Leiomyoma originating from the extrapleural tissue of the chest wall

We describe a rare case of leiomyoma of the chest wall in a 55-year-old female. Computed tomography showed a well-circumscribed neoplasm with a diameter of 2 cm in the right chest wall. The tumor was excised with video-assisted thoracic surgery. Histopathology confirmed that the tumor was leiomyoma arising from the microvascular smooth muscle in the chest wall. We present the immunohistochemical profiles of the tumor in detail, critically reviewing the previously reported cases.     

Leiomyomas requiring chest wall resection and reconstruction

Leiomyomas of the chest wall are very rare in the literature; only nine cases have been reported. We present two cases: First case was a 32-year-old female. Two separate pleural tumors were detected and resection was performed. Local recurrence occurred after 1 year follow-up and required chest wall resection and reconstruction. The second case is a 43-year-old male. A tumor was found in 7th rib’s cartilage at radiological examination, and chest wall resection and reconstruction was performed. Both cases were diagnosed as leiomyoma in pathological examination. Multiple leiomyomas of chest wall or leiomyoma in rib was not reported in literature previously. Clinical and radiological appearance of leiomyomas can be variable, and discordance can be seen between these and the pathological diagnosis. Chest wall resection may be required for cure of the leiomyomas although they are rare and considered as benign.     

Enucleation of Esophageal Leiomyoma with Azygos Continuation of the Inferior Vena Cava: Report of a Case

We herein report a rare case of esophageal leiomyoma in an 18-year-old woman with azygos continuation of the inferior vena cava. A submucosal tumor was located in the left wall of the esophagus behind the carina. The enlarged azygos vein made video-assisted thoracic surgery so difficult that conversion to a minithoracotomy and transection of the right superior intercostal vein were necessary to fully visualize the tumor. A pathological diagnosis revealed leiomyoma. Our experience suggests that a transection of the right superior intercostal vein is effective for the proper exposure of an esophageal tumor located behind the carina in a patient with an enlarged azygos vein.     

Metastatic somatostatinoma of the chest wall

A 72-year-old male was diagnosed as having a thoracic tumor in the left chest wall five years after resection of primary pancreatic somatostatinoma. The tumor was suggestive of metastasis to the chest wall or to the left lung from the previously resected somatostatinoma based on the abnormally elevated serum somatostatin level. Percutaneous biopsy confirmed that the lesion was an islet cell tumor and thoracotomy demonstrated metastasis to the left third rib without involvement of the left lung. Our case represents a rare documentation of somatostatinoma metastatic to the chest wall for which complete resection was performed.     

Resection of malignant fibrous histiocytoma through a combined thoracic and abdominal wall approach

We report a case of resection of malignant fibrous histiocytoma (MFH) via combined thoracic and abdominal wall incision reconstructed using GORE DUALMESH. A 60-year-old woman underwent resection of a left lower chest wall tumor. Since the tumor infiltrated into the diaphragm, a part of the left diaphragm and left upper abdominal wall were resected together. The left chest was closed by suturing the diaphragm to the ribs. The resected area of the thoracic and abdominal wall was 12×12 cm and was reconstructed with GORE DUALMESH. She received adjuvant radiotherapy as the tumor cells were detected in the surgical margin of the diaphragm. The patient has remained well without signs of recurrence for 10 months after the operation.     

A surgical case of T-cell non-Hodgkin's lymphoma originating in the wall affected by chronic tuberculous empyema following artificial pneumothorax]

A 63-year-old male patient underwent artificial pneumothorax for right pulmonary tuberculosis 39 years ago, and thereafter suffered from chronic empyema, though asymptomatic. In December, 1989, he was found to have a 5 cm tumor in his right chest wall. The tumor grew to 15 cm in 2 weeks and was associated with severe pain. A chest CT revealed that the tumor of the chest wall corresponded to the area of the wall affected by empyema. The patient underwent full thickness resection of the chest wall including the tumor and the empyematous wall (20 x 20 cm) on March 7, 1990. The tumor was 11 x 8 x 7 cm large and had developed from the empyematous wall to the lateral side of chest wall. There was no invasion of the thoracic cavity by the empyema. The lesion was pathologically diagnosed as diffuse, large to intermediate T-cell non-Hodgkin's lymphoma. Postoperatively the patient was treated with radiotherapy and VEPA therapy, but the tumor metastasized to both lungs, and the patient died 161 days after surgery. The majority of cases of malignant lymphoma reported to have originated in empyematous chest walls have been of the B-cell type. The T-cell type is rare, and the present case is only the second case reported. Chest CT was an effective method of diagnostic imaging in this disease.     

Chondromyxoid fibroma of the chest wall

A chondromyxoid fibroma of the chest wall is a rare occurrence. A case study of a 40-year-old woman diagnosed with this tumor in the left chest wall is presented. The lesion was removed by video-assisted thoracic surgery (VATS), and the final pathology examination confirmed a chondromyxoid fibroma. At present, this patient has continued to visit our outpatient unit regularly and has shown no recurrence during the past 1 year.     

Leiomyomas and extramucosal cysts of the esophagus in adults. The clinical picture and surgical therapy

BACKGROUND: Leiomyoma is the most common type of benign esophageal tumor, whereas extramucosal cysts of the esophagus are congenital anomalies frequently asymptomatic in the adult and in most cases detected incidentally on chest X-ray. Conventional imaging tests do not lead to a precise diagnosis. Endoscopic ultrasonography is very accurate in visualizing these lesions and in differentiating cystic from solid submucosal esophageal masses; in addition, the test can establish the exact location of the mass in relation to the esophageal wall and mediastinum. METHODS: Fifteen patients with esophageal leiomyoma and 27 patients with extramucosal esophageal cyst were operated on in our Institution. Dysphagia was the most common symptom in patients affected by leiomyoma and esophageal duplication cyst, whereas chest pain was more frequent in patients with bronchogenic cyst. RESULTS: Complete surgical excision of the mass was performed in all patients with esophageal leiomyoma and in 26 patients with mediastinal cyst, while a right upper pulmonary lobectomy was performed in the patient with an intrapulmonary cyst. CONCLUSIONS: Endoscopic ultrasonography plays an important role in the differential diagnosis of leiomyoma and mediastinal cyst. Surgery is mandatory in all patients especially after the advent of the mini-invasive procedures. Observation alone must be reserved for patients who refuse or are not suitable for thoracic surgery.     

Tumor of the bony thoracic wall: Associated with trauma literature and case report

A brief statistical summary of tumors of the bony thoracic wall was given. The history of a case of osteochondroma of the chest wall was reported briefly. In this case there seemed to be a rather definite causative relationship between a single trauma and the formation of the tumor. Some literature on the subject was quoted and the case was discussed from that standpoint. The importance of prompt early excision of such tumors was mentioned.     

Angiosarcoma of the chest wall in a patient with fibrous dysplasia.

We have experienced a case of angiosarcoma of the chest wall in a patient with fibrous dysplasia. The patient was a 64-year-old man and had large bilateral thoracic masses. Each tumor, resected metachronously with the chest wall, was diagnosed as angiosarcoma. One of these tumors had a histological component of fibrous dysplasia. The patient died from brain metastasis 19 months after the first operation. Angiosarcoma associated with fibrous dysplasia of the chest wall is very rare.     

Complete thoracoscopic enucleation of the esophageal leiomyoma at the level of the azygos vein: A case report

Benign tumors of the esophagus are rare. Among them, leiomyomas are common. Surgical enucleation is indicated in cases, which have symptoms or large tumors. The enucleation through video assisted thoracoscopic surgery has been developed as a preferred approach for the majority of lesions in recent years. However, the complete thoracoscopic enucleation for an esophagus leiomyoma at the level of the azygos vein without cutting the vein and nor using artificial pneumothorax by CO₂ insufflations is a challenge for thoracic surgeons.This case report was a 64-year-old female who presented dysphagia and chest pain. Chest computed tomography and esophageal endoscopy displayed an esophageal mass. We used complete thoracoscopic enucleation to treat this condition. The tumor was at the level of the azygos vein. Therefore, it was difficult to remove the tumor without cutting the azygos vein without utilizing the artificial pneumothorax. However, we enucleated it completely with no complications.The complete thoracoscopic enucleation of the esophageal leiomyoma at the level of the azygos vein without cutting the vein without using the artificial pneumothorax should be applied. A methylene blue swallowing study is an alternative method to a barrium swallowing study while the chest tube is still placed in the pleural space.     

Angiosarcoma arised from a solitary schwannoma of the chest wall

Angiosarcomas rarely develop within a peripheral nerve or a peripheral nerve sheath tumor. A 68-year-old woman was admitted for right hemothorax. She had suffered from the left thoracic empyema and the right chest wall tumor which had been regarded as schwannoma clinically. Anemia got serious due to continuous bloody effusion. Although bleeding point was not detected by thoracotomy. The right chest wall tumor was resected. Postoperatively bloody effusion still drained continuously, she died ten days after the operation. Resected tumor was almost necrotized. The tumor was diagnosed as angiosarcoma pathologically, in which a part of schwannoma component resided. It is indicated that angiosarcoma in this case arised from degenerated schwannoma. It is necessary to consider angiosarcoma, rarely arised from degenerated schwannoma, during conservative, long-term observation on the care of schwannoma.     

Radiation-induced osteosarcoma of the chest wall

A case of radiation-induced sarcoma of the chest wall is reported. Twenty-seven years 11 months after orthovoltage radiotherapy of the right breast a 69-year-old woman developed a radiation-induced osteosarcoma of the right thoracic wall. Initial diagnosis has been T-cell lymphoma of the skin. The right breast was irradiated with tangential fields and a total dose of 40 Gy, 2 Gy/day, 5 days a week. Orthovoltage treatment was performed in two courses of 20 Gy, 3 months apart. The clinical appearance of the secondary sarcoma was a diffuse infiltrated area in the irradiated breast which seemed to be fixed to the chest wall. Magnetic resonance imaging (MRI) demonstrated a mass in the right anterior thoracic wall which destroyed the fourth to the sixth rib. The tumor infiltrated the thoracic wall, including subcutaneous tissue and pericardium, as well as extending into the subphrenic space. Biopsy of the lesion revealed a poorly differentiated osteosarcoma. The patient's general condition precluded surgical or chemotherapeutic intervention; she died due to a cerebral stroke 6 months later. This case fulfilled all criteria for radiation-induced sarcoma, as there was a prior history of radiotherapy, latency period of several years, development of sarcoma within the irradiated field, and histologic confirmation of sarcoma.     

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 urinary retention due to a female paraurethral leiomyoma

A case of urinary retention due to a female paraurethral leiomyoma is reported. The patient was a 67-year-old female who visited our clinic complaining of urinary retention. Urinary sediment and infravenous pyelography revealed no abnormal findings. An oval-shaped mass was palpated at the anterior vaginal wall. The tumor was 7 X 6 cm in size, elastic hard in consistency, irregular surfaced and well movable. Computed tomography revealed a calcified tumor in the urethrovaginal septum extending over all the urethral length from the bladder neck to the urethral meatus. Cystourethroscopic examination revealed a bladder neck elevation. Transvaginal needle biopsy was performed and the pathological diagnosis was benign leiomyoma. Transvaginal removal of the tumor was performed under the diagnosis of female paraurethral leiomyoma. The tumor was easily dissected from the vaginal wall but was adhered rather firmly to the urethra. The origin of the tumor could not be identified. Postoperatively, urination was improved. Female paraurethral leiomyoma is rare but must be considered as a cause of urinary retention.     

Successful use of intraoperative radiotherapy for local control of an Askin's tumor recurrence

Askin s tumor is an infrequent disease, with a high tendency to local recurrence. We present the case of a 16-year-old female diagnosed with a new recurrence of this tumor affecting the thoracic wall. There had been a previous 5-year history of 3 local recurrences treated each time by apparently complete surgery. A multidisciplinary approach consisting of chemotherapy, complete chest tumor resection and intraoperative radiotherapy was undertaken. After 2-year follow-up, the patient is alive and free of disease. The role of surgery is still the key to obtaining good survival, but in this case intraoperative radiotherapy proved to be a good adjuvant treatment.     

Elastofibroma of the thoracic wall

Soft tissue tumors of the chest wall are rare. Between 1998 and 2007 we treated eight cases of elastofibroma of the thoracic wall, an infrequent primary tumor of the chest. Seven females and one male between 44 and 62 years presented with dorsal subscapular tumors of months and even years of evolution. One case was a relapse from previous interventions and in three cases the tumor was bilateral. A surgical excision was performed in all cases, confirming the source of the tumor. There were no postoperative complications or relapses. We concluded that elastofibroma is a tumor that appears most frequently in middle aged women, and that diagnosis can be established through the use of imaging and fine needle aspiration biopsy. Given its benign character and slow growth, in cases where it is asymptomatic, its evolution can be controlled without surgical intervention.     

Leiomyoma of urinary bladder: report of a case

A case of leiomyoma of the urinary bladder in a 46-year-old woman is reported. The patient was referred to us because of incidental finding of a mass in the bladder. Cystoscopy revealed a protruding tumor covered with normal-appearing urothelium on the right posterior wall of the bladder. The tumor was well-demarcated from adjacent organs on echography and computed tomographic scan. Transurethral biopsy revealed a bladder leiomyoma. Partial cystectomy was performed. The patient is now apparently free of disease 7 months after the operation.     

Principles of chest wall resection and reconstruction

Despite significant improvements in surgical technique and perioperative care, the management of patients requiring chest wall resection and reconstruction is an ongoing challenge for thoracic surgeons. A successful approach includes a thorough assessment of the patient and the lesion, an adequate biopsy to confirm tissue diagnosis, and a well-established treatment plan. In the case of a primary tumor of the chest wall, the extent of the resection should not be limited by the size of the resulting defect. Following resection, chest wall reconstruction mandates an appreciation for restoration of functional and structural components. An algorithmic approach to chest wall reconstruction begins with the assessment of the nature of the defect, taking into consideration factors such as infection, tumor location, previous radiation therapy, and surgical intervention. The latter factors bear influence on the type of tissue required as well as whether reconstruction can be performed in a single stage or whether it is better delayed. Finally, patient factors including lifestyle and work, as well as prognosis, are considered to determine the best reconstructive option.     

Advantage of earlier thoracoscopic clipping of thoracic duct for post-operation chylothorax following thoracic aneurysm surgery

We report that an earlier thoracoscopic clipping of the thoracic duct was advantageous in a case of post-operation chylothorax that occurred following thoracic aneurysm surgery. A 61-year-old man developed chylothrax on postoperative day 2 following graft replacement of the descending thoracic aorta using a left-sided thoracotomy. Since a replaced graft infection is lethal, earlier thoracoscopic clipping of the thoracic duct through the right side chest wall was indicated. The patient underwent thoracoscopic clipping on postoperative day 7 and was successfully treated. The duration of drainage was 2 days and oral intake was started on the seventh day. From our results, we recommend a thoracoscopic procedure through the opposite (right) side chest wall in the early stage of chylothorax development following thoracic aneurysm surgery.