Wen-Chieh Liao

Primary Cutaneous Leiomyosarcoma

Primary cutaneous leiomyosarcomas are rare malignant tumors. They can occur at any age, but most commonly between the fifth and seventh decade of life. Because of the small number of patients treated, treatment recommendations are still evolving. We report the results of a retrospective study of 12 patients treated for leiomyosarcomas through a thirty year period (from 1973 to 2002). Five males and seven females (mean age, 54.4 years; age range, 22-81 years), more than 58% of the patients were at least 50 years old. The tumors presented mainly as solitary lesions and were located on the upper and lower extremities (seven lesions), trunk (three lesions), and the head and neck (two lesions). The main treatment of choice was surgical wide excision. Clinical follow-up revealed local recurrences in four patients after a period ranging from 3 to 72 months after surgical excision. No distant metastases have been observed in our series. We reviewed published articles. The clinical findings, pathologic examinations and treatments were analyzed. We believe primary cutaneous leiomyosarcoma should be considered biologically benign with regard to distant metastases, despite the malignant histologic appearance. Wide local excision is recommended, and it would seem that narrow margins with a tumor-free plane should be sufficient.

Benign symmetric lipomatosis

Background: Madelungs disease, benign symmetric lipomatosis, is a rare proliferative disease predominantly seen in middle-aged male patients. The disorder is characterized by multiple symmetrical, painless deposits of non-encapsulated fat around the neck, upper arms and upper part of the thorax. No clear etiology has been recognized while a close correlation to alcohol and metabolic disturbances has been observed. Aim and Objectives: To evaluate the clinicopathologic, morphologic and biochemical findings in this disease, we present and discuss various factors in this disease of 5 cases and give a survey of the literature. Materials and Methods: Five patients with benign symmetric lipomatosis were reviewed. All were male, aged 38 to 73 years, with a history of disease ranging from 6 months to 7 years. Patients usually complain of their cosmetic appearance, limited range of motion of the neck, difficulty in swallowing and compression of the airway. We performed the surgical excision via lipectomy with or without liposuction in all patients for the neck tumors. Results: The mean follow-up period was 88.6 months. The functional results were satisfactory in all patients. A recurrence was observed in one of our patients six months after the operation. Severe complications were not observed. Conclusions: According to our experience, surgical removal of lipomatous tissues in BSL can yield satisfactory functional and cosmetic results.

Alveolar Soft Part Sarcoma: Clinical Experience in VGHTPE

Background: Alveolar soft part sarcoma (ASPS) is rare malignant tumor constituting 0.5-0.9% of all soft tissue sarcomas in adults and 0.8-1.85 of those in children. Published series on presentation and treatment outcome of this sarcoma are scarce. Aim and Objectives: We present our experience in treating patients with this disease. The clinical features, diagnosis, treatment and prognostic factors of patients with ASPS were studied. Materials and Methods: Between 1975 and 2008, 23 patients with alveolar soft part sarcoma were treated in our hospital. We collected the files and described their characteristics, therapy and course. Reslts: The study group consisted of 11 male and 12 female patients, the median age at diagnosis was 24 years (13-66 years). The primary site was the lower extremity (n=13), upper extremity (n=4), head and neck (n=2), abdominal wall (n=1), chest wall (n=1), back (n=1) and flank (n=1). The median follow-up was 110(2-301) months. The median survival was 48 months with an overall 5-year survival of 62%. At time of diagnosis 5 patients already had metastases. Fifteen patients (65%) suffered from lung metastasis. Among them 9 of 15 patients had lung metastasis at the initial diagnosis, 6 patients developed lung metastasis later. Median survival after diagnosis of metastases was 38.5 (1-101) months. Conclusion: Alveolar soft part sarcoma is found especially in young adults. When diagnosed it is often metastasized with a poor prognosis. However, with adequate treatment, long-term survival is possible.

Tracheal Stenosis after Inhalation Burn Injury-A Case Report

Tracheal stenosis is most commonly the result of mechanical trauma from endotracheal intubation. Other known causes of acquired tracheal stenosis are external trauma, infection, inflammation and thermal or caustic injuries. Inhalation injury itself has the potential risk of tracheal stenosis. Patient with tracheal stenosis may present with dyspnea, stridor, and even lift-threatening airway obstruction. We report a case of severe tracheal stenosis following an inhalation burn injury. The patient experienced progressively dyspnea and stridor one month after his injury. The CT scan of neck demonstrated severe subglottic and tracheal stenoses. He was successfully treated by the insertion of a tracheal T-tube. The patient has been symptom-free and no restenosis could be detected for the last 30 months.

Primary Mucinous Carcinoma of the Scalp-A Case Report

Primary mucinous carcinoma of the skin is a rare tumor with only cases reported in the literature since the first description of a case by Lennox et al. in 1952. This tumor is a histologic subtype of sweat gland carcinoma. Because of the histopathologic appearance, primary mucinous carcinoma of skin can be mistaken for metastasis from extracutaneous sites. Most cases occur mainly between the fifth and the seventh decade of life. They are growing slowly with a propensity for local recurrence and metastasis. This tumor has not been widely reported in the plastic surgery literature. We describe a 59-year-old woman with a tumor on the right scalp. This lesion enlarged progressively and showed a reddish, elevated, dome-shaped surface. Excisional biopsy of the tumor revealed mucinous carcinoma. Further treatment involved wide local excision and reconstruction. In attempt to improve the recognition of this clinical entity, we discuss the histopathology, clinical course, surgical management and prognosis. Mucinous carcinoma can occur in noncutaneous visceral sites and metastasize to the skin. Systemic investigation were undertaken to exclude the possibility of metastatic mucinous carcinoma.

A Well-Differentiated "Lipoma-Like" Liposarcoma Arising in a Recurrent Intramuscular Lipoma-A Case Report and Review of Literature

Intramuscular lipoma and well-differentiated liposarcoma are hardly differentiated both clinically and histologically. Intramuscular lipoma is benign but easy to recur. Well-differentiated liposarcoma is regarded as low grade malignancy. It does not metastasize but may recur after surgery and in some rare cases de-differentiate to a high-grade sarcoma. Malignant transformation of well-differentiated liposarcoma in a preexisting lipoma is rare and only a few cases have been reported previously. Wide resection is the treatment of choice for both tumors to minimize the potential risk of recurrence. Histologically, three variants of well-differentiated liposarcoma can be distinguished and the ”lipoma-like” variant is the most common. We presented a 42-year-old male patient of left thigh well-differentiated liposarcoma which was diagnosed as recurrent intramuscular lipoma for four times over the past 10 years. Wide excision was performed and pathology revealed well-differentiated ”lipoma-like” liposarcoma. The pathological characteristics and management are described and the previous literatures are reviewed.

Chest Wall Reconstruction with Breast Flap

Chest wall defects after ablative surgery for cancer, trauma, infection, or radiation-related ulcer present a challenging problem for the plastic surgeon. The pectoralis major, latissimus, dorsi, external oblique, rectus abdominis, and trapezius muscles have been utilized. The breast flap is a useful method in a woman after the surgical treatment of osteoradionecrosis of the chest wall or recurrent breast cancer. We performed contralateral breast flap to repair the surgical defects in 6 patients with local breast cancer recurrences or radiation ulcers. The defects of these patients were tumor recurrence and radionecrosis of irradiated tissue. The treatment consisted of aggressive debridements of all involved tissue including underlying bone or cartilage if necessary. Then we perform the breast flap for reconstruction. In all but one patient, who was left with a small chronic granulating nonhealing wound. All flaps survived completely. In conclusion, this technique is suitable especially for patients with large, healthy breasts and for relatively poor patients.