S-100 protein expression in a case of elastofibroma dorsi

Elastofibroma is a rare tumorlike process that manifests as slowly growing, solid mass in the subscapular region of elderly persons. Histologically, it is characterized by the presence of fibrous connective tissue in which eosinophilic fibers and globular masses, stained by the elastic tissue stains, are interspersed. We report the immunohistochemical study of the cellular component in a case of subscapular elastofibroma in a 41-year-old man. An unexpected immunoreactivity for S-100 protein was detected in most fibroblast-like cells. S-100 protein expression may be related to a chondroid metaplasia of fibroblast-like cells in response to the continuous traumatic process occuring during the friction between the scapula and the underlying chest wall.

Thoracic desmoid tumors: a rare evolution of rib fracture. Etiopathogenesis and therapeutic considerations

The Authors report a case of thoracic desmoid tumor. The strict correlation between a previous chest injury and the site of desmoid tumor in this patient seems to strengthen the possible etiological role of trauma, as already suggested.

Peripheral neuroectodermal tumor of the chest wall in a patient treated for Hodgkin's disease

The occurrence of second malignancies after treatment for Hodgkin's disease is a well recognized phenomenon. In this report we describe a case of a 22-year-old male who developed a peripheral neuroectodermal tumor of the chest wall four years after completing successful treatment with combined chemotherapy and radiotherapy for Hodgkin's disease.

Thoracoscopic implantation of cancer with a fatal outcome

A case is presented in which an indeterminate lung lesion was extracted through an accessory incision during a video-assisted thoracic surgical lung biopsy. The lesion was malignant, and a completion lobectomy was performed. An incisional recurrence developed 5 months later, and this was treated with a wide chest wall resection and reconstruction. However, there was a second massive chest wall recurrence that proved fatal. We believe that tumor seeding to the chest wall occurred at thoracoscopy. To prevent such tumor seeding, thoracoscopic biopsy specimens should be removed in some sort of receptacle when cancer is suspected.

Thoracic mesothelioma associated with abdominal mesenteric panniculitis

Mesenteric panniculitis (MP) is characterized by an abdominal inflammatory reaction and mesenteric fat necrosis. Clinically, MP manifests as recurrent abdominal pain, pyrexia, and space-occupying peritoneal masses. We report a patient with MP, severe enough to require immunosuppressant treatment, who developed a recurrent pleural effusion. Malignant mesothelioma was identified in the pleural space 3 yr after initial pleural investigation. This case is the second report of pleural effusion associated with MP. It is the first report in which thoracic mesothelioma and MP occurred together. MP has been associated with other malignancies.

Thoracic splenosis after blunt trauma: frequency and imaging findings

OBJECTIVE

Thoracic splenosis is an uncommon sequela of simultaneous splenic and diaphragmatic injury. The aim of this prospective study was to evaluate the prevalence of thoracic splenosis in 17 subjects who had sustained splenic and diaphragmatic injury and to describe the CT and MR features of thoracic splenosis.

SUBJECTS AND METHODS

All patients had 99mTc-RBC scintigraphy. Subjects with radionuclide uptake in the thorax were further examined with radiography, CT, and MR imaging of the chest.

RESULTS

Three subjects (18%) had evidence of ectopic splenic activity in the left side of the thorax. The CT features consisted of one pleural nodule and two pleural masses. The MR appearance of the ectopic splenic tissue was similar to that of normal spleen.

CONCLUSION

Thoracic splenosis occurs with moderate frequency after combined splenic and diaphragmatic injury. The CT appearance is that of pleural masses or nodules. The MR appearance is relatively similar to that of normal spleen.

Sun exposure and basal cell carcinomas in the nevoid basal cell carcinoma syndrome

BACKGROUND

Nevoid basal cell carcinoma syndrome (NBCC) is an autosomal dominant multisystem disorder. Persons with the NBCC gene have varied susceptibility to basal cell carcinoma (BCC) development.

OBJECTIVE

We examined the anatomic site-specific distribution of BCCs and the relation between sun exposure and numbers of BCCs in NBCC cases.

METHODS

A questionnaire asking about lifetime sun exposure, sun behavior habits, and number of BCCs was sent to 16 families with NBCC evaluated between 1985 and 1991. The results were compared with previously published data for the general population.

RESULTS

In the general population, 88% of all BCCs in women and 86% in men occurred on the face, head, neck, and arms versus 59% in women with NBCC and 65% in men with NBCC. Of BCCs in the general population 9% and 12% occurred on the trunk versus 38% and 32% of BCCs in NBCC cases, in women and men, respectively. We did not observe a strong relation between numbers of BCCs and history of lifetime sun exposure.

CONCLUSION

The anatomic-site distribution of BCCs suggests that frequent sun exposure may not be essential for the development of BCCs in patients with NBCC. However, the observation that there are more tumors on sun-exposed areas suggests that exposure to the sun promotes the development of BCCs in patients with NBCC.

Primitive neuroectodermal tumor of the chest wall in a patient with Jeune's syndrome and renal transplant

Jeune's syndrome is a rare autosomal disorder characterized by osseous dysplasia, fetal respiratory distress, and renal failure in later life. We describe a 27-year-old man with Jeune's syndrome who underwent renal transplantation and 6 years later developed a sarcoma (primitive neuroectodermal tumor [PNET]) in the soft tissue of the chest wall, a principal site of dysplasia in this disorder.

Synchronous carcinoma and soft-tissue sarcoma. The importance of searching for incidental radiation exposure

A 68-year-old woman was found to have synchronous soft-tissue sarcoma of the anterior chest wall and adenocarcinoma of the breast. During her initial interview, she denied prior radiation therapy. On further questioning, it was learned that the patient had been treated for tuberculosis, as a young woman, by the induction of a pneumothorax that was monitored by repeated chest fluoroscopies. Biologically important doses of ionizing radiation can be given as an incidental part of a variety of medical treatments. The importance of searching for atypical radiation exposures, particularly in patients with unusual tumor presentations, is stressed.

Clinical aspects of malignant mesothelioma in Australia

Australia is currently experiencing an epidemic of malignant mesothelioma. The clinical aspects of malignant mesothelioma were investigated in 295 Australian patients as part of a national study of the disease. Most patients were male (91%), with the mean age at diagnosis being 64 years. The predominant cell type was epithelial (38%) and the majority of primary tumours arose from the pleura (94%). Mean survival was poor (17.6 months from first symptom; 11.8 months from diagnosis). Patients with a pleural primary tumour were more likely to present with dyspnoea, chest pain and cough; to have a pleural effusion diagnosed radiologically; and to have metastatic spread. Patients with a peritoneal primary tumour were more likely to present with weight loss, loss of appetite, abdominal pain and ascites; to have radiologic evidence of asbestos exposure; and to have spread along a needle track created during a diagnostic tap. A minority of patients had past thoracic conditions, or radiologic findings, specifically related to previous asbestos exposure. About one fifth of patients had no known asbestos exposure. Forty-one per cent of subjects received some form of chemotherapy, radiotherapy and/or surgery, but no formal disease staging had been documented for any patient. Proper controlled trials of secondary and tertiary treatments in malignant mesothelioma are now needed.

[Histiocytic lymphoma and pulmonary fibrosis in a female patient with essential thrombocythemia]

The case of a patient with the diagnosis of essential thrombocythemia is presented. Following treatment with melphalan during three years the patient presented clinical and radiologic data of pulmonary fibrosis. Thoracotomy with lung biopsy histologically proving fibrosis was performed. The patient developed a true histiocytic lymphoma afterwards. The rarity of pulmonary fibrosis induced by melphalan and the exceptional association of essential thrombocythemia and histiocytic lymphoma is emphasized. The characteristics of the latter disease, diagnostic difficulties and possible treatment are commented upon.

Thoracic Kaposi sarcoma in AIDS: CT findings

Cases of acquired immunodeficiency syndrome (AIDS) related Kaposi sarcoma (KS) were reviewed to characterize the spectrum of thoracic findings seen with chest CT. Of 15 patients with AIDs-related KS involving the chest, 13 (87%) demonstrated pulmonary parenchymal disease characterized by multiple, bilateral flame-shaped or nodular lesions with ill-defined margins distributed along bronchovascular bundles. Pleural disease was noted in 10 (67%) patients, characterized by 9 cases of pleural effusions and 1 case of pleural implants. Chest wall disease involving the sternum, ribs, thoracic spine, and/or subcutaneous tissue was noted in eight (53%) patients. Although pleural and parenchymal lung disease are recognized manifestations of thoracic KS, there is also a high incidence of extrapulmonary chest disease evident on CT in patients with AIDS.

[Thoracic lymphoma and AIDS]

During the past 4 years, 122 patients with AIDS and 20 with thoracic lymphoma associated to AIDS were observed. There were 18 cases of non-Hodgkin's lymphoma, mostly at a high grade and a high b-cell stage (Burkitt's or Burkitt-like lymphoma) (16 cases). This prevalence reflects the general increase in the number of neoplasms secondary to immunosuppression, which goes along with the improvement of prevention and the control of opportunistic infections. Out of these 20 lymphomas in AIDS, 5 (25%) produced thoracic lesions; in 4 cases, the initial site of the disease was in a thoracic site. The frequency of such expressions is greater that reported in the literature. The radiological appearances are atypical relative to the classical signs of lymphoma in the general population, with predominantly nodular forms (60%) or peripheral, fast-growing masses that are likely to invade the thoracic wall. Isolate lymph node invasion is possible, as well as pleural effusion. Though not pathognomonic, this appearance is highly suggestive of lymphoma in AIDS (LDS) in HIV-positive patients. In all patients with pulmonary lymphoma, CT showed bilateral lesions in a greater number than plain radiography had shown, with morphological and CT appearances that allowed a correct approach of the diagnosis and an appropriate choice of the site of biopsy.

Desmoid tumour in thoracotomy scar 5 years after excision of a left giant atrial appendage aneurysm in female with a family history of Gardner's syndrome

A very large desmoid tumour extensively involving the chest wall and the left anterior abdominal wall is described in a patient with a family history of Gardner's syndrome. The desmoid arose at the site of a thoracotomy scar due to the removal of a large aneurysm of the left atrial appendage five years before. Both a plastic surgeon and a thoracic surgeon were required to remove the tumour. Aneurysmal dilatation of the left atrium is extremely rare and has not been reported in association with Gardner's syndrome before.

[Chemo-thermotherapy of radiation-induced squamous cell carcinoma in anterior chest wall]

A 62-year-old woman had visited our hospital with the large and deep ulcer formation on the left anterior chest wall. A biopsy of the ulcerous lesion established the diagnosis of a squamous cell carcinoma which might be induced by the irradiation after mastectomy. Although a wide resection of the chest wall including left arm was performed, it was impossible to resect completely. After then, she had operations for local recurrence for three times in three years. However, cure was not obtained, and residual lesions gradually enlarged and all layers of the anterior chest wall was replaced with tumor tissues. Conventional chemotherapy using ftorafur and mitomycin C was not effective. Therefore, we tried combined therapy with intravenous administration of cisplatin (CDDP) and vindesine (VDS), and local hyperthermia using radiofrequency (RF) wave. A total number of 11 courses of this treatment modality was carried out at once a week intervals. The tumor-temperature was maintained at the range of 40-43 degrees C for 40 min in each treatment session. Chemotherapeutic agents were administered simultaneously with hyperthermia. After these treatments, the recurrent tumor was markedly reduced, and epithelization of the ulcer was recognized from the surrounding normal skin. The residual tumor was then resected completely. The operative wound was successfully closed by surrounding normal tissue mobilization. She is in good postoperative condition. We concluded that the chemo-thermotherapy is safe and promising therapeutic modality for such invasive squamous cell carcinoma, and the normal tissues are not affected. Furthermore, this approach will expand the scope of radical resection for such an uncontrollable tumor.

Thoracic and abdominal manifestations of lymphoma occurring in the immunocompromised patient

Organ transplant and AIDS patients are at a much higher risk for developing non-Hodgkin's lymphoma than is the general population. This increased risk is directly related to chronic immunosuppression and often is associated with viral infections. In contrast to lymphomas occurring in nonimmunocompromised patients, these tumors typically are of higher grade, are more aggressive, have a worse prognosis, and exhibit a higher frequency of extranodal disease. The most frequent organs involved are the head and neck, bowel, liver, and lungs. Thoracic manifestations of ARL and PTLD are similar, consisting of nodular, diffuse alveolar, and interstitial pulmonary disease, mild to moderate mediastinal adenopathy, and pleural effusions. Of these findings, pulmonary nodules are the most specific, although they can be difficult to differentiate from Kaposi's sarcoma and opportunistic infections. Abdominal findings are also similar for the two diseases, with the most common lesions appearing as low attenuation, hypoechoic masses in the solid abdominal organs; ulcerating nodular or diffusely infiltrating bowel lesions; and bulky retroperitoneal, mesenteric, or omental adenopathy. The identification of solid masses in the abdominal organs in AIDS and transplant patients is highly suspicious for ARL and PTLD. Due to the overlap of imaging characteristics of different pathologies, however, biopsy usually is necessary to confirm the diagnosis. Both ARL and PTLD respond to therapy; however, the prognosis for patients with ARL is uniformly poor, whereas the prognosis for treated PTLD is remarkably good. An awareness of the imaging characteristics of ARL and particularly PTLD can have significant impact on prognosis by allowing for timely diagnosis and therapy.

Large soft tissue tumor of the chest occurring after trauma

The unusual soft tissue tumor we have described may be the largest yet reported. The tumor was considered benign, and its histologic features were most consistent with fibromatosis arising in a region that had been previously traumatized. Although the patient is doing well, it is premature (2 years later) to conclude that the tumor will not recur.

[A case of chest wall rhabdomyosarcoma]

A 56-year-old man was admitted to our hospital with right chest pain. Chest X-ray, CT scan and MRI revealed a chest wall tumor and enlarged mediastinal lymph nodes. Percutaneous lung biopsy was performed, and the pathological diagnosis of pleomorphic rhabdomyosarcoma was obtained. The only significant abnormal laboratory finding was elevation of serum NSE (24.5 ng/ml). Although chemotherapy (VAC-ADM) and radiation therapy were performed, the patient died about 7 months after admission. To our knowledge, only 17 cases of chest wall rhabdomyosarcoma have been reported in Japan.