Large Chest Wall Mass Research Articles

Oncoplastic reconstruction of a large chest wall defect using dual fasciocutaneous flaps: A case report.

Introduction and importanceLarge chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy.Case presentationA 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well.Clinical discussionFasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury.ConclusionsOncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation.

Large Chest Wall Mass Presentation of Advanced Breast Implant Associated Anaplastic Large Cell Lymphoma

Large Chest Wall Mass Presentation of Advanced Breast Implant Associated Anaplastic Large Cell Lymphoma

PLEURAL-BASED LUNG MASS WITH AN UNUSUAL PRESENTATION

SESSION TITLE: Disorders of the Pleura 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Primary tumors of the pleura are rare. Majority of the tumors are benign. About 10–20% of the cases reported in the literature are malignant. We present a case of a patient with non specific symptoms and radiological findings consistent with a mass of pleural origin. CASE PRESENTATION: 44 year old African American male, presented with symptoms of productive cough, fever and left sided pleuritic chest pain since the last two months. He was recently incarcerated and released two weeks prior to presentation. He was a former smoker of 20 pack years. PPD and HIV test done within the last one year were normal. On physical examination, he had a fever of 102.2F, heart rate of 127/min, and respiratory rate 22/min. Chest auscultation revealed bilateral expiratory wheezing. Labs showed a normal complete blood count and metabolic panel. TB Gold quantiferon was less than 0.01 IU/ml. Respiratory virus panel was positive for rhinovirus. Initial Chest X ray showed a relatively well demarcated round mass in the left mid-lung with minimal displacement of the carina to the right. CT Chest confirmed the presence of a 12.0 x 14.6 x 13.1 cm pleural based lung mass with atelectasis of the left upper lobe and mass effect on the left hilar structures. Patient underwent a CT guided biopsy of the mass. Pathology revealed atypical cells with a low to moderate degree of pleomorphism. Immunohistochemistry revealed expression of CD 34 and diffuse nuclear expression of STAT6. Patient underwent surgical resection of the mass with partial pleurectomy. Intraoperative findings revealed large chest wall mass attached to the anterior parietal pleura. Post-operative course was unremarkable. Surgical pathology confirmed the presence of a malignant solitary fibrous tumor. DISCUSSION: Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms of mesenchymal origin believed to arise from sub mesothelial connective tissue. SFTP is common in the fifth and sixth decades of life compared with SFTs arising intra-abdominally or in soft tissue. There is no sexual predilection. Evidence of a genetic predisposition or a relationship to exposure to asbestos or tobacco have not been demonstrated. The most common presenting symptoms are non-specific and include cough, chest pain and dyspnea. Paraneoplastic syndromes may be occur and present with clubbing, pulmonary osteoarthropathy secondary to secretion of hyaluronic acid, and refractory hypoglycemia due to secretion of insulin like growth factor II. Our patient presented with symptoms of an upper respiratory tract viral infection and non specific symptoms consistent with SFTP .Surgical resection is the mainstay of treatment in both benign and malignant variants. CONCLUSIONS: SFTP are rare. They may present with non specific symptoms.The prognosis for patients with SFTP is generally favorable with a 5-year overall survival rate ranging from 79 to 100%. Reference #1: 1. Solitary fibrous tumors of the pleura.Cardillo G1, Lococo F, Carleo F, Martelli M.Curr Opin Pulm Med. 2012 Jul;18(4):339-46. https://doi.org/10.1097/MCP.0b013e328352f696 Reference #2: Solitary fibrous tumor of the pleura.Robinson LA.Cancer Control. 2006 Oct;13(4):264-9 DISCLOSURES: No relevant relationships by MUHAMMAD ADEEL, source=Web Response no disclosure on file for Ashish Arora; No relevant relationships by Bilal Bangash, source=Web Response No relevant relationships by Jeff Kwon, source=Web Response No relevant relationships by Safal Shetty, source=Web Response

Use of the ipsilateral breast in anterolateral chest wall reconstruction

Chest wall ablative surgery often requires autologous tissue transfer to reconstruct the resulting defect. The female breast is commonly of a suitable size to provide anteromedial chest wall coverage as a pedicled dermoglandular flap. In anterolateral defects the latissimus dorsi or serratus anterior flaps are often the preferred choice, in the absence of which free tissue transfer is an alternative technique. However these options may not always be available or suitable. A 90-year-old female presented with a large chest wall mass in keeping with recurrence of oesophageal squamous cell carcinoma in the thoracotomy scar following a previous oesophagectomy. The latissimus dorsi and serratus anterior muscles were transected during the previous thoracotomy. Following complete resection, the ipsilateral breast was used as a rotational dermoglandular flap to provide coverage over the exposed ribs. The use of breast as a local flap is an alternative option in anterolateral chest wall reconstruction.

Local recurrence of low-grade myofibroblastic sarcoma of the chest wall: Report of a case and literatures review

A 71-year-old female with a history of a resected sarcoma of the chest wall presented for a follow-up examination 34 months after surgery. She had undergone wide excision of a soft tissue mass on the right chest wall in January 2004. The mass, together with involved intercostal muscles, ribs (fifth and sixth), and pleura was resected en bloc. Defects of the chest wall were repaired using Prolene mesh. Postoperative pathological diagnosis revealed low-grade fibroblastic/myofibroblastic sarcoma involving skeletal muscle, ribs, and pleura. On immunohistochemical staining, the tumor was negative for actin, desmin, CD34, cytokeratin and S-100, except for CD99. Her postoperative course was uneventful, and she received no postoperative adjuvant therapy. At her follow-up visit in November 2006, she presented with a 3-month history of a progressively enlarging mass on the right chest wall. Physical examination was significant for a large mass measuring 10×7 cm on the right chest wall with a well-healed scar. CT revealed a large chest wall mass (maximum diameter=11 cm, Fig.1). Distant metastasis was excluded with a preoperative evaluation, and en bloc resection was then planned. Exploratory surgery revealed that the tumor had invaded the pectoralis major, ribs, intercostal muscle, pleura and lung. En bloc resection involving the pectoralis major, ribs four to seven, partial lung (middle and lower lobe) was performed. The chest wall was reconstructed with Marlex mesh and a latissimus flap. Pathological examination of the specimen revealed a LGMS involving skeletal muscle, ribs, pleura, and lung. Immunohistochemically, the tumor was positive for smooth muscle actin, desmin, CD34, CD99 and actin, but negative for cytokeratin, epithelial membrane antigen, fibronectin, and HBME1(Fig.2). The patient received no postoperative treatment and felt well 9 months after the second operation.

Non-Hodgkin’s Lymphoma Presenting as a Large Chest Wall Mass

Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.

Thoracoscopic-Assisted Resection of a Chest Wall Hamartoma with Secondary Aneurysmal Bone Cyst

Introduction: Thoracoscopic-assisted resection of thoracic aneurysmal bone cyst has never been described in the literature. Infantile cartilaginous hamartoma of the rib is a large tumor characterized by cartilaginous, vascular, and mesenchymal elements. Most cases are diagnosed before the age of one year due to their rapid rate of growth and expansion. Aneurysmal bone cysts usually arise secondary to a pre-existing tumor, and are known for their hypervascularity. Use of preoperative embolization is one technique that has been described in the literature to facilitate resection of aneurysmal bone cysts and to avoid complications from hemorrhage. This is a presentation of the case of a ten-month-old boy with a large chest wall mass, confirmed by computed tomography guided biopsy to be a chest wall hamartoma with secondary aneurysmal bone cyst. Preoperatively the patient had an episode of hemorrhage into the mass requiring blood transfusion. Due to the concern for major hemorrhage during the procedure, the m...