differential diagnosis includes extraskeletal myxoid chondrosarcoma and chordoma in the histologic finding. Thus, histologic findings with immunohistochemistry may be helpful in distinguishing parachordoma from extraskeletal myxoid chondrosarcoma and chordoma. I report with a brief review of literatures one case of parachordoma of the chest wall which was successfully treated by en-bloc resection and chest wall reconstruction using 2 mm Gore-Tex(R) soft tissue patch and free from recurrence for 16 months.

Chest Wall Metastasis from Unknown Primary Hepatocellular Carcinoma: A case report / 대한흉부외과학회지

Chest wall metastases from malignant tumors are rare and the majority of them are from adjacent structures such as the breast, lung, pleura, and mediastinum. Paticularly, chest wall metastases from distant organs are an even rarer event. There are few reports of chest wall metastasis with obscure or absent primary tumor. A 51-year-old man was diagnosed with metastatic hepatocellular carcinoma after an operation for a palpable mass on his left upper chest wall. At that time, there was no evidence of primary hepatocellular carcinoma in the liver after various examinations. We report a case of chest wall metastasis from unknown primary hepatocellular carcinoma.

Elastofibroma Dorsi: A case report / 대한흉부외과학회지

Elastofibroma dorsi, a rare, noncapsulated benign entity is characterized by the proliferation of fibrous tissue with elastin and occurs most often in the infrascapular area of elderly women. It is a relatively slowly growing lesion and no reports of malignant transformation exist. Which is overlooked easily because it rarely causes symptoms such as tenderness, pain, or restriction of movement. The diagnosis of elastofibroma is established by typical histopathologic findings. Radiographic evaluation may lead to a presumptive diagnosis. We experienced a case of elastofibroma dorsi in a 48-year-old woman and report this case with a review of the literature.

Clinical Review of Primary Chest Wall Tumors / 대한흉부외과학회지

BACKGROUND: Primary chest wall tumors originate from soft tissue, bone or cartilage of the chest wall and it comprises 1~2% of all primary tumors. Resection of tumor is often indicated for chronic ulceration or pain, and long-term survival might be achieved after surgery depending on the histology and the surgical procedure. MATERIAL AND METHOD: Retrospective study of 125 primary chest wall tumors (86 benign, 39 malignant) operated between Sep. 1976 to Mar. 2001 were reviewed and their clinical outcomes were analyzed. Follow-up data were collected at the outpatient clinic. RESULT: All patients with benign tumors were treated by excision without recurrence or death, and most malignancies were treated by wide resection. Malignant fibrous histiocytoma and chondrosarcoma constituted 46.2% of the malignant neoplasm. There was no operative death. The overall 3-year survival for patients with primary malignant neoplasm was 76.0%, and the 10-year survival was 60.5%. All deaths were disease-related and the tumor recurred in 11 patients. There was no significant difference in survival between patients with resection margins less than 4 cm and those with resection margins greater than 4 cm. CONCLUSION: Chest wall resection offers excellent results for benign chest wall tumors and substantial long-term survival for malignant diseases. Safe resection margin of 4 cm or more did not correlate with the survival rate although the tumor recurrence correlated with poor survival.

Primary Leiomyosarcoma of the Left Lower Posterior Chest wall with Lung Metastasis: One Case Report / 대한흉부외과학회지

An unusual case of primary leiomyosarcoma at the left lower posterior chest wall with metastasis to the right lung parenchyme is presented. The patient was a 43-year-old man who was asymptomatic but a slow growing hard mass was noted at the left lower posterior chest wall. The chest computed tomography showed a tumor at the left lower posterior chest wall with multiple metastasis to the right lung. The left lower posterior chest wall mass was examined by percutaneous needle aspiration and it was revealed as rhabdomyosarcoma histologically. En bloc resection to the left lower posterior chest wall tumor and metastasectomy to the multiple nodules in the right lung were done and pathological examination finally revealed primary leiomyosarcoma at the left lower posterior chest wall with multiple metastasis to the right lung. Chemotherapy was scheduled as adjunctive measure.

Langerhans' Cell Histiocytosis in Chest Wall / 대한흉부외과학회지

Langerhans' Cell Histiocytosis(LCH) is a disease of unknown origin, characterized by abnormal proliferation of Langerhans' cells. Previously, it has been called histiocytosis X, which included eosinophilic granuloma, Hand-Sch ller-Christian's disease, and Letterer-Siwe disease. Any organs or tissues such as skin, lymph nodes, bone and bone marrow can be involved. However, LCH of chest wall is rarely reported in our country. We experienced a 18 month old male child, who had osteolytic lesion involving the rib with axillary lymph node metastasis. The tumor was confirmed as LCH after surgery.

Malignant Fibrous Histocytoma Originating from the Chest Wall / 대한흉부외과학회지

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5x8x4cm with a 3x3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.

Lymphangioma of the Chest Wall / 대한흉부외과학회지

Lymphangioma(or cystic hygroma) of the chest wall is rare case. We experienced one such case in a 16-year-old girl who complained of a large recurrent mass on her right upper post erolateral chest wall which had developed several years ago. The diagnosis was made following a physical examination, chest magnetic resonance imaging(MRI), and radio isotope (RI) lymphangiogrphy and was confirmed by a histopathological examination. We performed total excision of the lesion followed by a repeated sclerosing therapy with intralesional injection of Vibramycin.

Review of Primary Chest wall Tumors / 대한흉부외과학회지

BACKGROUND: Chest wall tumors can classified into soft tissue tumors and bone tissue tumors and can be subclassified into benign and malignant tumors. MATERIALS AND METHODS: We report an analysis of 68 patients with primary chest wall tumors treated at the department of thoracic and cardiovascular surgery at Hanyang University Hospital from January, 1973 to September 1997. RESULTS: Among a total of 68 patients 33 (48.5%) were males and 35 (51.5%) were females. The ages of the patients ranged from 10 to 79 years with a mean age of 39.3 years. According to the age distribution, 23 patients (33.8%) were from the 4th decade, 12 patients (17.6%) were from the 6th decade, and 10 patients (14.7%) were from the 5th decade. Among the primary chest wall tumors, 53 cases were benign and 15 cases were malignant. Among the benign tumors, 17 cases (32.1%) were in the 4th decade and among the malignant tumors, 6 cases (40%) were in the 4th decade. In both malignant and benign tumors the most common ages were in the 4th decade. The most common tumors were fibrous dysplasia and chondroma, each with a total of 14 cases (26.4%). Osteochondroma and lipoma each had 8 cases (15.1%). Among malignant tumors, osteosarcoma was most common with 8 cases (53.3%). According to location, 49 cases occured in both bone and cartilage tissue, 19 cases occurred in cartilage. Among the presenting symptoms, palpable mass was present in all cases. Fifty-one patients complained of tenderness and among cases with involvement of the lung, 3 patients had complained of respiratory distress. Among the malignant tumors 6 cases underwent a radical operation and 4 cases of benign tumors underwent a radical operation. Postoperativly, there was one case with recurrence from a desmoid tumor. There were no deaths postoperativly and no deaths due to complications (and their postoperative courses were uneventful). CONCLUSIONS: Most patients with primary chest wall tumors initially present with mass at admission. Resection is sufficient treatment for benign tumors but in malignant tumors wide resection of the chest wall is needed and mchest wall reconstruction.

Malignant Schwannoma on the Right Chest Wall: 1 Case Report / 대한흉부외과학회지

Malignant schwannoma is rare tumor which is derived from schwan cells or nerve sheath cells, and it is frequently associated with Von Rechlinghausen's disease. We experienced one case of malignant schwannoma on the right chest wall without Von Rechlinghausen's disease. Patient was 64-year-old man who presented painless palpable mass on the right lower chest wall for about 2 months. On chest computed tomography, the mass which was 6 X 6 cm in size and had central necrosis, involved 11th rib with destruction, invaded the diaphragm and displaced the kidney anteriorlly. He underwent en-bloc resection of the tumor and discharged without any problem after 20 days.

Chest Wall Giant Malignant Peripheral Nerve Sheath Tumor: One case report / 대한흉부외과학회지

A case of chest wall malignant peripheral nerve sheath tumor(MPNST) was reported in the U.S.A by Mark and coworkers(1991), but none in kerea. MPNST accounts for approximately 10% of all soft tissue sarcoma, mostly in patients between 20 and 50 years of age. MPNST arises in association with a major nerve trunk, including the sciatic nerve, brachial plexus, and sacral plexus and the most common anatomical site is the proximal portion of the upper and lower extremity and trunk. Surgical treatment is local excision of mass in low grade sarcoma but enblock resection is necessary in high grade sarcoma. We experienced multiple huge low grade MPNST on left chest wall of a 50 years old man. The tumor and invalved chest wall were removed, and the chest wall defect(15 X 8 cm) was reconstructed with Teflon. Postoperative course was unevenful.