Giant cell tumor of the bony thorax

Two cases of giant cell tumor of the bony thorax are described. Case 1 presents a 21-year-old female with a recurrent giant cell tumor of the third and the fourth thoracic vertebrae that directly compressed the membranous portion of the trachea and brought about severe air way obstruction. The tumor was completely resected and the patient remains healthy without recurrence 30 months after surgery. Case 2 presents a 18-year-old female with a giant cell tumor invading transverse process of the seventh thoracic vertebra and the seventh rib and making a big mass in the thoracic cavity on the right side. This patient was first seen with hemothorax and treated just by tube drainage three months before undergoing total resection of the tumor. She remains well nine months after surgery.     

Tracheal neurofibroma and Recklinghausen's disease]

Neurogenic tumours arising in the trachea are rare; the association with Von Recklinghausen's disease is exceptional. Only two cases of tracheal neurofibroma with neurofibromatosis have been reported. We report on another patient, a thirty year old man, who presented with acute shortness of breath; laser resection was performed via an endotracheal approach, then, a few days later, resection of the exotracheal tumor and tracheal segment was performed. Postoperatively, the patient did well for nine years without any respiratory complaint or neurofibromatosis relapse.     

Extensive total spondylectomy for recurrent giant cell tumor in the thoracic spine. Case report

The authors report the case of a 47-year-old woman who harbored a giant cell tumor at the T-5 level. She had undergone curettage of the tumor via a combined anterior and posterior approach at a regional hospital and was later referred to the authors' institution for treatment after the tumor recurred. On examination she exhibited progressive paraparesis and was nonambulatory due to cord compression caused by the tumor, which had invaded the spinal canal and extended to the right paravertebral muscles and right thoracic cavity. A spondylectomy was performed through a single posterior approach. The tumor, together with a portion of the dura mater, pleura, and muscles, was resected en bloc from T-4 to T-6. After resection, spinal reconstruction was performed by placement of an anterior titanium mesh cage as well as posterior pedicle screw and rod instrumentation. The patient's postoperative course was uneventful, and she exhibited substantial neurological recovery and became ambulatory. Two and a half years after surgery, the patient was tumor free. En bloc resection of a recurrent giant cell tumor was successfully achieved through a single posterior approach. This surgical technique can be an effective option for this pathological condition, which is difficult to manage using other conventional treatment options including repeated curettage and radiotherapy.     

A lung metastasis from giant cell tumor of bone at eight years after primary resection.

We report a case of extensive pulmonary metastasis from a histologically benign giant cell tumor. A 34-year-old woman had undergone tumor resection, curettage and artificial bone grafting for giant cell tumor in the left tibia. At eight years after surgery, a chest radiograph revealed an extensive tumor shadow in the right thoracic cavity. Tumor resection with right upper and middle bilobectomy was performed. Its histological features were consistent with those of the primary tumor of the tibia. Distant metastases from a giant cell tumor of bone are rare, with only 50 reported cases. Metastasis has occurred mainly within 3 years after the primary resection. However, in 20% of reported cases, metastasis occurred after 5 years or longer. Long-term follow-up and careful observation for distant metastasis are necessary for this histologically benign disease.     

A lung metastasis from giant cell tumor of bone at eight years after primary resection

We report a case of extensive pulmonary metastasis from a histologically benign giant cell tumor. A 34-year-old woman had undergone tumor resection, curettage and artificial bone grafting for giant cell tumor in the left tibia. At eight years after surgery, a chest radiograph revealed an extensive tumor shadow in the right thoracic cavity. Tumor resection with right upper and middle bilobectomy was performed. Its histological features were consistent with those of the primary tumor of the tibia. Distant metastases from a giant cell tumor of bone are rare, with only 50 reported cases. Metastasis has occurred mainly within 3 years after the primary resection. However, in 20% of reported cases, metastasis occurred after 5 years or longer. Long-term follow-up and careful observation for distant metastasis are necessary for this histologically benign disease.     

Giant cell tumor expanded into the thoracic cavity with spinal involvement

This article describes a case of a giant cell tumor that expanded into the thoracic cavity and through the spinal canal into the vertebrae. A 36-year-old man presented with a 6-month history of back pain and dyspnea. Plain chest radiographs showed a huge mass accompanied by right pleural effusion. The mass involved the 12th thoracic spine, and the spinal cord was severely compressed. The tumor was resected with a 2-stage procedure. As a first stage to separate the tumor from the anterior vital structures under direct vision, thoracic surgeons performed a right thoracotomy with chest wall reconstruction from the 8th to 11th ribs. The right lung and inferior vena cava were gently retracted, and the tumor was carefully detached from these structures. We were not able to separate the tumor from the right diaphragm due to severe invasion; therefore, we performed partial resection of the right diaphragm with the tumor. After excision of the anterior part of the tumor, the thoracic wall was reconstructed with the right eighth rib and Marlex mesh. When the patient's general condition improved 2 weeks later, spondylectomy by posterior approach was performed. We achieved excision of a giant cell tumor that had expanded into the thoracic cavity and through the spinal canal into the vertebrae. The patient had achieved full rehabilitation with no neurological or respiratory abnormalities at 7 years postoperatively.     

A case of retroperitoneal malignant peripheral nerve sheath tumor in a patient with neurofibromatosis

We report a case of retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with neurofibromatosis 1. A 42-year-old woman was admitted because of a palpable left abdominal mass. Her mother, son, and daughter had neurofibromatosis 1. Computed tomography and magnetic resonance imaging revealed a 73 x 76 mm retroperitoneal mass. We performed complete resection of the tumor, confirming the margin status by frozen section examination intraoperatively. The histopathological examination revealed MPNST. Although no further therapy was performed, she is alive with no evidence of disease 11 months after surgery.     

Presacral solitary giant neurofibroma without neurofibromatosis type 1 presenting as pelvic mass--case report.

A 35-year-old woman presented with a solitary neurofibroma in an unusual presacral location without neurofibromatosis manifesting as bilateral chronic sciatica for 2 years. She was initially considered as having a giant right ovarian mass, but was referred with a prediagnosis of solitary giant sacral nerve sheath tumor. The initial differential diagnosis was based on neuroimaging. A right-sided J incision with the extraperitoneal approach provided good exposure and handling of the tumor bed. Almost total excision without neurological deficit was possible. The histological diagnosis was neurofibroma. Benign retroperitoneal neural sheath tumors in patients without von Recklinghausen's disease are quite rare. Intrapelvic tumors are often diagnosed at a later stage. Neuroimaging is very helpful to delineate this unusual site and the extent of tumor development, and to determine the appropriate surgical intervention. A clear understanding of retroperitoneal anatomy is essential for safe removal of such tumors. Complete resection is preferred to prevent local recurrence and malignant transformation. Although root section is inevitable, neurological deficit is unlikely.     

Retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with neurofibromatosis I: a case report

A 64-year-old man who was diagnosed with type I neurofibromatosis was referred to our hospital with a pelvic mass incidentally found by ultrasonography. When examined by CT and MRI, the mass in the pelvis was 5 x 3 x 2 cm. In addition, another mass was found close to the obturator nerve at the S1-2 level. Transrectal biopsy was carried out, and a diagnosis of neurofibroma suspicious for low grade malignancy was made. We performed surgical resection of both of the tumors. The resected tumor was pathologically diagnosed as retroperitoneal malignant peripheral nerve sheath tumor (MPNST). We report our case and review the literature of MPNST detected in type I neurofibromatosis.     

Surgical management of idiopathic tracheal stenosis

Most nonmalignant upper tracheal stenoses are caused by prolonged endotracheal intubation or tracheostomy, and idiopathic stenosis is uncommon. A 43-year-old woman complained of increasing shortness of breath during exercise over a year prior to admission. She had no significant past medical history, including endotracheal intubation. Bronchoscopy and tracheal tomography revealed nonmalignant circumferential upper tracheal stenosis 20 mm long. Single-stage surgical resection with cricotracheal anastomosis completely relieved her respiratory symptoms. Idiopathic tracheal stenosis is extremely rare, and the treatment of choice is surgery.     

Surgical management of idiopathic tracheal stenosis.

Most nonmalignant upper tracheal stenoses are caused by prolonged endotracheal intubation or tracheostomy, and idiopathic stenosis is uncommon. A 43-year-old woman complained of increasing shortness of breath during exercise over a year prior to admission. She had no significant past medical history, including endotracheal intubation. Bronchoscopy and tracheal tomography revealed nonmalignant circumferential upper tracheal stenosis 20 mm long. Single-stage surgical resection with cricotracheal anastomosis completely relieved her respiratory symptoms. Idiopathic tracheal stenosis is extremely rare, and the treatment of choice is surgery.     

Schwannoma in the crural cistern removed without permanent functional deficits--case report

A 33-year-old male presented with a rare intracranial oculomotor schwannoma not associated with neurofibromatosis manifesting as an 8-month history of right oculomotor nerve paresis. Neuroimaging examinations revealed a 4-cm mass in the right crural cistern. The tumor was totally removed. The right oculomotor nerve paresis resolved 7 months after surgery. Removal of the oculomotor or trochlear schwannoma usually results in parent nerve paresis, but subcapsular tumor resection in our case probably allowed complete recovery of the nerve function.     

Temporary claviculectomy approach for plexiform neurofibroma of the first intercostal nerve

Plexiform neurofibroma at the thoracic inlet has rarely been reported and to our knowledge, the use of a temporary middle claviculectomy approach for thoracic inlet tumors has never been reported. We report a case of plexiform neurofibroma of the first intercostal nerve resected using a temporary claviculectomy approach. An abnormal shadow detected radiographically in a 16-year-old boy led to a diagnosis of neurofibromatosis 1 (NF-1) with a chest wall tumor at the thoracic inlet. The patient underwent resection of the tumor with the right first rib. The resected clavicle was reapproximated with a plate and postoperative shoulder function was satisfactory. The tumor was diagnosed pathologically as a plexiform neurofibroma and the patient’s postoperative course was uneventful. The temporary middle claviculectomy approach provides excellent exposure of the subclavian vessels and brachial plexus before resection of the tumor. We recommend this approach for tumors of the anterior thoracic inlet.     

Mitral valve replacement in a patient with a collapsed lung

A 67-year-old man, with a history of pulmonary tuberculosis since 18 years old, presented shortness of breath because of severe mitral regurgitation. Magnetic resonance imaging showed that the heart was displaced into the left thoracic cavity and rotated clockwise around its long axis. The forced expiratory volume per second was 1.06 l (46.7% of the predicted value) and the vital capacity was 2.48 l (72.1% of predicted value). Surgery was performed through a median sternotomy. An internal mammary artery harvest retractor was used to obtain operative exposure. Extensive pericardial suspension was used to push the over-inflated right lung across the midline. Extracorporeal circulation was established. The mitral valve was replaced with a mechanical prosthesis. The patient was weaned easily from extracorporeal circulation and was extubated on the day of surgery. If preoperative respiratory function is adequate, cardiac surgery can be performed safely in a patient with only one functional lung.     

经乳突下-颌下联合入路行寰椎侧块肿瘤切除术

目的 探讨经乳突下-颌下联合入路行寰椎侧块肿瘤切除术及疗效.方法 2003年1月至2008年5月,采用乳突下-颌下联合入路行肿瘤切除术治疗8例寰椎侧块肿瘤患者,男4例,女4例;年龄19～61岁,平均40.3岁;肿瘤位于左侧侧块6例,右侧侧块2例.患者均出现不同程度的枕颈部疼痛,7例伴头颈歪斜、颈部旋转活动受限,3例伴眩晕,3例伴吞咽不适或吞咽异物感,2例伴四肢麻木、乏力,1例伴患侧肢体乏力.肿瘤类型:骨软骨瘤3例,骨母细胞瘤、骨巨细胞瘤、浆细胞瘤、软骨肉瘤、嗜酸性肉芽肿各1例.肿瘤切除后所有病例均一期行后路枕颈内固定.浆细胞瘤、骨巨细胞瘤、软骨肉瘤患者术后4～8周接受局部放疗.结果 手术显露良好,肿瘤顺利切除,无椎动脉损伤、神经损伤及感染并发症.术后局部疼痛缓解,3例伴咽部不适症状者均有不同程度改善.术后随访8～72个月,平均46个月.1例软骨肉瘤患者于术后14个月局部复发,术后39个月死于高位瘫痪、呼吸及循环衰竭;1例浆细胞瘤患者定期行骨髓穿刺,未发现异常改变;其余患者未见复发.结论 手术切除治疗单侧寰椎侧块肿瘤,采用经乳突下一颌下联合入路较为理想,该入路显露充分,可游离保护患侧椎动脉,有助于寰椎侧块肿瘤的彻底切除,并可避免经口腔入路相关并发症.     

Mediastinal granular cell tumor: report of a case

Mediastinal granular cell tumor is rare. We report a case of 16-year-old woman with a granular cell tumor in the right upper-middle mediastinum. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.0 x 2.5 x 5.5 cm well circumscribed mass in the right upper-middle mediastinum. Tumor resection was performed. It was found that the tumor involved right vagus nerve. The tumor was completely excised with combined resection of the right vagus nerve peripheral to the right recurrent nerve. Histopathologically, the tumor consisted of round to polygonal cells with abundant eosinophilic granular cytoplasm, and diagnosed a granular cell tumor.     

A rapidly growing benign intrathoracic neurofibroma after lung lobectomy.

A 67-year-old male underwent a right upper lung lobectomy for lung cancer in January 1993. Follow-up chest X-rays revealed a progressive and rapidly growing intrathoracic mass in the right thorax. The mass, however, did not resemble a tumor recurrence, and the patient complained only of shortness of breath. Computerized tomography and magnetic resonance imaging confirmed the presence of the intrathoracic mass and its associated compression of the residual lung. A right thoracotomy was performed in January 1998, and a mass found arising from the sympathetic nerve trunk was resected. Microscopic examination revealed stellate or spindle-shaped cells in myxoid stroma with sparsely distributed collagen fibers. Immunohistochemically, the cells were positive for neuron-specific enolase, and the tumor was identified as neurofibroma. The patient did not suffer from von Recklinghausen's disease, and there was no family history of the disease. After resection of the neurofibroma, the compressed lung was able to re-expand, and the patient's shortness of breath disappeared. At one year postoperative, the patient remains well, and there is no evidence of recurrence.     

Organizing pneumonia with an enlarging tumor-like lesion: immunohistochemical study

An 86-year-old woman was transferred to our department for investigation of an abnormal enlarging pulmonary shadow with vascular convergence. She had no respiratory symptoms or laboratory data suggesting inflammatory disease. A pulmonary wedge resection was performed under video-assisted thoracic surgery. Pathology examination revealed that the tumor was organizing pneumonia and was composed of fibroblast-like spindle cells, macrophages, lymphoplasma cells, and collagen fibers. Immunohistochemical study revealed that the lesion was in the proliferative state with the relatively more Ki-67-positive fibroblast-like spindle cells. When a surgical resection is necessary for an enlarging abnormal pulmonary mass without any systemic inflammatory reaction or respiratory symptoms, a less invasive approach should be selected.     

A case with esophageal carcinoma associated with metastatic pulmonary tumor in lung cancer at seven years after the resection of lung cancer

A 69-year-old woman was admitted to our hospital because of dysphasia. The upper G-I examination showed a stenosis at the middle thoracic esophagus and poorly differentiated adenocarcinoma was revealed histologically. Chest CT scan showed a mass shadow in the right upper lobe of the lung. She had undergone a partial resection of right upper lobe because of lung cancer seven years before. She was diagnosed as metachrous double carcinoma of the lung and the esophagus. The method of surgery included right upper lobectomy of the lung, esophagectomy and intrathoracic esophageal reconstruction using the gastric tube. The patient manifested pneumonia due to the failure of the sutures after the surgery and died on the twentieth postoperative day. When conducting simultaneous resection of both cancer and esophageal reconstruction for the double cancer of the lung and the esophagus, it was considered necessary to conduct the anastomosis outside the thoracic cavity for the purpose of preventing the pulmonary complication due to the failure of the sutures.     

Mediastinal granular cell tumor arising from the left recurrent nerve; report of a case

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 36-year-old woman with a granular cell tumor in the left upper mediastinum. She was admitted to our hospital because of hoarseness. Laryngoscopic examination revealed left vocal cord paralysis. Chest computed tomography (CT) showed a 3.0 x 2.0 cm well circumscribed tumor at the left side of the trachea in the left upper mediastinum. As hoarseness was suspected to be attributable to the mediastinal tumor, tumor resection was performed. It was found that the tumor involved the left recurrent nerve. The tumor was completely excised with combined resection of the left recurrent nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and S-100 protein positive materials in the cytoplasm, and diagnosed a granular cell tumor.