Videotoracoscopía en cáncer de ovario avanzado con sospecha de compromiso torácico / Video-assisted thoracoscopy in advanced ovarian cancer with a probable thoracic involvement

Objetivo: Evaluar la experiencia con videotoracoscopía en pacientes con sospecha de cáncer de ovario avanzado con probable compromiso del tórax. Método: Se analiza las pacientes con sospecha clínica e imagenológica de cáncer de ovario avanzado que presentan derrames pleurales moderado y severo, así como procesos tumorales torácicos para evaluar la posibilidad de citorreducción óptima o completa. Todos los casos sometidos a este procedimiento entre enero de 2009 a Agosto de 2011, son analizados con énfasis en el diagnóstico y en los hallazgos a la videotoracoscopía, así como sus resultados. Resultados: 11 pacientes con clínica y tomografía axial computarizada de tórax sospechoso de compromiso pleural o pulmonar, son sometidas al procedimiento previo al intento de citorreducción abdominopélvica. La edad promedio fue de 62 años y Ca 125 promedio de 1030 U/ml. En 6 pacientes se encontró enfermedad macroscópica pleural, la biopsia fue positiva para adenocarcinoma en 5. Dos de ellas se consideraron no citorreducible en abdomen y se indicó neoadyuvancia. La tercera se citorredujo en forma óptima. En 2 pacientes se indicó neoadyudancia por tener residuo tumoral torácico mayor a 1 cm, consideradas citorreducibles en abdomen. De las 6 pacientes sin enfermedad torácica, 4 se citorredujeron óptimamente, una falleció previo a la cirugía abdominal y otra resultó un tumor ovárico benigno. Conclusión: La videotoracoscopía es útil para evaluar enfermedad torácica y tomar decisiones en relación a la citorreducción abdominal o neoadyuvancia en cáncer avanzado de ovario.

Objective: To describe the experience with video-assisted thoracic evaluation in patients with suspected advanced ovarian cancer with a probable thoracic involvement. Method: Patients with clinical and imaging suspicion of advanced ovarian cancer who have pleural effusions, and thoracic tumor processes are examined to evaluate the possibility of optimal debulking. All cases that underwent this procedure between January 2009 to August 2011, were studied with emphasis on diagnosis, results and findings at videotho-racoscopy. Results: 11 patients with a suspected thoracic commitment, with clinical and computerized axial tomography scan, undergo the procedure previous to an abdominopelvic cytoreductive surgery attempt. The average age was 62 years and CA 125 of 1030 U/ml average. Macroscopic pleural disease was found in 6 patients, but in 5 of them the biopsy gave positive for adenocarcinoma. Two of them were not considered for a cytoreductive surgery in the abdomen and neoadjuvant therapy was indicated. The third patient of the 5 previously mentioned, underwent an optimal cytoreduction. In 2 patients, neoadjuvant therapy was indicated for having residual tumor in the thorax greater than 1 cm, although they were considered for a cytoreductive surgery in the abdomen. Of the 6 patients without chest involvement, 4 underwent an optimal cytoreductive surgery, and one died before the abdominal surgery and the other had a benign ovarian tumor. Conclusion: Videothoracoscopy is useful for diagnosing thoracic metastasis and making decisions regarding cytoreduction and neoadjuvant therapy in advanced ovarian cancer.

Chest wall metastasis of squamous cell carcinoma of larynx.

Distant metastases in squamous cell carcinoma of head and neck are most often to the lung, liver and bone. They rarely metastasise to chest wall. We report a 60-year-old male patient who initially presented with an abscess over the anterior chest wall that was initially treated for infective pathology. Due to lack of response, cytological examination was performed that turned out to be metastasis from carcinoma larynx.

Metastasis a pared torácica de liposarcoma / Thoracic wall metastasis in liposarcoma

El liposarcoma mixoide frecuentemente presenta metástasis a sitios extrapulmonares. Sin embargo, las metástasis óseas son relativamente raras. Informamos el caso de un hombre de 52 años con metástasis ósea única a la pared torácica de un liposarcoma mixoide, con componente de células redondas, primario de muslo.

Myxoid liposarcoma often metastasizes to extrapulmonar sites; however, osseous metastases are rare. We report the case of a 52-year-old male with a single histologically proven bone metastasis of the thoracic wall from a primary myxoid liposarcoma with a round cell component of the right thigh.

Clear Cell Hepatocellular Carcinoma with Spontaneous Regression of Primary and Metastatic Lesions

The prognosis of advanced hepatocellular carcinoma (HCC) tends to be poor. Spontaneous regression of this lesion is extremely rare. In this report, we describe a case of HCC which spontaneously regressed along with a metastatic lesion of the chest wall. A huge HCC in the right lobe, the largest diameter of which was about 15x12 cm, developed in a 72-year-old man. He and his family refused further treatment. Three months after the diagnosis, metastasis to the chest wall was detected. We prescribed a painkiller for him in order to alleviate chest pain. Fourteen months after the diagnosis, the tumor size of the primary lesion was downsized to 3x4 cm in diameter. A biopsy taken from the chest wall proved to be clear cell HCC (CHCC). Since then, the metastatic lesion has also disappeared. Here, we report this unusual histologically proven CHCC with literature reviews.

Hepatic and thoracic metastases from a meningeal haemangiopericytoma

Meningeal haemangiopericytomas are more aggressive than typical meningiomas, with a high rate of recurrence and distant metastasis. We report a case of recurrent meningeal haemangiopericytoma associated with hepatic and thoracic metastasis. Although local growth control of the meningeal tumour was obtained by tumor removal in a 33-year-old woman, the tumour was locally recurrent and metastasised extracranially within a period of 13 years. We emphasise the importance of complete removal at the first operation and subsequent radiation therapy to prolong the time to recurrence and extend survival

Chest wall implantation of carcinoma after fine needle aspiration biopsy

Implantation of malignant cells along the needle aspiration tract in patients with lung cancer is a rare but potential complication following percutaneous fine needle aspiration biopsy. Dissemination of cancer cells by aspiration biopsy can change resectable, potentially curable lung cancer to unresectable cancer. We report a 55 year male patient who underwent completion pneumonectomy due to squamous cell carcinoma and one cycle of chemotherapy. He developed outgrowing chest wall tumor at the site of needle aspiration biopsy performed prior to completion pneumonectomy and was pathologically diagnosed as metastatic squamous cell carcinoma. The lesion was successfully treated by radical full-thickness resection of the chest wall and reconstruction with latissimus dorsi musculocutaneous island flap.

Liposarcoma mixoide secundario en un paciente con enfermedad de Hodking: reporte de um caso / Secondary myxoid liposarcoma in a patient with Hodgki's lyphoma

Se presenta el caso de un paciente con enfermedad de Hodgkin que después de recibir tratamiento combinado con mecloretamina, vincristina, prednisona y procarbazina (MOPP) así como radioterapia en manto y en "Y" invertida, logró entrar en remisión. Sin embargo, 9 años depués desarrolló un liposarcoma mixoide de pared torácica rebelde a cirugía, radioterapia y quimioterapia con metástasis pulmonares y probablemente cardíacas, que lo llevó a la muerte 10 meses más tarde. Este es el tercer de liposarcoma secundario informado en la literatura. Se hace una revisión de pacientes con enfermedad de Hodgkin que desarrollan neoplasias secundarias al tratamiento, con énfasis en los sarcomas postradiación