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The aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.We retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.A total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.Biological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.

Chondrosarcoma (CS) is a primary chest wall tumor causing huge masses arising from rib, sternum or costochondral junction. Successful treatment warrants complete surgical resection with wide, free margins followed by reconstruction of the bony chest wall and soft tissue coverage of the defect. We report the case of excision of giant recurrent sternal CS followed by reconstruction of Neo-sternum using steel wires. This novel technique portrays steel wire-based reconstructions as a safe, reproducible and readily available prosthetic material for complex chest wall surgeries.

Highlights • Intercostal hemangioma is an extremely rare disease, accounting for approximately 0.01% of all benign hemangiomas. • Hemangiomas are prone to bleed spontaneously or after minor traumatic injury. • Complete excision of the tumor is mandatory even after embolization to prevent recruitment of a collatera1 blood supply., Introduction Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence. Case presentation A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5 × 4 × 5.6 cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma. Discussion Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas. Conclusion Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence.

Primary osseous tumors of the chest wall are uncommon neoplasms. They occur in a wide variety of pathologic forms, most of which can be distinguished by unique radiologic appearance. Management of these tumors depends on the diagnosis and stage. Adequate surgical resection is critical in achieving the best outcomes for most of these tumors. Chemotherapy and radiation may have an adjuvant role. Surgeons considering resection of any chest wall tumor should have a sound knowledge of the principles of resection and reconstruction.

Fil: Olivera Lopez, Soledad Belen. Instituto Universidad Escuela de Medicina del Hospital Italiano; Argentina

Chondrosarcoma of a rib is a very rare malignant tumor of the bone. Most patients were present with an enlarging painful anterior chest wall tumor. We present a case of an asymptomatic 29-years old female with a tumor size of 10cm×12cm on the left anterior chest wall involving the 8th rib. CT scan with intravenous contrast is the gold standard for radiological imaging and planning for surgery. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment.

Ewing sarcoma is a rare tumor, which represents, nevertheless, the most common primary chest wall tumor in children. The management and prognosis of these tumors have markedly improved with the use of multimodal therapy including adjuvant chemotherapy, surgery and/or irradiation. A good response to chemotherapy often avoids the need for extensive local treatment without sacrificing local control or long-term survival. Here, we report a new case of a bulky rib Ewing sarcoma, well managed by neoadjuvant chemotherapy resulting in significantly tumor shrinking that allowed complete resection. At the histological examination of the specimen, there was only inflammatory and fibrosis tissues without viable tumoral tissue.

Summary Purpose of the study Desmoid-type fibromatosis is a fibroblastic proliferation that develops in the deep soft tissues and is characterized by infiltrative growth and a tendency towards local recurrence but does not metastasize. Fibromatosis of the chest wall is rare, representing only 10 to 20% of all deep fibromatoses. Case report We report a six cases series of fibromatosis of the chest wall treated at our institution between 1996 and 2009. There were five men and one woman with a mean age of 42.2. Swelling of the chest wall was the most frequent symptom. Imaging showed an expansive homogeneous mass, invading the rib (four cases) or the sternum (two cases). Surgical resection was performed in all cases. The outcome was favorable (five cases) or marked by local recurrence (one case). Discussion Although it is considered to be a benign lesion, this tumor can be locally very aggressive, and has a high local recurrence rate depending upon the efficacy of surgical resection.

Chondromyxoid fibromas are benign tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms and display a hypermetabolic appearance on PET imaging. Oftentimes, they are misdiagnosed as chondrosarcomas and are excised due to concern for malignancy. We present a case of a condromyxoid fibroma originating from the second rib of a 15-year-old girl.

Primary chest wall tumors are uncommon. Common soft tissue neoplasms and non-neoplastic chest wall masses include peripheral nerve tumors, lipomas, liposarcomas, lymphoma, haemangiomas, elastofibromas, metastases from distant tumors, desmoids tumors, infectious mass lesions, and malignant fibrous histiocytoma. Lymphoma comprises 2% of primary chest wall tumors. Treatment of these tumors is unclear. We are presenting a case of 65 years old male who presented to us with primary chest wall lymphoma on right lateral chest wall. Resection followed by adjuvant chemotherapy provided optimal disease control in our case. Key message Isolated chest wall lymphoma is a rare entity, treatment is also uncertain. Resection followed by adjuvant chemotherapy may be the appropriate management.

Hydatidosis, caused by Echinococcus granulosus, is still an endemic parasitic disease in the Mediterranean area, South America, North Africa, and Australia. The most common anatomic location of hydatid disease is the liver, followed by the lung. Hydatidosis is located in the bones in 0.5% to 2% of all cases. A hydatid cyst can be seen in any part of the body. However, primary hydatid cyst of the rib in childhood is exceedingly rare. We report the first case of a pediatric hydatid cyst of the rib mimicking chest wall tumor.

Resume L'elastofibrome est une tumeur benigne rare des parties molles, presque constamment situee en dessous de la pointe de l'omoplate et a la profondeur du muscle serratus anterior (grand dentele). Il s'observe surtout chez la femme âgee. La localisation caracteristique et le tableau clinique evocateur le distinguent des tumeurs malignes des parties molles. Le diagnostic d'elastofibrome repose le plus souvent sur ses caracteristiques en imagerie. Malgre sa rarete, cette tumeur benigne doit etre connue pour eviter des biopsies inutiles, voire des gestes chirurgicaux de resection pratiques dans l'optique du diagnostic differentiel avec une tumeur maligne. Nous rapportons ici le cas d'une femme âgee de 55 ans, souffrant de douleurs chroniques liees a une masse situee a la partie inferieure de l'omoplate droite. L'imagerie par resonance magnetique (IRM) a permis de diagnostiquer des masses tumorales symetriques situees sous chacune des omoplates, compatibles avec un elastofibrome dorsal bilateral. Le traitement a comporte une resection de la lesion droite symptomatique par une voie d'abord intermusculaire.

SUMMARY The use of MR imaging in thoracic diseases has increased with the development of newer scanners which provide faster scan times and improved image quality. Because of its high soft-tissue contrast and ability to detect flowing blood, MR imaging has significant advantages for assessing tissue characteristics and vascular pathologic conditions. Potential clinical applications of MR imaging include assessment of vascular anomalies, preoperative evaluation of mediastinal or chest wall tumor extent, differentiation of tumor versus fibrosis, and characterization of pleuroparenchymal diseases.

En el periodo entre 1991 y 1994 se han realizado en nuestro servicio 582 intervenciones, de las cuales 19 han correspondido a tumores primitivos de pared toracica (3,26%). Analizamos edad, sexo, clinica, caracteristicas radiologicas, diagnostico, terapeutica y evolucion. Se dividen en 10 tumores benignos y nueve malignos. La clinica mas frecuente fue la presencia de dolor y/o tumor. El diagnostico preoperatorio solo se obtuvo en 2 casos. A no ser en casos de claros signos radiologicos y macroscopicos de benignidad, se realizo exeresis amplia de la pared toracica, a veces con reseccion de estructuras adyacentes. El defecto se reparo directamente en 12 casos y en los restantes se cubrio el defecto con protesis de diversos materiales y/o plastias musculares. El tumor mas frecuente fue el condrosarcoma (3 casos), en dos ocasiones, osteoblastoma y osteocondroma y solamente en un caso los demas tumores (plasmocitoma, condroma, displasia fibrosa, granuloma eosinofilo, osteosarcoma, tumor de Ewing, sarcoma epiteloide, fibrosarcoma, hemangioma, neurilemoma benigno, tumor desmoide y liposarcoma). Dos pacientes con condrosarcoma fueron intervenidos por presentar recidiva y el tumor de Ewing tambien lo hizo. Hubo 2 fallecidos: uno con condrosarcoma y otro con tumor de Ewing. Concluimos que: 1) los tumores de pared toracica son tumores poco frecuentes; 2) el tratamiento es la exeresis amplia, que a menudo requiere protesis, y 3) el mas frecuente es el condrosarcoma, de mala evolucion en los casos objeto de nuestro estudio.

Reconstruction of the chest wall in a child is an uncommon problem for pediatric surgeons. The available material for chest wall reconstruction typically has been borrowed from the adult experience. The authors describe their recent experience with a commercially available bioabsorbable plate in a variety of conditions that require chest wall reconstruction.

Three patients are reported in whom chest wall tumors developed 19 to 28 years after thoracoplasty and increased in size with time. The tumors could be removed operatively with good results. All tumors were composed of hematoma and necrotic material, and in all cases they revealed foreign bodies microscopically. Diagnosis and possible etiological factors are discussed.

ntramuscular hemangiomas (IMHs) are rare benign tumors affecting mainly the muscles of the upper and lower extremities; even rarer are those affecting the chest wall.1,2 If they do not cause swelling and pain, they may go unnoticed for many years and an accurate preoperative diagnosis may be difficult. 2 We report the case of a patient with IMH of the chest wall that went undiagnosed for a long time and was completely resected after 5 years.

A 24-year-old woman was admitted due to dyspnea on exertion. A chest roentgenogram revealed a massive tumor originating from the right anterior chest wall when pleural effusion was drained. Diagnosis of Askin tumor was made based on light microscopic findings characterized by composing with small round cells, immunocytochemical findings suggestive of neuroectodermal origin, and cytogenetic analysis demonstrating the chromosomal translocation (11; 22). After intensive combined modality therapy, including chemotherapy, irradiation, and additional surgery, she was followed up as an outpatient and has remained disease-free for 16 months after initial diagnosis.

Skeletal muscle hemangiomas are uncommonly described in a variety of locations. This report details the diagnosis and management of a 39-year-old woman with a right chest wall mass detected on physical examination. After a negative diagnostic evaluation, exploratory thoracotomy revealed an intercostal hemangioma, undescribed in recent literature. The lesion was excised.

A case of Candida costochondritis seen initially as a chest wall tumor in a narcotic addict is reported. Bone and cartilage are rare sites of Candida infection from whatever cause. Since 1973, only 6 cases of Candida costochondritis have been reported; 5 were complications of thoracic operations and the other, of intravenous hyperalimentation. Treatment by a one-stage en bloc resection of chest wall, and reconstruction by rib graft and Marlex mesh resulted in cure in our patient, without complications.

The value of ultrasonography and UGAB for diagnosing chest wall tumors was investigated in 21 patients of whom 13 had metastatic and eight benign disease. Chest wall tumor showed a hypoechoic mass with tapered edges. The margin between the tumor and lung was curved and smooth in all cases. Movement of the tumor during breathing was synchronized with that of the chest wall. We believe that the ultrasonography is of value in identifying tumors that are localized to the chest wall by examination of their margin and movement with respiration, in addition to their shape. Using UGAB, we were able to diagnose correctly all eight metastatic tumors and two of four benign tumors. UGAB is a safe and simple procedure for diagnosing chest wall tumors. (Chest 1988; 94:1271-73)

Our clinical experience with a group of 30 chest wall tumors, of which 13 (43 per cent) were malignant, has been presented. The neurogenic tumors were found to be the commonest of the benign neoplasms whereas the chondrosarcomas were the most frequently encountered of the malignant neoplasms. Two metastatic tumors were documented, each masquerading as a primary chest wall tumor. The surgical approach to tumors of the chest wall was discussed, emphasizing the importance of early and adequate primary excision by thoracotomy approach, and radical re-excision when indicated by study of the excised specimen. It is our opinion that early radical excision will result in a much higher salvage rate, especially for the chondrosarcomas. One can assume that almost half of the deep-seated chest wall tumors will prove to be malignant. Repair of the chest wall defects resulting from radical excisional procedures was found to be most easily effected by means of plastic technics. The use of prosthetic materials was unnecessary in our experience.