Chest wall and diaphragm reconstruction; a technique not well established in literature – case report

Introduction Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. Case presentation A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. Conclusion We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.

Breast implant capsule‑associated squamous cell carcinoma: case report

Breast augmentation with the use of silicone breast implants is a routine practice for breast surgeons. Breast implant capsule‑associated squamous cell carcinoma is a rare and aggressive malignant tumor accounting for less than 0,1 % of invasive breast cancer. Currently there is no single concept of a complex therapy for such tumors due to the low incidence rate. The article describes a case of a 49‑year‑old female patient after surgical treatment of left‑sided breast implant capsule‑associated squamous cell carcinoma diagnosed in 2019. After the disease progression the patient underwent removal of the chest wall tumor with resection of ribs 3–5, allo‑and autoplasty, and left axillary lymph node dissection (ALND). In most cases, breast implant capsule‑associated squamous cell carcinoma is treated surgically but the role of adjuvant chemotherapy, radiation therapy, and endocrine therapy is still ambiguous.

Aortic valve replacement and coronary artery bypass grafting through a right thoracotomy for a patient with a left chest wall tumor

A 68-year-old man was diagnosed with severe aortic stenosis and right coronary artery occlusion on preoperative examination for total extirpation of a giant left breast liposarcoma. Prior to the intervention for the liposarcoma, he underwent successful aortic valve replacement and coronary artery bypass grafting via a right anterolateral thoracotomy to avoid the tumor close to the sternum. On postoperative day 28, the patient underwent a successful wide excision of the left chest wall tumor.

Chest wall pseudotumor: a case of non-tuberculous mycobacterial infection

Background Non-tuberculous mycobacterial (NTM) infections are increasing worldwide, making them an international public health problem. Surgical management is often indicated for localized infectious disease; however, most surgeons are unaware of the potential risks of transmission during surgery. Case presentation An 88-year-old Asian female was referred to our hospital for a tumor in the right lateral thoracic region. One month prior, she had a feeling of fullness and complained of localized pain and warmth in the right lateral thoracic wall. Pain and warmth gradually resolved without intervention; however, the fullness was getting worse. Computed tomography (CT) scan showed a mass of approximately 65 × 30 mm with an osteolytic change, involving the right 8th rib. Based on the rapid growth rate and CT findings, we strongly suspected a malignant chest wall tumor, and en bloc tumor resection with the 8th rib was performed. When the specimen was cut, a large amount of viscous pus was drained and its culture showed growth of Mycobacterium avium. Microscopically, the non-caseating epithelioid cell granuloma extended into the rib, infiltrating the bone cortex. On follow-up 1 month after discharge, there were no signs of infection or other adverse events associated with the surgery. Conclusions Herein, we report about a patient with a mass diagnosed as an NTM abscess involving the rib cage, which was confused with a malignant tumor and eventually diagnosed following surgical excision. This report emphasizes the need to be aware of the possibility of NTM infection and take appropriate precautions if the patient has a rapidly growing mass in the chest wall.

Squamous cell breast cancer: description of a rare clinical case

Squamous cell carcinoma of the breast is a rare, aggressive tumor with a poor prognosis. To date, due to the low incidence of morbidity, there is no single concept in the complex treatment of this pathology. The article describes the case of a 49-year-old patient after surgical treatment of squamous cell carcinoma of the left breast from 2019 on the anamnesis. A year later after the progression of the disease the patient underwent removal of a chest wall tumor with resection of IIIV ribs, allo- and autoplasty, axillary lymphadenectomy on the left. In most cases, the treatment of squamous cell carcinoma of the breast is surgery, but the role of adjuvant chemotherapy, radiation therapy and endocrinotherapy are still unambiguous.

Low-grade chondrosarcoma mimicking breast cancer

Chondrosarcomas are rare cartilage-like mesenchymal tumors. Some rib-sited tumors can mimic other common tumors. We present the case of a 24-year-old female with chondrosarcoma of the fourth left rib, mimicking breast cancer. Complete resection with chest wall reconstruction was performed successfully with good prognostic results. Physicians should bear in mind the possibility of a primary chest wall tumor mimicking breast cancer that needs a different therapeutic strategy. Complete surgical resection and chest wall reconstruction is the mainstay of treatment for chondrosarcoma.