Chest wall resection for invasive lung carcinoma, soft tissue sarcoma, and other types of malignancy. Pathologic aspects in a series of 107 patients.
Chest wall resection for invasive lung carcinoma, soft tissue sarcoma, and other types of malignancy. Pathologic aspects in a series of 107 patients.
复制标题
胸壁切除术用于治疗浸润性肺癌、软组织肉瘤和其他类型的恶性肿瘤。
DOI：
10.1053/j.anndiagpath.2004.04.002
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发表时间：
2004
影响因子：
2
通讯作者：
P. Dartevelle
中科院分区：
文献类型：
--
作者：
V. Thomas;A. Chapelier;E. Fadel;S. Mussot;É. Dulmet;P. Dartevelle
随着切除和重建胸壁的手术技术的改进，病理学家面临着复杂的手术标本。目前还没有专门用于处理这些标本的指导方针。肺癌胸壁侵犯的扩大切除可能改变某些TNM亚群的临床价值。我们回顾了一系列连续107例累及胸壁的恶性肿瘤，并在3年内切除。107例患者中，女性39例，男性68例，年龄6~80岁，平均53岁。98例(92%)全部切除。肺癌侵袭55例，其中泛海岸肿瘤19例。根据目前的TNM分类，5例因侵犯椎孔而行椎体切除术的肺癌为T3。4例肺癌仅因锁骨上或胸壁淋巴结侵犯而诊断为N3或M1。其他肿瘤包括原发软组织肿瘤20例，原发骨骼肿瘤13例，转移瘤12例，乳腺肿瘤局部侵袭4例，杂性病变3例。切除肋骨1~6根(平均2.6根；89根)，胸口2 4根，3~4个椎体13根，胸骨17根，锁骨15根，肩胛骨4根，上肢2根，皮肤2 9根，肺2根，隔膜2根，纵隔2根。10例为不完全切除，其中5例为椎体或椎孔肿瘤侵犯。由于肿瘤的组织学类型和涉及的解剖结构的多样性，对胸壁恶性肿瘤切除后的手术标本的研究是复杂的。标本射线照片有很大的信息价值。手术切缘的评估，尤其是椎孔的评估势在必行。在侵犯胸壁的肺癌中，我们建议椎孔侵犯可被分为T4级，胸壁淋巴结孤立侵犯的预后价值应评估为可能的N1分类。
With improvements in surgical techniques for resection and reconstruction of the chest wall, pathologists are confronted with complicated surgical specimens. There are no currently available guidelines specifically dedicated to the handling of these specimens. Extended resections of lung carcinoma chest wall invasions may change the clinical value of some TNM subsets. We reviewed a series of 107 consecutive malignant tumors involving the chest wall and resected in our institution during a 3-year period. The 107 patients included 39 females and 68 males aged 6 to 80 years (mean, 53 years). Ninety-eight cases (92%) were en bloc resection. There were 55 invasions by lung carcinomas including 19 Pancoast tumors. With the current TNM classification, five lung carcinomas, treated with vertebral body resection because of vertebral foramina invasion, were T3. Four lung carcinomas were N3 or M1 only because of supraclavicular or chest wall lymph node invasion. Other tumors included 20 primary soft-tissue tumors, 13 primary skeletal tumors, 12 metastases, four local invasions by breast tumors, and three miscellaneous lesions. Resected structures included one to six ribs (mean, 2.6; n = 89), thoracic inlet (n = 24), three or four vertebral bodies (n = 13), sternum (n = 17), clavicles (n = 15), shoulder blade (n = 4), upper limb (n = 2), skin (n = 29), lung (n = 64), diaphragm (n = 2), and mediastinum (n = 2). Ten cases were incomplete resections including five because of vertebral body or vertebral foramina tumor invasion. The study of surgical specimens resulting from resection of malignant tumors of the chest wall is complicated because of the variety of both tumor histologic types and involved anatomic structures. Specimen radiograms have a great informative value. Assessment of surgical margins, especially vertebral foramina, is imperative. In lung carcinomas invading the chest wall, we suggest that vertebral foramina invasion could be classified T4 and that the prognostic value of chest wall lymph nodes isolated invasions should be assessed for a possible N1 classification.