Chest Wall Lipoblastoma in a Seven-Month-Old Girl: A Case Report By S.S. Erkmen Gu ¨ lhan, Pinar Yaran Adams, Erkin A. Sarıca, Hasan Turut, and Yetkin Agackıran Ankara, Turkey Lipoblastoma is a rare benign tumor of adipose tissue seen almost always in infanthood and early childhood. It is typi- cally located in the extremities and the trunk and less fre- quently in the head–neck region, mediastinum, and retro- peritoneum. However, cases of pleural, thoracic wall, and pulmonary lipoblastoma have also been reported in the literature. Lipoblastoma is a tumor with good prognosis despite its potential for local invasion and rapid growth. Our patient is a 7-month-old girl who was brought to our clinic for a rapidly growing mass in the right hemithorax. With the aim of both diagnosis and treatment, the mass was removed by thoracic wall resection and the resultant defect covered with an absorbable polyglactine mesh. The excised mass was diagnosed pathologically as a benign lipoblastoma. In the postoperative period, the thorax wall was stable, and after 24 months of follow-up no recurrence was observed. In the literature, 4 types of thoracic wall lipoblastomas have been reported, but thoracic wall resection has not been applied in any benign lipoblastoma case. To the best of our knowledge, the only benign lipoblastoma case in which a thoracic wall resection was carried out, with its clinical and histopatho- logic specifications alongside that in the literature, is pre- sented here for the first time. J Pediatr Surg 39:1414-1417. © 2004 Elsevier Inc. All rights reserved. INDEX WORDS: Lipoblastoma, chest wall, thoracic wall re- section. L IPOBLASTOMA is a rare benign mesenchymal tumor that occurs primarily in infanthood and early childhood. Although it has the capability of growing rapidly and causing local invasion, it does not lead to distant metastasis. It has a good prognosis. Operative treatment is essential. 1 In the literature, about 170 lipo- blastoma cases have been reported so far, 2 and only 4 of them were located in the thoracic wall. We proudly present here the only benign lipoblastoma case in which a thoracic wall resection was performed. CASE REPORT A 7-month-old girl was brought to our clinic with a rapidly growing mass on the right side of the chest wall, which was first noticed by her parents a month earlier when she was only 6 months old. Physical examination found a hard, nontender, lobulated and fixed mass with well-demarcated borders in the right posterolateral aspect of the hemi- thorax just under the scapula and measuring 4  5 cm in size. Other findings of the physical examination were not remarkable. Serum chemistry, complete blood count, human chorionic gonadotropin, al- pha-fetoprotein, and neuron-specific enolase levels were all within their normal limits. The vanillylmandelic acid to creatinine ratio in her spot urine was normal. The peripheral diffusion and bone marrow aspirate examination were both normal. An abdominal ultrasound scan also was normal. The posterior-anterior (P-A) and right lateral chest radiographs showed a 4  5-cm opacity on the right posterior hemithorax showing extension into the diaphragm (Fig 1). A computed tomography (CT) study of the chest showed a heterogeneous solid mass of 4.5  5.5  6.5 cm in the posterior thoracic wall distorting the structures of the seventh, eighth, and ninth ribs on the right with lobulation and exten- sion into the overlying skin (Fig 2). Because general anesthesia is necessary for any invasive diagnostic method, it was decided that surgical resection be used to accomplish both diagnostic and treatment goals. Therefore, under general anesthe- sia, exploration of the mass was conducted, which showed a mass with soft consistency on palpation. It showed lobulation with a capsule and well-circumscribed borders measuring 9  5  4 cm in size involving the seventh, eighth, and ninth ribs. It was also found to show extension into the thorax as well as the extraparenchymal structures. During the operation, on revelation of a mesenchymal tumor by examination of the frozen section, the mass was removed completely with partial resection of the seventh, eighth, and ninth ribs together with the parietal pleura. After resection of the chest wall, a mesh measuring about 11  7  4.5 cm was placed on the defect in the chest wall area to prevent failure in respiration physiology as well as paradoxical respiration. Considering the fact that the patient was just 7 months old and, therefore, still growing, an absorbable polyglactine mesh was preferred. No compli- cation developed acutely after the operation. The postoperative macroscopic pathologic examination of the ex- cised material showed a solid creamy-pink cross, partially myxoid or gelatinous, evenly looking elastic lobular mass of 9  5  4.5 cm embedded in the chest wall involving 3 ribs ranging from 6 cm to 9 cm in length. Microscopically, in the sections analyzed, lobules separated by thin fibers and a lesion containing lipoblasts in various develop- mental stages ranging from partly loose or myxoid satellite and spindle shaped primitive mesenchymal cells with pre-adipocytic properties to univacuoler mature adipocytes in the stroma were observed. Within the vicinity of the lesion there was no destruction in bone tissues. Exten- sion of the lesion to striated muscle tissues in the vicinity was not observed. Based on these features, the diagnosis of benign lipoblastoma was made (Figs 3 & 4). The thoracic wall was found to be stable in the From the Departments of Thoracic Surgery and Pathology, Atatu ¨rk Chest Diseases and Thoracic Surgery Center, Ankara, Turkey. Address reprint requests to Dr Pinar Yaran Adams, Atatu ¨rk Go ¨g ˇu ¨s Hastaliklari ve Go ¨g ˇu ¨s Cerrahi Merkezi, Go ¨g ˇu ¨s Cerrahi Klinig ˇi, Ke- c ¸io ¨ren, Ankara, Turkey. © 2004 Elsevier Inc. All rights reserved. 0022-3468/04/3909-0022$30.00/0 doi:10.1016/j.jpedsurg.2004.05.029 1414 Journal of Pediatric Surgery, Vol 39, No 9 (September), 2004: pp 1414-1417