As we observed International Childhood Cancer Day on 15th February 2024, we share the recovery story of a 12-year-old girl who presented to Sri Shankara Cancer Hospital and Research Centre, Bengaluru with a cough and swelling of the left chest wall. The child was investigated with a CT scan of the chest. The CT Scan revealed a left thoracic tumour - 17x15x8 cm in size, arising from the left 2nd rib which displaced the mediastinum to the right. It was adherent to the pericardium and major vessels. The most common type of bone tumour which we see in this location and site is Ewing’s sarcoma, which is very amenable to chemotherapy, surgery and radiation. However, what we found in the biopsy was one of the rarest diagnoses.
Biopsy was done by the Intervention Radiology team (Dr. Sunil Kalmath) which revealed a rare bone tumour in the thorax - an aneurysmal bone cyst which required major surgery. This added to the stress on the child as well as the parents. Since it was a rare diagnosis, we had the histopathology report reviewed by our highly experienced Histopathologists Dr. Sulakshana M. S. and Dr. Rekha V. Kumar; they concurred on the findings of the report. When a tumour or mass involves the thorax, also referred to as the rib cage, it tends to be very close to the heart and lungs and impacts the function of both these major organs. This made the mere location of the tumour, a major challenge for the surgery.
Aneurysmal bone cyst is a rare bone tumour, that can be treated by only surgery. No chemotherapeutic agents have shown benefit, despite its locally aggressive nature. Since surgery was the only hope for a cure despite the challenges and complexities of performing a surgical procedure on this child; the parents were counselled and the child was prepared for the same. It involved extensive planning from the departments of Paediatric Surgery (Dr. Ramesh S., Dr. Raghunath, Dr. Vinupriya D.), Thoracic Surgery (Dr. Ganesh Nayak, Dr. Sanjeev Kulkarni), Radiology (Dr. Sandeep), Plastic Surgery (Dr. Radhika Kapahtia), Anaesthesiology (Dr. Vinod N. K.) and Paediatric Oncology (Dr. Anand K. C., Dr. Aarthi N., Dr. Shashank B.).
The surgery was successful. The large tumour was removed along with the involved ribs by the thoracic and paediatric surgeons while the plastic surgeon completed the reconstruction of the chest wall. We anticipated prolonged post-operative ventilation because of the large size of the tumour. However, our surgeons and anaesthesiologists worked with the child on pre-op preparation to improve her lung capacity through physiotherapy and intensive spirometry. The condition of the child was managed remarkably by Dr. Vinod N. K. and the entire team of doctors who were vigilant in monitoring her. She barely required ventilation for 4 hours during the post-operative period. She recovered well and was discharged a week after the surgery without any complications.
This is a perfect example of how having an experienced and committed team of doctors helps the management of even the most difficult cases with ease.
A joyous, healthy child is a heart-warming sight that fills us with hope and gratitude.
