A Modified Reconstruction Technique of Chest Wall after Radical Resection of Chondrosarcoma Underlying the Breast

Chest wall tumors are uncommon and include a variety of Cartilaginous, bony, and soft tissue lesions. The clinical presentation varies from asymptomatic to chest pain or ulcerating chest mass. Retro mammary chondrosarcoma of the chest wall can present as a painless breast mass and may be mistaken for a breast tumor. A careful clinical examination and relevant investigations are a cornerstone to plan an appropriate surgical procedure.

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Chest Wall Tumors

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239800600314 ◽

1998 ◽

Vol 6 (3) ◽

pp. 212-215 ◽

Cited By ~ 2

Author(s):

B Ali Özuslu ◽

Onur Genç ◽

Sedat Gürkök ◽

Kunter Balkanli

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Distant Metastases ◽

Metastatic Tumor ◽

Prosthetic Material ◽

Benign Tumors ◽

Chest Wall Resection ◽

En Bloc ◽

Reconstructive Procedures ◽

Chest Wall Tumors

We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.

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Reconstruction methods in chest wall resections

Journal of Surgical Arts ◽

10.14717/jsurgarts-210101 ◽

2021 ◽

pp. 1-6

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Preoperative Evaluation ◽

Chest Wall Resection ◽

Soft Tissue Coverage ◽

Chest Wall Tumors ◽

Metastatic Lesions ◽

Reconstruction Methods ◽

Pulmonary Mechanic ◽

Skeletal Stability

Chest wall defects generally result from resection of primary chest wall tumors, locally-invasive malignancies, or metastatic lesions. After an R0 chest wall resection, first skeletal stability must be established with prosthetic or bioprosthetic materials, or a combination of both. Regardless of the technique used to establish skeletal stability, soft tissue coverage of the prosthesis is necessary. The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs and provide soft tissue coverage. In this article, our aim is to review the basic principles and indications of the chest wall resection and reconstruction, preoperative evaluation of patients, and the materials and methods used for the reconstruction.

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Benign but Terminal: Cardiopulmonary Collapse from a Massive Chest Wall Lipoma

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620949293 ◽

2020 ◽

Vol 8 ◽

pp. 232470962094929

Author(s):

Shweta Paulraj ◽

Prateek Suresh Harne ◽

Kanish Mirchia ◽

Sundus Mian ◽

Raman Sohal ◽

...

Keyword(s):

Soft Tissue ◽

Chest Wall ◽

Excisional Biopsy ◽

Wide Resection ◽

Rare Presentation ◽

Tissue Mass ◽

Restrictive Lung Disease ◽

Chest Wall Tumors ◽

Extrinsic Compression ◽

Treat All

Lipomas are the most common benign soft tissue tumor. Yet, strikingly simple tumors can become problematic when compounded by odd characteristics such as size and location. We report the case of a 53-year-old male who developed complete right lung collapse secondary to a large right-sided chest wall lipoma with accelerated growth in the past 6 months. Bronchoscopy revealed extrinsic compression of the right mainstem bronchus. Histopathology of the soft tissue mass was suggestive of a lipoma. The mass was not amenable to surgery due to a high risk of mortality from his underlying comorbidities. His hospital stay was complicated by progressive end-stage restrictive lung disease necessitating intubation and eventually a tracheostomy, recurrent pneumonias, multiorgan dysfunction, and his eventual demise. We highlight a rare presentation of an unchecked lipoma, which ultimately led to the death of our patient. Simple lipomas show insidious growth and can remain asymptomatic until they reach a large size. Chest wall tumors should be considered malignant until proven otherwise by excisional biopsy. This reiterates the need to treat all chest wall tumors with wide resection in order to provide the best chance for cure.

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T2 Gallbladder Cancer—Aggressive Therapy is Warranted

The American Surgeon ◽

10.1177/000313481608200612 ◽

2016 ◽

Vol 82 (6) ◽

pp. 518-521 ◽

Cited By ~ 2

Author(s):

Mohd Raashid Sheikh ◽

Houssam Osman ◽

Susannah Cheek ◽

Shenee Hunter ◽

Dhiresh Rohan Jeyarajah

Keyword(s):

Clinical Presentation ◽

Radical Surgery ◽

Radical Resection ◽

Gall Bladder Cancer ◽

Incidental Diagnosis ◽

Radical Cholecystectomy ◽

Node Positive ◽

Operative Findings ◽

Worse Prognosis

Treatment of gall bladder cancer (GBC) has traditionally been viewed with pessimism and lymph node positivity has been associated with worse prognosis. The aim of this study is to analyze the role of radical cholecystectomy in T2 tumors. All patients who underwent surgery for GBC between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Twenty-five patients had incidental GBC diagnosis after cholecystectomy. Ten patients were T2 on initial cholecystectomy pathology and all underwent radical resection. Two patients were N1 on initial cholecystectomy pathology. Four were upstaged to N1 and two patients were upstaged to T3 after further surgery. Overall, 60 per cent patients with T2 disease had node positivity and 60 per cent were upstaged by further surgery. Eleven patients were diagnosed on imaging. Four of these patients were unresectable and six were either stage T3 or higher or node positive. Sixty per cent of T2 GBC was node positive and 60 per cent were upstaged with radical cholecystectomy. This finding supports the call for radical resection in patients with incidental diagnosis of T2 tumor on cholecystectomy. This study also emphasizes the role of radical surgery in accurate T staging.

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PROSTHESIS FOLLOWING EXCISION OF CHEST WALL TUMORS

Journal of Thoracic Surgery ◽

10.1016/s0096-5588(20)30951-x ◽

1956 ◽

Vol 31 (1) ◽

pp. 45-59

Author(s):

Bert H. Cotton ◽

George A. Paulsen ◽

Jack Dykes

Keyword(s):

Chest Wall ◽

Chest Wall Tumors

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Real world cost and health outcomes of patients presented with chest pain in England: which is the most cost-effective first-line test?

European Heart Journal ◽

10.1093/ehjci/ehaa946.3547 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Tsiachristas ◽

H West ◽

E.K Oikonomou ◽

B Mihaylova ◽

N Sabharwall ◽

...

Keyword(s):

Chest Pain ◽

Health Outcomes ◽

Diagnostic Tests ◽

Clinical Presentation ◽

Cost Effective ◽

Funding Source ◽

First Line ◽

Nice Guidelines ◽

Exercise Ecg ◽

Stable Chest Pain

Abstract Background The National Institute for Health and Care Excellence (NICE) updated their guidance for the management of patients with stable chest pain and recommended that all patients undergo computed tomography coronary angiography (CTCA). This update has sparked a great deal of debate, and was followed by upgrade of CTCA into a Class I indication in the recent ESC guidelines. The cost-effectiveness of using CTCA as first line investigation is still unclear. Purpose To describe the current clinical pathway of patients with stable chest pain presented to outpatient clinics, assess the compliance with the updated NICE guideline, and explore the costs and health outcomes of different non-invasive diagnostic tests in real-world clinical setting. Methods We used data of 4,297 patients who attended chest pain clinics in Oxford between 1 January 2014 and 31 July 2018. Data included clinical presentation (e.g. age and previous cardiovascular conditions), diagnostic tests, outpatient visits, hospitalization, and hospital mortality and was compared between 6 alternative first-line diagnostic tests. Multinomial regressions were performed to estimate the probability of receiving each alternative and the associated cost after adjusting for clinical presentation. A decision tree was developed to describe the clinical pathway for each alternative first-line diagnostic in terms of subsequent diagnostic tests and treatments and to estimate the associated costs and life days. Results The proportion of patients who received CTCA as first line diagnostic test increased from 1% in 2014 to 17% in 2018, while the publication of the updated NICE guidelines in 2016 led to a threefold increase in this proportion. CTCA is less likely to be provided as a first-line diagnostic to patients who are younger age, males, smokers, and have angina, PVD, or diabetes. The standardised rate of hospital admission was the lowest in the exercise ECG cohort (0.35 admissions per 1,000 life-days) followed by the CTCA cohort (0.40 admissions per 1,000 life-days) while the latter cohort had the lowest standardised rate of cardiovascular treatment (2.74% per 1,000 life days). Stress echocardiography and MPS were associated with higher costs compared with CTCA, other ECG, and exercise ECG after adjusting for clinical presentation and days of follow-up. CTCA is the pathway most likely to be cost-effective, even compared to exercise ECG, while the other diagnostic alternatives are dominated (i.e. they cost more for less life-days). Conclusions Currently, the updated NICE guidelines for stable chest pain are implemented only to a fifth of the cases in England. Our findings support existing evidence that CTCA is the most-cost effective first-line diagnostic test for this population. Hopefully, this will inform the debate around the implementation of the guidelines and help commissioning and clinical decision processes worldwide. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research Oxford Biomedical Research Centre

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Evaluating a calcium-aware kernel for CT CAC scoring with varying surrounding materials and heart rates: a dynamic phantom study

European Radiology ◽

10.1007/s00330-021-08076-5 ◽

2021 ◽

Author(s):

Niels R. van der Werf ◽

Ronald Booij ◽

Bernhard Schmidt ◽

Thomas G. Flohr ◽

Tim Leiner ◽

...

Keyword(s):

Coronary Artery ◽

Soft Tissue ◽

Patient Specific ◽

Reconstruction Technique ◽

Ct Reconstruction ◽

Raw Data ◽

Heart Rates ◽

Tissue Equivalent ◽

Tin Filtration ◽

Reconstruction Kernel

Abstract Objectives The purpose of this study was twofold. First, the influence of a novel calcium-aware (Ca-aware) computed tomography (CT) reconstruction technique on coronary artery calcium (CAC) scores surrounded by a variety of tissues was assessed. Second, the performance of the Ca-aware reconstruction technique on moving CAC was evaluated with a dynamic phantom. Methods An artificial coronary artery, containing two CAC of equal size and different densities (196 ± 3, 380 ± 2 mg hydroxyapatite cm−3), was moved in the center compartment of an anthropomorphic thorax phantom at different heart rates. The center compartment was filled with mixtures, which resembled fat, water, and soft tissue equivalent CT numbers. Raw data was acquired with a routine clinical CAC protocol, at 120 peak kilovolt (kVp). Subsequently, reduced tube voltage (100 kVp) and tin-filtration (150Sn kVp) acquisitions were performed. Raw data was reconstructed with a standard and a novel Ca-aware reconstruction technique. Agatston scores of all reconstructions were compared with the reference (120 kVp) and standard reconstruction technique, with relevant deviations defined as > 10%. Results For all heart rates, Agatston scores for CAC submerged in fat were comparable to the reference, for the reduced-kVp acquisition with Ca-aware reconstruction kernel. For water and soft tissue, medium-density Agatston scores were again comparable to the reference for all heart rates. Low-density Agatston scores showed relevant deviations, up to 15% and 23% for water and soft tissue, respectively. Conclusion CT CAC scoring with varying surrounding materials and heart rates is feasible at patient-specific tube voltages with the novel Ca-aware reconstruction technique. Key Points • A dedicated calcium-aware reconstruction kernel results in similar Agatston scores for CAC surrounded by fatty materials regardless of CAC density and heart rate. • Application of a dedicated calcium-aware reconstruction kernel allows for radiation dose reduction. • Mass scores determined with CT underestimated physical mass.

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