Reconstruction of the chest wall after resection of malignant peripheral nerve sheath tumor: A case report

BACKGROUNDMalignant peripheral nerve sheath tumors (MPNSTs) are a group of rare and aggressive sarcomas that often arise from major peripheral nerves and represent a notable challenge to efficacious treatment. MPNSTs can occur in any body surface and visceral organs with nerve fiber distribution. The treatment options for MPNSTs include surgery, chemotherapy, and adjuvant radiotherapy. CASE SUMMARYA 26-year-old female cellist presented with chest pain on her left side when she squatted to lift the cello. One week later, a chest X-ray was performed and revealed fracture of the fourth rib on the left side. Three months later, the patient inadvertently touched a mass on the left side of the chest wall. Chest computed tomography (CT) three-dimensional reconstruction of the ribs revealed bone destruction of the fourth rib on the left side with a soft tissue mass shadow measuring 5.7 cm × 3.7 cm. CT-guided puncture biopsy of the tumor showed that heterotypic cells (spindle cells) tended to be nonepithelial tumor lesions. PET-CT demonstrated bone destruction and a soft tissue mass with avid 18F-fluorodeoxyglucose activity (SUV_max7.5) in the left fourth rib. The tumor of the left chest wall was resected under general anesthesia, and reconstruction of the chest wall was performed. The postoperative pathological report exhibited an MPNST.CONCLUSIONMPNSTs are relatively chemo-insensitive tumors. The mainstay of treatment for MPNSTs remains resection with tumor-free margins.     

Primary maxillary chondrosarcoma: A case report

BACKGROUND Sarcomas of the head and neck region are rare tumors,constituting less than 1%of malignant neoplasms in this area,of which few cases(20%)originate from bone or cartilage.Chondrosarcoma is a malignant neoplasm that develops in bone,with a predilection for the pelvis,chest wall,and scapula,and is uncommon in the maxilla and jaw.Although this type of lesion has locally aggressive behavior,destroying the affected bone,it can metastasize when it is not diagnosed early and compromise the patient's life.CASE SUMMARY On intraoral examination of a 32-year-old female with a tumor in the middle third of the face,a well-defined rise in volume of approximately 3 cm in diameter was observed.Computed tomography with 3-dimensional reconstruction was performed,and we observed that the osteolytic lesion affected the vestibular cortex as the palatal bone.Hematoxylin and eosin staining revealed an appearance that was similar to mature hyaline cartilage,hypercellularity,nuclear and cellular pleomorphism,and multinucleated cells,with significant vacuolization.CONCLUSION Determination of the clinical and histopathological characteristics of rare neoplasms in the maxillofacial region,such as chondrosarcomas,allows the pathologist and surgeon to make the appropriate therapeutic decisions,optimizing the patient’s prognosis.     

原发性盆壁软骨肉瘤1例

患者女,45岁,因反复右臀部及友大腿疼痛1年就诊.查体见右臀部隆起,皮肤表面颜色正常,局部压痛,质地稍硬.     

Reconstruction of complex chest wall defects: A case report

BACKGROUNDChronic radiative chest wall ulcers are common in patients undergoing radiation therapy. If not treated early, then symptoms such as erosion, bleeding and infection will appear on the skin. In severe cases, ulcers invade the ribs and pleura, presenting a mortality risk. Small ulcers can be repaired with pedicle flaps. Because radioactive ulcers often invade the thorax, surgeons need to remove large areas of skin and muscle, and sometimes ribs. Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARYA 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer. The patient was diagnosed with chronic radioactive ulceration. After multidisciplinary discussion, the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator (DIEP) flap combined with a high-density polyethylene (HDPE) patch. The patient was followed-up 6 mo after the operation. No pigmentation or edema was found in the flap.CONCLUSIONDIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.     

胸骨切除后钛网胸廓重建治疗胸骨肿瘤的临床研究

目的：探讨钛网用于胸骨切除后胸廓重建的方法和临床效果。方法：10例胸骨肿瘤患者行胸骨切除后采用钛网对缺损胸骨进行重建,随访观察以评价手术效果。结果：10例患者手术均成功,患者术后前胸壁外观良好,未发生排斥反应,无呼吸循环并发症,仅2例出现轻度呼吸反常。随访至撰稿日止无死亡病例。结论：钛网具有良好的生物相容性,对胸廓具有有效的支撑作用,值得在临床上推广应用。     

Delayed complications of intradural cement leakage after percutaneous vertebroplasty: A case report

BACKGROUNDIntradural cement leakage following percutaneous vertebroplasty is a rare but acute and devastating complication that usually requires emergent treatment. Here, we report a delayed complication of intradural leakage after percutaneous vertebroplasty.CASE SUMMARYA 71-year-old female patient with an L1 osteoporotic compression fracture underwent percutaneous vertebroplasty in 2014. She was referred to our hospital 5 years later due to complaints of progressive weakness and numbness in both legs combined with urinary incontinence and constipation. Initially, she was suspected to have a spinal meningioma at the level of L1 according to imaging examinations. Postoperative pathological tests confirmed that cement had leaked into the dura during the first percutaneous vertebroplasty.CONCLUSIONGuideline adherence is essential to prevent cement from leaking into the spinal canal or even the dura. Once leakage occurs, urgent evaluation and decompression surgery are necessary to prevent further neurological damage.     

Chondrosarcoma of the toe: A case report and literature review

BACKGROUNDChondrosarcoma of the foot is a rare malignant bone tumour, and it is even rarer when it originates in a toe bone. Surgical excision is the only effective treatment. The osteolytic destruction of the tumour severely affects limb function and carries the risk of distant metastasis. Most such tumours are removed surgically to minimize local recurrence and distant metastases, maximize limb function, and prolong the patient''s tumour-free survival time. The main objective of this article is to present the case of a chondrosarcoma that invaded the first phalanx of the left foot and formed a large phalangeal mass with osteolytic destruction of the distal bone.CASE SUMMARYA 74-year-old man suffered from swelling of his left toe for six months, with pain and swelling for two months. Computed tomography and magnetic resonance imaging showed that the tumour on the first phalanx of the left foot was approximately 54.9 mm × 44.6 mm, surrounded by a significant soft tissue signal mass, with osteolytic destruction of the distal phalanx and a speckled bone-like high-density shadow within it.CONCLUSIONChondrosarcoma occurring in a toe bone is extremely rare. In this case, extensive surgical resection of the large low-grade chondrosarcoma, which showed osteolytic destruction and invaded the distal metatarsal bone, was safe and effective.     

Reconstructing abdominal wall defects with a free composite tissue flap: A case report

BACKGROUNDReconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task. An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps, restoration of the abdominal wall integrity, and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia. When treating huge full-thickness defects, composite autologous tissue flaps are a good option for the repair. CASE SUMMARYThis study reported the case of a 43-year-old male patient suffering from full-thickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen. After debridement for abdominal electric burns and end-to-end anastomosis for the necrotic bowels, reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure. The remaining 18 cm × 15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap. The proposed method achieved the functional reconstruction of the abdominal wall.CONCLUSIONThis approach restored the abdominal wall integrity, maintained certain muscle tension, avoided abdominal hernia, reached satisfactory aesthetic effect, and resulted in no complications in the grafting regions.     

Plastic surgery for giant metastatic endometrioid adenocarcinoma in the abdominal wall: A case report and review of literature

BACKGROUNDEndometrial cancer (EC) is a common gynecological malignancy, but metastasis to the abdominal wall is extremely rare. Therefore, an appropriate treatment approach for large metastatic lesions with infection remains a great challenge.CASE SUMMARYWe report the case of a 65-year-old woman who developed abdominal metastasis of endometrioid adenocarcinoma, as defined by International Obstetrics and Gynecology stage II, in which the lesion was complicated by infection. A right hemicolectomy was performed for colon metastasis in relation to her initial gynecological cancer 3 years ago. When admitted to our department, a complete resection of the giant abdominal wall lesion was performed, and a Bard composite mesh was used to reconstruct the abdominal wall. A local flap was used to close the resultant large defect in the external covering of the abdomen. The patient underwent chemotherapy following cytoreductive surgery. Pathology revealed metastasis of EC, and molecular subtyping showed copy number high of TP53 mutation, implying a poor prognosis.CONCLUSIONWhen EC patients develop giant abdominal wall metastasis, a plastic surgeon should be included before contemplating resection of tumors.     

Traumatic giant cell tumor of rib: A case report

BACKGROUNDGiant cell tumor (GCT) of the anterior rib origin is extremely rare. We report the first case of trauma-induced GCT of the rib.CASE SUMMARYA 22-year-old female developed a mass over the right anterior chest wall with pain 3 mo after a falling injury with blunt trauma of the right chest wall. Chest computed tomography (CT) showed a tumor originating from the right 6th rib with bony destruction, and a CT-guided needle biopsy revealed a GCT. We completely resected the tumor with chest wall and performed reconstruction. The pathological diagnosis was GCT of the bone. Twelve months after surgery, no signs of recurrence were observed. CONCLUSIONGCT of the rib after trauma has not been reported. Meticulous history-taking and image evaluation are essential for the differential diagnosis of unusual chest wall tumors.     

Using ketamine in a patient with a near-occlusion tracheal tumor undergoing tracheal resection and reconstruction: A case report

BACKGROUNDTracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation. Due to its rarity, there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors, therefore individualized strategies are necessary. There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction (TRR) in the literature. We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARYA 25-year-old female reported progressive dyspnea and hemoptysis. Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis, which occluded > 90% of the tracheal lumen. The patient was scheduled for TRR. Considering the risk of complete airway collapse after the induction of general anesthesia, we decided to secure the airway with a tracheostomy with spontaneous breathing. The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders: a time-consuming process. Coughing and movement needed be minimized; thus, we added intravenous ketamine to local anesthetic infiltration. After tracheostomy, an endotracheal tube was placed into the distal trachea, and general anesthesia was induced. The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall. We performed a video-laryngoscopy to place a new endotracheal tube. Finally, the surgeons anastomosed the anterior tracheal walls. The patient was extubated uneventfully.CONCLUSIONKetamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.