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胸壁肿瘤累及胸腔:病例报告。

Extended intrathoracic chest wall tumor: A case report.

作者信息

Sabri Muhammad

机构信息

Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine, University Riau, Pekanbaru, Indonesia; Division of Cardiothoracic and Vascular Surgery, Arifin Achmad Hospital, Pekanbaru, Indonesia.

Division of Cardiothoracic and Vascular Surgery, Arifin Achmad Hospital, Pekanbaru, Indonesia.

出版信息

Int J Surg Case Rep. 2024 Dec;125:110627. doi: 10.1016/j.ijscr.2024.110627. Epub 2024 Nov 16.

Abstract

INTRODUCTION AND IMPORTANCE

Solitary Fibrous Tumors (SFTs) of the chest wall are rare and present unique challenges, particularly when they recur and extend into the thoracic cavity. This case contributes to the limited surgical literature on the management of chest wall SFTs with significant intrathoracic involvement. Understanding the complexities and potential for recurrence in such cases is crucial for improving surgical outcomes and patient care.

CASE PRESENTATION

A 63-year-old woman presented with a recurrent mass in the upper left breast, initially treated surgically in 2018. The mass reappeared in 2021, causing pain and shortness of breath. Clinical examination revealed diminished breath sounds on the left side, and imaging studies identified a large, complex chest wall tumor with intrathoracic extension.

CLINICAL DISCUSSION

The patient was diagnosed with a recurrent, extended intrathoracic chest wall SFT. She underwent thoracotomy for tumor resection, which was challenging due to dense vascular adhesions. The tumor was successfully removed with an estimated blood loss of 1100 mL. Postoperative recovery was uneventful, and histopathological analysis confirmed the diagnosis of SFT, with low proliferative activity on immunohistochemistry. The patient was discharged in good condition on postoperative day 7.

CONCLUSION

This case highlights the importance of comprehensive imaging, meticulous surgical planning, and long-term follow-up in managing recurrent chest wall SFTs. The successful outcome reinforces the value of a multidisciplinary approach in treating rare and complex tumors. Vigilance in monitoring for recurrence and ensuring clear resection margins are essential take-away lessons from this case.

摘要

引言与重要性

胸壁孤立性纤维瘤(SFTs)较为罕见,带来了独特的挑战,尤其是当它们复发并延伸至胸腔时。该病例丰富了关于伴有显著胸腔内累及的胸壁SFTs治疗的有限外科文献。了解此类病例的复杂性和复发可能性对于改善手术效果和患者护理至关重要。

病例介绍

一名63岁女性,左上乳房出现复发性肿块,最初于2018年接受手术治疗。该肿块于2021年再次出现,导致疼痛和呼吸急促。临床检查发现左侧呼吸音减弱,影像学检查确定为一个巨大的、复杂的胸壁肿瘤并延伸至胸腔。

临床讨论

该患者被诊断为复发性、延伸至胸腔内的胸壁SFT。她接受了开胸肿瘤切除术,由于致密的血管粘连,手术具有挑战性。肿瘤成功切除,估计失血量为1100毫升。术后恢复顺利,组织病理学分析确诊为SFT,免疫组化显示增殖活性低。患者于术后第7天状况良好出院。

结论

该病例突出了在处理复发性胸壁SFT时综合影像学、细致手术规划和长期随访的重要性。成功的结果强化了多学科方法在治疗罕见复杂肿瘤中的价值。从该病例中吸取的重要经验教训包括警惕复发监测和确保切缘清晰。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ab7/11747601/a3a3562ee812/gr1.jpg

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