Primary Chest Wall Tumors Research Articles

Primary and secondary chest wall tumors from the pathologist's viewpoint

Fibrous dysplasia (20%), metastases (16%) and chondrosarcoma (11%) are the most common bone tumors of the chest wall. Except lipoma, primary lesions of the soft tissue of the chest occur rarely as well. The Askin- and Abrikosoff tumor, elastofibroma dorsi and desmoid can be seen as typical exceptions. With respect to the histogenetic classification of undifferentiated sarcomas and thoracic metastases (f.e. prostatic carcinomas or mesotheliomas) an intimate cooperation of surgeons and pathologists as well as modern immunohistochemical investigations are required.

Primary Chest Wall Tumors: Factors Affecting Survival

Between 1955 and 1975, chest wall resection was done in 90 patients for primary chest wall tumors. Ages ranged from 8 to 96 years (mean, 44.3 years). A painful mass was the most common sign and symptom. Eighty-two tumors (91.1%) were located in the lateral chest wall and eight, in the anterior thorax. The tumor was malignant in 71 patients (78.9%) and benign in 19. All patients with benign tumors had complete excision and are currently free from disease. Malignant fibrous histiocytoma, chondrosarcoma, and rhabdomyosarcoma constituted 62% of the malignant neoplasms. Most malignancies were treated by wide resection. There were no thirty-day operative deaths. Overall 1-, 5-, and 10-year survival was 89%, 57%, and 49%, respectively. Recurrent tumor developed in 37 patients (52%); 5-year survival, however, was only 17% after recurrence. Cell type and extent of invasion significantly influenced survival. Both chondrosarcoma and rhabdomyosarcoma had a better prognosis than malignant fibrous histiocytoma ( p < 0.05). We conclude that early resection is the treatment of choice for primary malignant chest wall tumors and that development of recurrent disease is an ominous event.

Primary chest wall tumors

Primary chest wall tumors

Malignant fibrous histiocytoma in thoracic surgical practice

Malignant fibrous histiocytoma is a rare, although increasingly recognized, deep-seated pleomorphic sarcoma. A primitive tumor, it arises from tissue histiocytes and typically occurs in the extremities. Primary intrathoracic tumors have been reported rarely. The presentation of malignant fibrous histiocytoma in our series of seven patients has been varied. Two cases presented as solitary primary intrapulmonary tumors, two as primary chest wall tumors, one as an anterior mediastinal mass, one as a retroperitoneal tumor extending cephalad through the diaphragm, and one as a late metastasis from a primary pelvic site. Malignant fibrous histiocytoma is aggressive, with a propensity for early local and distant spread; three of the patients in our series died of progressive disease within 17 months of operation. The histologic nature of the tumor makes diagnosis on small biopsy specimens difficult and frequently misleading. We would suggest a policy of open biopsy to obtain adequate and representative specimens for histologic study and preoperative computed tomographic scanning to augment the clinical search for metastatic disease and to facilitate planning of subsequent radical, excisional operation. The preoperative use of deep x-ray therapy or the newer chemotherapeutic agents may reduce tumor bulk and thereby facilitate radical operation, which presently appears to be the most appropriate primary modality of treatment of malignant fibrous histiocytoma.

Primary Chest Wall Tumors

A retrospective study of 53 primary chest wall tumors, 26 benign and 27 malignant, was carried out to review their clinical radiological and pathological features. Forty-nine of the 53 lesions presented in the ribs and the remaining 4, in the sternum. The overall 5-year survival for patients with primary malignant neoplasms of the chest wall was 33.3%, and the 10-year survival was 18.5%. All of the deaths were disease related. All of the patients with benign tumors were treated by excision without recurrence or death. Distinction between benign and malignant chest wall tumors was not possible using radiographic criteria unless cortical destruction and involvement of soft tissues were visualized. On the basis of our analysis, we believe that all tumors of the chest wall should be considered malignant until proven otherwise and that wide excision should be carried out. This is necessary not only to obtain an adequate diagnosis but also to provide the best chance for cure in both benign and malignant lesions.

Resection of tumors of the chest wall

The aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.We retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.A total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.Biological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.

Initial and Long-term Results in the Management of Primary Chest Wall Neoplasms

One hundred ten patients with primary chest wall neoplasms were analyzed for long-term results. The diagnosis of 59 malignant and 51 benign tumors was confirmed by the Armed Forces Institute of Pathology. No deaths were associated with primary definitive therapy. Among the five most frequently encountered malignant tumor types, five-year survivals were obtained in 9 of 17 (53%) patients with fibrosarcoma, 8 of 9 (89%) patients with chondrosarcoma, 2 of 8 (25%) patients with solitary chest wall plasmacytoma (multiple myeloma), 1 of 6 (17%) patients with Ewing's sarcoma, and 2 of 4 (50%) of patients with osteogenic sarcoma. Although the five-year survival appears to indicate therapeutic success in patients with Ewing's sarcoma and osteogenic sarcoma, patients with chondrosarcoma or fibrosarcoma may have a more protracted course, and those with solitary plasmacytoma usually develop multiple myeloma. The findings suggest that radical surgical excision is the treatment of choice for chondrosarcoma; radical surgical excision combined with chemotherapy, for fibrosarcoma and osteogenic sarcoma; surgical excision combined with radiation and chemotherapy, for Ewing's sarcoma; and systemic surveillance and therapy, for pathologically confirmed solitary plasmacytoma.

Primary Chest Wall Tumors

Forty-five chest wall tumors have been diagnosed in patients at Vanderbilt University Hospital since 1940. Twenty-two of these patients had benign lesions, and all were treated by wide excision without recurrence or death. Of the 23 patients with malignant tumors, only 1 patient with a tumor of skeletal origin survived more than ten years without recurrence. The remaining 3 patients who were ten-year survivors had deep soft-tissue or neural sarcoma. No patient with primary malignant tumor of the chest wall survived more than five years without radical excision. Of the 6 patients surviving five years or more, 1 had reexcision at eight years and another at ten years. This suggests that early wide excision of all primary chest wall tumors and all recurrent chest wall tumors is the treatment of choice.

Chest Wall Tumors: A review of clinical experiences with 30 cases.

Our clinical experience with a group of 30 chest wall tumors, of which 13 (43 per cent) were malignant, has been presented. The neurogenic tumors were found to be the commonest of the benign neoplasms whereas the chondrosarcomas were the most frequently encountered of the malignant neoplasms. Two metastatic tumors were documented, each masquerading as a primary chest wall tumor. The surgical approach to tumors of the chest wall was discussed, emphasizing the importance of early and adequate primary excision by thoracotomy approach, and radical re-excision when indicated by study of the excised specimen. It is our opinion that early radical excision will result in a much higher salvage rate, especially for the chondrosarcomas. One can assume that almost half of the deep-seated chest wall tumors will prove to be malignant. Repair of the chest wall defects resulting from radical excisional procedures was found to be most easily effected by means of plastic technics. The use of prosthetic materials was unnecessary in our experience.