Establishment and characterization of cell line TNMY1 derived from human malignant fibrous histiocytoma

Although malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas, its pathogenesis remains unclear. In this study, a cell line derived from human MFH, TNMY1, was established from a metastatic chest-wall lesion of a 60-year-old woman with MFH. The TNMY1 cell line was passaged 95 times, and it still retained the biological characteristics of the original tumor. TNMY1 consists of spindle-shaped cells and pleomorphic cells associated with multinucleated giant cells. Immunohistochemical studies showed that the spindle-shaped and pleomorphic cells were positive for vimentin, CD68 and alpha-smooth muscle actin, but negative for epithelial membrane antigen, desmin, muscle actin, alpha-sarcomeric actin, myoglobin, lysozyme and S-100 protein. The cells expressed collagen types I, III and V. These results indicate that MFH may originate from mesenchymal stem cells with the potential to differentiate into either fibroblasts or histiocytes. An elevated level of collagen type V mRNA expression is considered to support a diagnosis of MFH.

[Radiation-induced squamous cell carcinoma of the chest wall seven years after adjuvant radiotherapy following the surgery of breast cancer: a case report]

A 54-year-old woman, who had underwent an adjuvant radiotherapy following the modified radical mastectomy in the left primary breast cancer in June 1988. She underwent second surgery and adjuvant radiotherapy (electronic radiotherapy) for recurrent breast cancer in the major pectoral muscle and received chemoimmunotherapy in May 1989. In May 1996 she complained of two ulcers of the chest wall. The ulcer biopsy findings was squamous cell carcinoma, and we diagnosed she fell the radiation-induced skin cancer. She underwent chest wall resection and reconstruction with vertical rectal abdominal musculocutaneous flap (VRAM). However two months later her chest wall resection, she again got the recurrent squamous cell carcinoma in the right axillary lymph nodes and left pleura. The third radiotherapy and the chemotherapy with pepleomycin were uneffective on her recurrent cancer. And she died in March 1997.

Treatment for pyothorax-associated lymphoma

In eight patients with pyothorax-associated lymphoma (PAL), which resulted from artificial pneumothorax for the treatment of pulmonary tuberculosis, seven patients received radiotherapy and five showed no local recurrence. All four patients treated by primary chemotherapy had disease progression. Radiotherapy of 50 Gy with wide margins is recommended to treat PAL.

Abnormalities of the chest wall in pediatric patients

A variety of focal processes and diffuse abnormalities are found predominantly in children. In addition, thoracic manifestations of trauma differ in children because of increased chest wall compliance. Familiarity with both these abnormalities as well as the common normal variations provides optimal imaging evaluation.

Desmoid fibromatosis of the shoulder and of the upper chest wall following a clavicular fracture

A desmoid tumor of the shoulder girdle infiltrating the upper chest wall and weighing 1500 g was almost completely removed in an 18-year-old man, 27 months after a bifocal fracture of the clavicule. Thirteen years later, the patient was free of recurrence. The interval time between trauma and diagnosis, as the particular characteristics of aggressive fibromatosis, strongly support a major causal role of the clavicular fracture in the occurrence of this tumor.

Angiosarcoma of the chest wall

Angiosarcoma is a rare and highly malignant tumor of vascular origin. The causative factors include trauma, radiation, foreign bodies, thorium dioxide, and viral infections. We report a case of angiosarcoma occurring in a thoracotomy incision 17 years after operation for stage I lung cancer.

Needle track seeding following percutaneous ethanol injection for treatment of hepatocellular carcinoma

We report two cases of needle track seeding in the subcutaneous tissue and intercostal muscles following percutaneous ethanol injection for the treatment of hepatocellular carcinoma. In one patient, tumor seeding was observed 11 months after a total of 12 alcohol injections, and in the other patient, tumor seeding was observed 30 months after a total of 18 alcohol injections. The cases reported in the literature are discussed.

[Video-assisted thoracoscopy in diagnosis and therapy of intrathoracic diseases]

Video-assisted thoracoscopy has become an important adjunct to traditional thoracic surgical techniques for the diagnosis and therapy of numerous intrathoracic diseases. It has developed to the procedure of choice for patients with spontaneous pneumothorax, indeterminate peripheral lung nodule, diffuse lung disease, pleural disease and effusion and is a valuable alternative to traditional thoracotomy for various indications like the resection of benign intrathoracic tumors and cysts. Although video-assisted thoracoscopy is not recommended for curative therapy of malignancies, it can be useful for the diagnosis, staging and palliation of malignant disease. Video-assisted thoracoscopy should be performed only by surgeons with sufficient experience in thoracic surgery in institutions where adequate prerequisites are available. The clinical impact of video-assisted thoracoscopy is documented by the fact that in centers approximately 20 to 30% of all thoracic surgical procedures currently are performed with this new technique.

Malignant lymphoma arising from chronic tuberculous empyema. A case report

We report on a case of malignant lymphoma in the chest wall, associated with chronic tuberculous empyema. CT and MR imaging showed a soft-tissue mass contiguous with the empyema and invading the chest wall. MR imaging demonstrated a difference in signal intensity between the mass and the empyema. The extent of the chest-wall lymphoma was optimally delineated on fat-suppressed contrast-enhanced MR images.

[Malignant hemangioendothelioma associated with chronic pyothorax]

A 67-year-old man was admitted to the hospital because of a fever. A chest CT scan showed multilobular heterogeneous shadows on the right side in the chest wall and the lung, but clinical examinations and examination of a biopsy specimen did not lead to a diagnosis. At autopsy, a hemorrhagic tumor was found on the right side in the chest wall. Microscopical examination showed that large atypical cells had proliferated and formed vascular structures, which were stained positively with anti-factor VIII antibody. The histological findings led to the diagnosis of malignant hemangioendothelioma. Chronic empyema-associated malignant hemangioendothelioma is rare.

Radiation-induced malignant mesenchymoma of the chest wall following treatment for breast cancer

21 years after radiotherapy for breast cancer, a 63-year-old woman developed a malignant mesenchymoma of the chest wall. The total irradiation dose was 132 Gy. The first clinical symptom of this second malignancy was a slight irregular calcification around the implanted silicon protheses observed in a conventional chest X-ray. Radiation-induced sarcoma is a very rare complication of radiotherapy. In cases of chest wall calcification after radiation therapy further investigation should be carried out, because some patients with radiation-induced sarcoma could be saved, if an early diagnosis is reached.

[Three cases of malignant lymphoma that developed from the chest wall]

Chronic tuberculous pyothrax and the development of non-Hodgkin's lymphoma (NHL) on the chest wall are believed to be closely related. We encountered three patients with NHL involving the chest wall in whom the tumor may have had a different origin Patient 1: A 65-year-old man with a history of pulmonary tuberculosis and right-sided pyothrax at the age of 28 years was found to have a tumor on the right sided of the chest wall, and NHL was diagnosed. Patient 2: A 65-year old woman with a history of right-sided tuberculous pyothrax at the age of 2 years had a left-sided chest-wall tumor, and NHL was diagnosed. Patient 3: A 78-year-old man with a history of tuberclous pleuritis on the left side at the age of 77 years was found to have a left-sided chest-wall tumor, and NHL was diagnosed. In patients 1 and 2, the Epstein-Barr virus was found in tissue specimens by in situ hybridization. These findings suggest that chronic tuberculous pyothrax and the development of NHL on the chest wall were not closely related in these patients, and that the Epstein-Barr virus may play an important role in the development of NHL on the chest wall after tuberculous pyothrax.

Radical resection of radiation-induced sarcoma of the chest wall: report of 15 cases

BACKGROUND

Surgical management of radiation-induced sarcoma of the chest wall remains difficult because of its impressive local aggressiveness.

METHODS

Between 1987 and 1995, 15 patients (median age, 58 years) underwent radical resection of radiation-induced sarcoma of the chest wall. This type of tumor was defined as a metachronous, histologically different neoplasm in the irradiated field of the original tumor. Ten patients had a history of primary breast cancer and 5 patients, Hodgkin's disease. The median delivered radiation dose to the primary tumor area was 45 Gy, and the median interval between radiotherapy and diagnosis of sarcoma was 14 years. Seven tumors were located on the sternum, three on the lateral chest wall, and five in the thoracic outlet. Four total and three partial sternectomies, three lateral chest wall resections and five resections of tumors in the thoracic outlet (three first-rib resections) were performed. Seven patients required stabilization of the chest wall with prosthetic material. Soft tissue reconstruction was carried out with either muscle flaps and skin advancement in 9, musculocutaneous flaps in 4, or skin flaps alone in 2 patients.

RESULTS

One patient died 3 months after total sternectomy of respiratory failure. Two patients (13.3%) had a local complication: sepsis after sternectomy in 1 and cutaneous necrosis in 1. Local recurrence occurred in 7 patients after a median interval of 10 months. Two of them died, and 4 underwent a repeat resection, 3 of whom are still alive. Four patients died of systemic recurrence. With a median follow-up of 30 months, overall 5-year survival and 5-year disease-free survival rates were 48% and 27%, respectively.

CONCLUSION

Despite poor long-term disease-free survival, radical resection of radiation-induced sarcoma of the chest wall is justified on the basis of low postoperative morbidity and the lack of other available therapies.

[Radiation induced osteosarcoma of the chest wall]

We report a successful resection of an osteosarcoma in the chest wall developed 25 years after irradiation. A 74-year-old woman was admitted to our hospital for her swelling in the left chest wall at August 24, 1995. At 49-year-old, she had undergone an operation and postoperative irradiation for left breast cancer. A computed tomography demonstrated a mass in the left chest wall that destructed the first rib, extending into the pleural space and invaded into the left common carotid and subclavian arteries. We planned a radical resection of the mass after repeated CT scannings, since it was histopathologically diagnosed as a chondrosarcoma and showed a rapid growth. The tumor was completely removed with radical transmediastinal forequarter amputation of the partial chest wall and total left upper extremity. The left common carotid artery was partially replaced with 6 mm EPTFE vascular prosthesis. The chest wall was reconstructed with Marlex-mesh prosthesis and a myocutaneous flap. She was discharged uneventfully and has not shown any evidence of recurrence.

Granulocytic sarcoma of the chest wall at site of Hickman catheter tract

Insertion of a Hickman central venous catheter before administration of induction chemotherapy is a common practice in treatment of patients with acute myeloblastic leukemia (AML). Granulocytic sarcoma associated with AML may be the initial clinical manifestation of newly diagnosed or relapsed AML, heralding systemic involvement by weeks to months. A case of granulocytic sarcoma of the chest wall occurring as subcutaneous nodules along a scar of a previous Hickman catheter tract in a 45 year old female patient with AML is described. The patient who was in first complete remission, developed granulocytic sarcoma simultaneously with complaints associated with leukemic CNS infiltration. This is the second case described of granulocytic sarcoma of the chest wall at the site of a Hickman catheter tract. The simultaneous CNS and chest wall manifestations raise the interesting question whether both sites behaved as sanctuaries for resistant leukemic cells, in this case.

Chest wall metastasis after percutaneous fine-needle aspiration biopsy

Presented is a case of a chest wall metastasis due to tumor seeding along the needle tract from a percutaneous fine-needle aspiration biopsy (FNAB) of a lung carcinoma. At thoracostomy, the patient was found to have a chest wall lesion at the site of the FNAB that had been performed 4 months earlier. This relatively uncommon complication has been reported elsewhere, but its significance with respect to the management of lung lesions suspected to be malignant has not been defined. The authors maintain that FNAB may not be indicated in select patients. The application of this diagnostic modality should be considered individually on the basis of the patient's operative risk as well as the risk for having a primary lung carcinoma develop.

[Leukemia lymphoma T-cell as first manifestation of ataxia-telangiectasia]

BACKGROUND

Variable degrees of T cell deficiency in ataxia-telangiectasia (AT) progressively worsen with time and death from malignant lymphoma is a common terminal event. T-cell lymphoma as the first manifestation of AT has never been reported.

CASE REPORT

A 22 month-old girl born to consanguineous parents, was treated for a thoracic T-cell lymphoma and remained in first complete remission, with a follow-up of 4 years. Prior to chemotherapy, cytogenetic studies on blood showed clonal rearrangements including t(7p;14q), T(2p;7q) and inv (7), while karyotype showed 6q- and 1p-mitoses on bone marrow blasts. Hypotonia became evident at 3 years. One year later, the neurological status deteriorated. The patient presented also severe respiratory tract infections. At that time, immunological investigations showed hypo IgG2, very low T4 lymphocytes level, all harbouring the CD45 RO phenotype. Increase in alpha-foetoprotein level, the ocular movements and the study of DNA synthesis after exposure to gamma-rays confirmed the diagnosis of AT.

CONCLUSION

In cases of childhood lymphoid neoplasia, AT should be considered whenever parental consanguinity, T-cell proliferation and/or unexpected toxic therapeutic responses are noted.

[Malignant lymphoma of the chest wall in a patient with chronic empyema]

A 76-year-old man presented with the chief complaints of appetite loss and general fatigue. He was admitted with the initial diagnosis of empyema necessitatis, and right thoracic drainage was performed. Nevertheless, the subcutaneous mass in the right side of the chest wall did not shrink, and examination of a specimen obtained by percutaneous needle biopsy resulted in the diagnosis of non-Hodgkin's lymphoma, intermediate lymphocytic type. The patient was treated with Adriamycin, vincristine, prednisolone, and cyclophosphamide, but died of pneumonia and cachexia five months after symptoms first appeared. The diagnosis of intermediate lymphocytic lymphoma, B cell type was made at autopsy. Only 53 cases of malignant lymphoma associated with chronic empyema have been reported in Japan. Surgery was often not done because of the patient's advanced age or poor pulmonary function; diagnosis was often difficult. However, review of the 53 reported cases suggested that resection of the tumor, if possible, would improve the prognosis. Malignant lymphoma should be considered when there is chronic empyema, because such cases are now being reported more frequently.

[A case of T-cell malignant lymphoma developing in the chest wall of chronic pyothorax after artificial pneumothorax]

A 66-year-old man, with a past history of artificial pneumothorax for pulmonary tuberculosis at the age of 17, was admitted to our hospital because of progressive left precordial pain and left anterior chest wall tumor. Because of chronic pyothorax complicated by a tumor suggested by imaging diagnosis, surgery was performed for the purpose of fenestration. A diagnosis of diffuse large cell T-cell malignant lymphoma was made by the biopsy taken at surgery. Postoperatively the patient received 6 courses of combination chemotherapy with CHOP, the course turned favorable. The left precordial pain and tumor disappeared. The patient is doing well at 11 months postoperatively. Recently, cases of malignant lymphoma developing in the chest wall of chronic pyothorax have been increased and the majority of cases of the malignant lymphoma is B-cell type. T-cell type is rare. Follow-up of chronic pyothorax's patients necessarily are attentioned on the developing of the malignant lymphoma.

Chest wall fibromatosis associated with silicone breast implants

Aggressive fibromatosis is a well described locally destructive benign lesion, comprising 0.3% of all solid tumors. Although the chest wall is a common location, this tumour has rarely been associated with breast tissue or breast implants. Herein is only the fourth case described in conjunction with a breast implant and the only case linked to a ruptured silicone implant. This tumour was locally aggressive and required wide surgical resection, including removal of the chest wall, to gain control. Wide surgical resection is recommended with the application of adjuvant radiation therapy being more controversial.

Intrathoracic Kaposi's sarcoma. CT findings

AIM

To describe the thin CT scans findings in AIDS patients with intrathoracic Kaposi's sarcoma (KS).

MATERIAL AND METHODS

Fifty-three CT scans of patients with KS were retrospectively reviewed. The diagnosis of intrathoracic KS was established histologically (n = 17) or on the association of skin KS and the visualization of characteristic endobronchial lesions (n = 36). CT scans were performed with thin slices (2 mm) obtained at 10-mm intervals, and a 512 x 512 reconstruction matrix. No patients had Pneumocystis carinii pneumonia within the 3 months preceding the CT scan examination.

RESULTS

Numerous nodules (n = 42), tumoral masses (n = 28), bronchovascular pathways thickening (n = 35), and pleural effusions (n = 28) were the most frequent patterns. Septal lines (n = 15), ground-glass opacities (n = 3), and mediastinal adenopathies (n = 8) were not frequent.

CONCLUSION

Numerous nodules, tumoral masses, bronchovascular pathways thickening, and bilateral pleural effusions were the main signs of intrathoracic KS; their association (66%) is very characteristic. An opportunistic infection or mycobacteriosis must be sought if the thin CT scans reveal ground-glass opacities and/or mediastinal adenopathies.

Desmoid tumor occurring after reconstruction mammaplasty for breast carcinoma

We present a case of desmoid tumor associated with prior alloplastic breast reconstruction. Wide local excision that includes chest wall resection, if necessary, is the primary treatment of choice. Patients with extensive nonresectable or recurrent disease may benefit from radiation therapy. Systemic therapy is a possibility in certain cases, but its toxicity generally precludes its use with this nonmetastatic tumor. Although this is the fourth reported case of desmoid tumor arising after implantation of a silicone prosthesis, we cannot claim a causal relationship. Careful follow-up consisting of yearly physical and mammagraphic examinations may facilitate early diagnosis and treatment of locally aggressive desmoid tumors but is not warranted, except in the context of routine screening for breast carcinoma.