|Year : 2020 | Volume
| Issue : 2 | Page : 81-90
Association between the pectoral muscles and rib anomalies in poland syndrome
Arife Zeybek1, Kürşad Tosun2, Ceren Uǧuz Gencer3, Serdar Kalemci4, Necdet Öz5, Sena Çalışkan6, Huriye Gülistan Bozdaǧ1
1 Department of Thoracic Surgery, School of Medicine, Mugla Sitki Koçman University, Mugla, Turkey
2 Department of Biostatistics, School of Medicine, Mugla Sitki Koçman University, Mugla, Turkey; School of Science, Siena College, New York, USA
3 Department of Anatomy, School of Medicine, Mugla Sitki Koçman University, Mugla, Turkey
4 Department of Chest Disease, Private Medical Park Hospital, Kocaeli, Turkey
5 Department of Thoracic Surgery, Private Medstar Hospital, Antalya, Turkey
6 Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, University of Health Sciences, Izmir, Turkey
|Date of Submission||14-Nov-2019|
|Date of Acceptance||06-Feb-2020|
|Date of Web Publication||30-Jun-2020|
Dr. Arife Zeybek
Department of Thoracic Surgery, School of Medicine, Mugla Sitki Koçman University, Mugla
Source of Support: None, Conflict of Interest: None
Introduction: The purpose of this study was to investigate the relationship between pectoralis major muscle (PMj) and rib defects in Poland syndrome (PS) and to evaluate the clinical findings and variabilities by the systematic review of all/current published articles on PS. Material and Methods: Based on our inclusion criteria, 86 patients were decided to be eligible for participating in this study. The data of the reviewed studies were classified according to the date of publication, age, sex, side of the deformity, defect type of PS, presence of other muscle or chest wall abnormalities, and dextrocardia. Further, other coexisting deformities and abnormalities were recorded. A logistic regression statistical analysis was carried out. Results: According to the reviewed cases, both left-sided presence-multiple muscle defects and left-sided presence-rib anomalies were found to be statistically significant (P = 0.007 and P = 0.04, respectively). The strength of the relationship between these two parameters was evaluated by binary logistic regression analysis, which revealed that multiple muscle defects and rib anomalies were associated with left chest side presence (P = 0.005 and P = 0.02, respectively). When the relationship between rib anomalies and PMj defect was analyzed, the association was found to be statistically significant (P = 0.03). Furthermore, the result of the strength analysis was also supported this association (P = 0.04). Discussion and Conclusion: Molecular and embryological development processes of the ribs and pectoral muscles are investigated to assess the presence of a structural relationship considering the causal connection between ribs and PMj in PS. As a supportive element to our study, the presence of a myogenic regulatory factor–Hox gene link was asserted in the animal experiments done by some researchers, showing a common development process of the rib and pectoral muscle. We believe that with the outcomes of this study, the clinical diversity and the etiopathogenesis of PS could be explained comprehensively.
Keywords: Hox gene, myogenesis, myogenic regulatory factor 5, Poland syndrome, sclerotome
|How to cite this article:|
Zeybek A, Tosun K, Gencer CU, Kalemci S, Öz N, Çalışkan S, Bozdaǧ HG. Association between the pectoral muscles and rib anomalies in poland syndrome. J Anat Soc India 2020;69:81-90
|How to cite this URL:|
Zeybek A, Tosun K, Gencer CU, Kalemci S, Öz N, Çalışkan S, Bozdaǧ HG. Association between the pectoral muscles and rib anomalies in poland syndrome. J Anat Soc India [serial online] 2020 [cited 2020 Sep 21];69:81-90. Available from: http://www.jasi.org.in/text.asp?2020/69/2/81/288672
| Introduction|| |
Poland syndrome (PS) is a rare congenital disorder that typically presents itself with the absence of the costosternal part of pectoralis major muscle (PMj) and ipsilateral brachysyndactyly of the upper limb. Other commonly seen abnormalities in PS are skeletal malformations of the thoracic wall and breast anomalies. Dextrocardia, lung herniation, liver herniation, kidney anomalies and tumors, and other skeletal defects have also been described in rare cases.,,,, Episodes of transient compression to the flow of the subclavian artery during the embryonic period are generally accepted etiopathogenesis of PS. Unfortunately, this etiopathological approach is insufficient to explain the clinical variants and findings in PS. This clinical diversity has brought along some questions about the etiology, diagnosis, and treatment of this disorder, and this approach could do no consensus or an accurate classification. In this study, we attempted to explain the pathogenesis of PS by investigating its association with the clinical outcomes of other comorbidities and aimed to evaluate this syndrome in an etiopathological point of view through a systemic review of case reports.
| Material and Methods|| |
A systematic literature search was performed. Web of Science, PubMed, Medline, and Google Scholar databases were employed for the studies on PS. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed while conducting this study [Appendix A]. The systematic review protocol was registered in the PROSPERO (CRD42017069888). The search strategies used are listed in Appendix B. The eligibility criteria were established before the data gathering from the full-text articles, including thorax computed tomography, published in Medline, Web of Science, PubMed Publisher, and Google Scholar databases.
The article screening for inclusion was carried out by two reviewers (M.A and R.Ö.B). The needed data regarding the characteristics and outcomes of the studies were collected independently by the reviewers through a standardized extraction table. Based on our inclusion criteria, 86 patients were included in our study. From the patient population of our clinic, two cases were selected to be eligible for this study [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]. The data from the included studies were categorized according to the name of publication, year of publication, age, sex, side of the deformity, defect type of PS, presence of other muscle or chest wall abnormalities, and dextrocardia.
|Figure 1: The absence of anterior costal ribs observed with an inspection in an adult patient|
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|Figure 2: Dextrocardia was observed in the chest X-ray of the adult patient|
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|Figure 3: Total absence of left pectoral major muscle were observed by computed tomography|
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|Figure 4: Total rib defects were observed in the pediatric patient's radiographs|
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|Figure 5: Three-dimensional tomographic scan of the child's thorax skeletal structure|
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The frequency of the disease, the correlation among chosen variables, and the significance of the results were statistically analyzed. The statistical significance was assessed with Fisher's exact test using the logistic regression method. The results were considered statistically significant when P < 0.05.
| Results|| |
A total of 3544 articles related to PS were reported in the Medline, Web of Science, PubMed, and Google Scholar databases. Based on our inclusion criteria, 86 patients were included in our study [Flow Chart 1].
Patient demographics were as follows: 74.4% of the patients (n = 64) were male, 25.6% (n = 22) were female, and their age ranged between 11 and 30 years (50%, n = 43). Other accompanying findings in the patients with PS were defined as 51.2% (n = 42) extremity malformation, 87.9% (n = 67) breast and nipple anomalies, and 26.7% (n = 23) dextrocardia with situs solitus. Overall clinical findings of the patients are given in [Table 1].
PS was more frequent in male subjects (74.4%) than in female subjects (25.6%), with a ratio of 3:1. Right hemithorax involvement was present in 42 (50%) patients. Sixty-seven of the 86 patients had the complete defect, while 17 patients had the partial defect of the PMj. Other muscle anomalies accompanying PMj defect have also been reported in various studies, and the number of patients with this specification was 41 in our study. The pectoral minor muscle (PMi) defect was one of the most frequently observed other concomitant muscle defects. Muscle defects are divided into two categories according to the involvement of other muscle deficiencies. Presence of other muscular defects, besides PMj defect, is named as multiple muscle defect. The correlation between the left side and multiple muscle defects was found to be statistically significant, P = 0.007. The strength of the relationship between these two parameters was evaluated by binary logistic regression analysis, which revealed that multiple muscle defect was associated with left chest side, P = 0.005 [Table 2].
Rib anomalies were detected in 50 patients (58.1%), and the mean value for deficient ribs was found as 2. The cases were divided into two groups according to the number of deficient ribs: one groups have number of deficient ribs more than two and other group have number of deficient ribs equal to and fewer than two. The left-sided presentation and rib anomalies were found to be significant, P = 0.04.
The presence of dextrocardia was found in 22 of 50 patients with rib anomalies, and the analysis supported the relationship between these variables [OR = 0.036, 95% confidence interval, 0.005–0.287 P = 0.002, [Table 2].
Rib anomalies were mostly detected in patients with a complete absence of PMj (P = 0.03), and the association between the variables is shown in Table 3 (P = 0.04).
| Discussion|| |
PS was first described by Alfred Poland in 1841. Other commonly used definitions could be listed as Poland sequence, Poland's anomaly, and Poland's syndactyly. Classical PS is characterized by hypoplasia or partial absence of the sternocostal head of PMj and ipsilateral brachysyndactyly.
While the majority of PS cases are sporadic, there are documented cases of inheritability which display an autosomal dominant inheritance pattern with incomplete penetrance. A wide range of frequencies from 1/30,000 to 1–9/100,000 has been estimated.,,
Males are more commonly affected than females, with a 3:1 ratio. In 75% of the cases, the right side of the chest is involved. However, in our study, we investigated the severity of the combination of rib anomaly and PMj defect on the left side of the thorax.
During our review, other pathological components such as rib defect, upper or lower limb hypoplasia/aplasia, digital structure, digital webbing, cardiac anomalies, nipple and axillary hair anomalies, diaphragmatic hernia or eventration, gonadal chromosomal anomalies such as turner syndrome, central nervous system and vertebral anomalies, liver and kidney anomalies, skin-related diseases, lack of subcutaneous fat tissue, hematologic disorders, optic lens anomalies, and urogenital tumors were reported in various studies.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
According to the results of our study, rib anomalies were commonly associated with left-sided involvement, and it is supported by the study of Torre et al. However, the real cause behind this fact is not fully explained, such as the etiology of PS.
For explaining the pathogenesis of PS, the most commonly accepted theory is the vascular injury during the 6th week of embryogenesis due to an interruption to the blood flow in the branches of subclavian and vertebral arteries when the pectoralis muscle is developing. Other possible causes could be listed as teratogens, intrauterine trauma, infections, and malformation of lateral plate mesoderm.,,
The main criterion for the diagnosis of PS is aplasia or hypoplasia of PMj. Moreover, in addition to the PMj anomaly, other muscular anomalies such as PMi, serratus anterior, trapezius, latissimus dorsi, external oblique, and peroneal muscle defects were reported in studies.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
In this study, it is observed that the incidence for the presentation of multiple muscle anomalies with left hemithorax involvement is significantly high. Binary logistic regression analysis is used for the evaluation. To explain this close relationship between rib anomalies and PMj defect, structural relationship and molecular and embryological development process of chest wall had been searched.
A common pathway during the development process of both pectoral muscle and skeletal structure of the chest wall is reported in the results of animal experimentations of some studies.,, As generally known, pectoral muscles originate from hypaxial myotome, while ribs develop from sclerotome. Furthermore, the myogenic regulatory factor 5 (Myf 5) gene is responsible for the development of the pectoral muscle, and the Hox gene is responsible for the development of ribs. Interestingly, the placement of the Hox protein receptors is suggested to be in the hypaxial myotome instead of sclerotome. It has been reported that the rib development in the thoracic vertebral levels was triggered by the activation of the Hox 6 gene through regulation of the Myf5/Myf6 gene expression in the hypaxial myotome. The information is transmitted to the sclerotome through platelet-derived growth factor-alpha subunit, and fibroblast growth factor 4 signaling by a cell nonautonomous mechanism had been asserted. This reported Myf-Hox gene link is upheld with the results of our study.
| Conclusion|| |
In light of these results, this study that we have conducted would be beneficial for explaining the clinical diversity and, even more importantly, the etiopathogenesis of PS. Investigating the role of Myf5 by advanced genetic research may enlighten the etiopathogenesis of many diseases concerning the thoracic wall anomalies.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Appendix|| |
Appendix A: Preferred Reporting Items for Systematic Review and Meta.Analysis 2009 Checklist
From: Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6 (7):e1000097. doi: 10.1371/journal.pmed1000097. For more information, visit: www.prisma-statement.org.
| Appendix B: Search Strategy|| |
((((“Poland Syndrome/analysis”[Mesh] OR “Poland Syndrome/anatomy and histology”[Mesh] OR “Poland Syndrome/blood”[Mesh])) AND (“Poland Syndrome/chemically induced”[Mesh] OR “Poland Syndrome/classification”[Mesh] OR “Poland Syndrome/complications”[Mesh] OR “Poland Syndrome/congenital”[Mesh] OR “Poland Syndrome/diagnosis”[Mesh] OR “Poland Syndrome/diagnostic imaging”[Mesh] OR “Poland Syndrome/embryology”[Mesh] OR “Poland Syndrome/epidemiology”[Mesh] OR “Poland Syndrome/etiology”[Mesh] OR “Poland Syndrome/genetics”[Mesh] OR “Poland Syndrome/history”[Mesh] OR “Poland Syndrome/pathology”[Mesh] OR “Poland Syndrome/physiology”[Mesh] OR “Poland Syndrome/physiopathology”[Mesh] OR “Poland Syndrome/surgery”[Mesh] OR “Poland Syndrome/therapy”[Mesh])) AND (“Pectoralis Muscles/abnormalities”[Mesh] OR “Pectoralis Muscles/analysis”[Mesh] OR “Pectoralis Muscles/anatomy and histology”[Mesh] OR “Pectoralis Muscles/blood supply”[Mesh] OR “Pectoralis Muscles/chemistry”[Mesh] OR “Pectoralis Muscles/diagnosis”[Mesh] OR “Pectoralis Muscles/diagnostic imaging”[Mesh] OR “Pectoralis Muscles/drug effects”[Mesh] OR “Pectoralis Muscles/embryology”[Mesh] OR “Pectoralis Muscles/etiology”[Mesh] OR “Pectoralis Muscles/growth and development”[Mesh] OR “Pectoralis Muscles/pathology”[Mesh])) AND (“Bone Diseases, Developmental/analysis”[Mesh] OR “Bone Diseases, Developmental/anatomy and histology”[Mesh] OR “Bone Diseases, Developmental/classification”[Mesh] OR “Bone Diseases, Developmental/congenital”[Mesh] OR “Bone Diseases, Developmental/embryology”[Mesh] OR “Bone Diseases, Developmental/genetics”[Mesh] OR “Bone Diseases, Developmental/history”[Mesh] OR “Bone Diseases, Developmental/surgery”[Mesh])
((((“Poland Syndrome/analysis”[Mesh] OR “Poland Syndrome/anatomy and histology”[Mesh] OR “Poland Syndrome/blood”[Mesh])) AND (“Poland Syndrome/chemically induced” OR “Poland Syndrome/classification” OR “Poland Syndrome/complications”[Mesh] OR “Poland Syndrome/congenital”[Mesh] OR “Poland Syndrome/diagnosis”[Mesh] OR “Poland Syndrome/diagnostic imaging”[Mesh] OR “Poland Syndrome/embryology”[Mesh] OR “Poland Syndrome/epidemiology”[Mesh] OR “Poland Syndrome/etiology”[Mesh] OR “Poland Syndrome/genetics” OR “Poland Syndrome/history”[Mesh] OR “Poland Syndrome/pathology”[Mesh] OR “Poland Syndrome/physiology”[Mesh] OR “Poland Syndrome/physiopathology”[Mesh] OR “Poland Syndrome/surgery”[Mesh] OR “Poland Syndrome/therapy”[Mesh])) AND (“Pectoralis Muscles/abnormalities”[Mesh] OR “Pectoralis Muscles/analysis”[Mesh] OR “Pectoralis Muscles/anatomy and histology”[Mesh] OR “Pectoralis Muscles/blood supply”[Mesh] OR “Pectoralis Muscles/chemistry”[Mesh] OR “Pectoralis Muscles/diagnosis '' OR “Pectoralis Muscles/diagnostic imaging”[Mesh] OR “Pectoralis Muscles/drug effects”[Mesh] OR “Pectoralis Muscles/embryology”[Mesh] OR “Pectoralis Muscles/etiology”[Mesh] OR “Pectoralis Muscles/growth and development”[Mesh] OR “Pectoralis Muscles/pathology”)) AND (“Bone Diseases, Developmental/analysis”[Mesh] OR “Bone Diseases, Developmental/anatomy and histology”[Mesh] OR “Bone Diseases, Developmental/classification”[Mesh] OR “Bone Diseases, Developmental/congenital”[Mesh] OR “Bone Diseases, Developmental/embryology”[Mesh] OR “Bone Diseases, Developmental/genetics”[Mesh] OR “Bone Diseases, Developmental/history”[Mesh] OR “Bone Diseases, Developmental/surgery”)
Web of Science
(“Poland Syndrome/analysis” OR “Poland Syndrome/anatomy and histology” OR “Poland Syndrome/blood”)) AND (“Poland Syndrome/chemically induced” OR “Poland Syndrome/classification” OR “Poland Syndrome/complications” OR “Poland Syndrome/congenital” OR “Poland Syndrome/diagnosis” OR “Poland Syndrome/diagnostic imaging” OR “Poland Syndrome/embryology” OR “Poland Syndrome/epidemiology” OR “Poland Syndrome/etiology” OR “Poland Syndrome/genetics” OR “Poland Syndrome/history” OR “Poland Syndrome/pathology” OR “Poland Syndrome/physiology” OR “Poland Syndrome/physiopathology” OR “Poland Syndrome/surgery” OR “Poland Syndrome/therapy”)) AND (“Pectoralis Muscles/abnormalities” OR “Pectoralis Muscles/analysis” OR “Pectoralis Muscles/anatomy and histology” OR “Pectoralis Muscles/blood supply” OR “Pectoralis Muscles/chemistry” OR “Pectoralis Muscles/diagnosis”OR “Pectoralis Muscles/diagnostic imaging” OR “Pectoralis Muscles/drug effects” OR “Pectoralis Muscles/embryology” OR “Pectoralis Muscles/etiology” OR “Pectoralis Muscles/growth and development” OR “Pectoralis Muscles/pathology”)) AND (“Bone Diseases, Developmental/analysis” OR “Bone Diseases, Developmental/anatomy and histology” OR “Bone Diseases, Developmental/classification” OR “Bone Diseases, Developmental/congenital” OR “Bone Diseases, Developmental/embryology” OR “Bone Diseases, Developmental/genetics” OR “Bone Diseases, Developmental/history” OR “Bone Diseases, Developmental/surgery”)
Poland Syndrome, Poland Syndrome classification, Poland Syndrome congenital, Poland Syndrome diagnosis, Poland Syndrome diagnostic imaging, Poland Syndrome epidemiology, Poland Syndrome etiology, Poland Syndrome genetics, Pectoralis Muscles/abnormalities, Pectoralis Muscles/anatomy and histology Pectoralis Muscles embryology, Pectoralis Muscles etiology, Pectoralis Muscles/growth and development, Bone Diseases, Developmental/anatomy and histology, Poland Syndrome pathology.
| Poland Syndrome|| |
A 29-year-old male patient was accepted to our outpatient clinic with blunt trauma to the right side of the chest. After a physical examination and radiological evaluations, no trauma-related complications on the right side of the chest were detected; however, an asymmetry in the left chest wall, an upward-positioned nipple at the left side, and collapsed left chest wall and abdomen were noted. When palpated, the absence of costal cartilage of the 5th–10th rib on the left chest wall and muscle weakness on the chest wall and anterior abdominal wall were identified, and a 20 cm × 15 cm area of hypopigmentation on the left chest wall – the area that was separated by a sharp border on the same level as the skin was noted [Figure 1]. No pathological findings or symptoms were found in the rest of the physical examination. There was no paradoxical respiration or dyspnea in the patient. Respiratory reserves were found to be within normal limits.
On the thoracic computed tomographic (CT) scan, total agenesis of the left pectoralis major muscle (PMj), pectoralis minor muscle hypoplasia, left rectus abdominis xiphoid adnexa head aplasia, and left 5th–10th costal cartilage defects were detected. These findings implied Poland syndrome (PS) and accompanying dextrocardia [Figure 2] and [Figure 3]. No congenital heart disease was detected by echocardiographic evaluation performed by a cardiologist. No decrease or change in the arterial bloodstream was reported in the upper left extremity or left subclavian arterial Doppler ultrasonography (USG). A moderate level of hepatosplenomegaly was noted in the abdominal USG. There was no abnormality in the vertebral or skeletal structure. In addition, the patient had no family history of PS.
A 6-year-old boy was referred to our outpatient clinic with a preliminary diagnosis of chest wall deformity. Our examination confirmed a deformity in the left chest wall and shoulder, while respiratory and cardiac assessments indicated normal results. In the upper left extremity, the hyperabduction was limited and the left scapula was located in an upward position, the muscle structure in the left chest wall was weak, and two nipples on that side were positioned upward [Figure 4].
According to the chest X-ray, abdominal USG, the thoracic magnetic resonance imaging and CT, the left third and fourth ribs had total agenesis, and the fifth and sixth ribs showed fusion with the vertebrocostal joint and had anterior defects; the patient was described with aplasia of the left PMj muscles and the serratus anterior, and his scapula was directed upward. The patient had a 15° thoracic scoliosis facing the left at the first lumbar vertebra and distal diastematomyelia, which was determined to be in a 5-mm confined area [Figure 5].
| References|| |
Poland A. Deficiency of the pectoralis muscle. Guy's Hospital Rep 1841;6:191-3.
David TJ. Nature and etiology of the Poland anomaly. N
Engl. J Med. 1972;287(10):487–489.
Bavinck JN., Weaver DD. Subclavian artery supply disruption sequence: hypothesis of a vascular etiology for Poland, Klippel-Feil and Mobius anomalies. Am J Med Genet.1986. 23:903–918
Perrotta S, Zubrytska Y. Isolated left pectoralis major muscle hypoplasia in Poland syndrome. Asian Cardiovasc Thorac Ann 2017;25:237-8.
Yadav GK, Lal S, Dange N, Marwah KG, Singh JP. Poland's syndrome with unusual hand and chest anomalies: A rare case report. Indian J Chest Dis Allied Sci 2014;56:191-4.
Deniz O, Tozkoparan E, Gümüş S, Yildiz Y, Savci S, Bilgiç H, et al.
Poland syndrome (a case report). Tuberk Toraks 2005;53:275-9.
Sharma CM, Kumar S, Meghwani MK, Agrawal RP. Poland syndrome. Indian J Hum Genet 2014;20:82-4.
] [Full text]
Yiyit N, Işıtmangil T, Oztürker C. The abnormalities of trapezius muscle might be a component of Poland's syndrome. Med Hypotheses 2014;83:533-6.
Baban A, Torre M, Bianca S, Buluggiu A, Rossello MI, Calevo MG, et al.
Poland syndrome with bilateral features: Case description with review of the literature. Am J Med Genet A 2009;149A:1597-602.
Rossello, M I. Poland's syndrome and spontaneous pneumothorax, a rare association. Tuberk. Toraks.2010; 58(2):173-6.
Calevo, M. G. A variant of Poland syndrome associated with dextroposition. J. Thorac Imaging.2007; Nov;22(4):341-2
Ahn MI, Park SH, Park YH. Poland's syndrome with lung cancer. A case report. Acta Radiologica. Sep;41(5):432-4.
Shaham D, Ramu N, Bar-Ziv J. Leiomyosarcoma in Poland's syndrome. A case report. Acta Radiol.1992; Sep;33(5):444-6
Delay E, Sinna R, Chekaroua K, Delaporte T, Garson S, Toussoun G. Lipomodeling of Poland's syndrome: A new treatment of the thoracic deformity. Aesthetic Plast Surg 2010;34:218-25.
Zhou F, Liu W, Tang Y. Autologous rib transplantation and terylene patch for repair of chest wall defect in a girl with Poland syndrome: A case report. J Pediatr Surg 2008;43:1902-5.
Kabra M, Suri M, Jain U, Verma IC. Poland anomaly with unusual associated anomalies: Case report of an apparent disorganized defect. Am J Med Genet 1994;52:402-5.
Luh SP, Yang PC, Lee CJ. Poland's syndrome with spontaneous pneumothorax: Report of two cases. J Formos Med Assoc 2002;101:148-51.
Cingel V, Bohac M, Mestanova V, Zabojnikova L, Varga I. Poland syndrome: From embryological basis to plastic surgery. Surg Radiol Anat 2013;35:639-46.
Okamo H, Miura K, Yamane T, Fujii H, Matsumoto Y. Invasive ductal carcinoma of the breast associated with Poland's syndrome: Report of a case. Surg Today 2002;32:257-60.
Kurt Y, Demirbas S, Ulu utku AH. Poland's syndrome and gastric cancer: report of a case. Eur J Cancer Prev. 2006; Dec;15(6):480-2.
Caksen H, Patiroglu T, Ozdemir MA, Patiroglu TE, Poyrazoglu MH, Tercan M. Neuroblastoma and Poland syndrome in a 15-year-old boy. Acta Paediatr Jpn 1997;39:701-4.
Athale UH, Warrier R. Poland's syndrome and Wilms tumor: An unusual association. Med Pediatr Oncol 1998;30:67-8.
Arango Tomás E, Baamonde Laborda C, Algar Algar J, Salvatierra Velázquez A. Chest wall reconstruction with methacrylate prosthesis in Poland syndrome. Arch Bronconeumol 2013;49:450-2.
Legbo JN. Poland's syndrome: Report of a variant. J Natl Med Assoc 2006;98:97-9.
Vélez A, Moreno J. Poland's syndrome and recessive X-linked ichthyosis in two brothers. Clin Exp Dermatol 2000;25:308-11.
Ailiwadi M, Arildsen RC, Greelish JP. Poland syndrome: A contraindication to the use of the internal thoracic artery in coronary artery bypass grafting? J Thorac Cardiovasc Surg 2005;130:578-9.
Akyol M, Gökdemir O, Öztürk T. Multimodality imaging features of Poland syndrome. Elective Med J 2014;2:282-5.
Atasoy HI, Yavuz T, Altunrende S, Guven M, Kılıcgun A, Polat O, et al.
A unique case of right-sided Poland syndrome with true dextrocardia and total situs inversus. Eur J Pediatr 2013;172:269-72.
Avci G, Misirlioǧlu A, Eker G, Aköz T. Mild degree of Poland's syndrome reconstruction with customized silicone prosthesis. Aesthetic Plast Surg 2003;27:112-5.
Aytaç E, Durgun AV, Büyüktaş D, Büyüktaş D, Erdamar S, Ongören S. Poland syndrome associated with pernicious anemia and gastric dysplasia. Turk J Haematol 2012;29:441-4.
Hadley GR, Bösenberg AT. Poland syndrome with exomphalos major. Pediatr Surg Int 1995;10:498-500.
Biçakçi Z. A Mild form case of Poland syndrome. Journal of Aydın Adnan Menderes University Medical Faculty. 2010;11(1) : 39 -42.
Karnak I, Tanyel FC, Tunçbilek E, Unsal M, Büyükpamukçu N. Bilateral Poland anomaly. Am J Med Genet 1998;75:505-7.
Çelik B. Poland's syndrome and spontaneous pneumothorax a rare association. Tuberk. Toraks 2010; 58(2): 173-176
Özer C M, Akça SD, Akça F, Yıldız S. Poland's Syndrome Associated with Opposite Side Retractile Testicle. SmyrnaMed Case Journal. 2014; 41-4
Anar C, Kocakuşak D, Yalçinkaya E, Güldaval F, Ünsal İ, Halilçol H. Poland Syndrome and Lung Cancer: A case report. Journal of Izmir Chest Hospital. 2015; Cilt XXIX Sayı 1.
Cordero García C, Nieto Castilla A, López Jiménez E, Amores García I. Dextrocardia associated with left-sided Poland syndrome. Am J Phys Med Rehabil 2009;88:168.
Terrence C D, Joh C, Love L, Posniak HV. Computed Tomography of Partial Unilateral Agenesis of the Pectoralis Muscles. Journal of Computer Assisted Tomography.1985; May;9(3):558-9.
Tokur M. Poland syndrome accompanied by isolated dextrocardia and scoliosis: A case report. Turkish J Thoracic Cardiovascular Surg 2013;21:1, 201-3.
Tomos I, Papaioannou AI, Vlami A, Apollonatou V, Manali ED, Papiris SA. Unilateral hypertransparency on chest radiograph: The congenital Poland Syndrome. Adv Respir Med 2016;84:342-3.
Tos T, Karaman A, Perçin F, Koçak H. Poland syndrome: A case report. Med Bulletin Haseki Training Res Hospital 2011;49;37-8.
Dingeldein MW, Lu CY, Kim AW, Ostric S, Liptay MJ, Holterman MJ. Simultaneous costal cartilage-sparing modified Ravitch procedure and latissimus dorsi transfer for chest wall deformity repair in Poland's syndrome. J Pediatr Surg 2009;44:e29-32.
Dustagheer S, Basheer MH, Collins A, Hill C. Further support for the vascular aetiology of Poland syndrome – A case report. J Plast Reconstr Aesthet Surg 2009;62:e360-1.
Elli M, Oǧur G, Daǧdemir A, Pinarli G, Ceyhan M, Daǧçinar A. Poland syndrome with intracranial germ cell tumor in a child. Pediatr Hematol Oncol 2009;26:150-6.
Flores A, Ross JR, Tullius TG Jr., Levin GS. A unique variant of Poland-Mobius syndrome with dextrocardia and a 3q23 gain. J Perinatol 2013;33:572-3.
Beer GM, Kompatscher P, Hergan K. Poland's syndrome and vascular malformations. Br J Plast Surg 1996;49:482-4.
Gan C, Hu J, Luo S, An Q, Lin K. Hybrid procedure for Poland syndrome associated with a Gerbode-type defect. Congenit Anom (Kyoto) 2014;54:240-2.
Gerlinger I, Járai T, Lujber L, Pytel J. Poland's syndrome and head-and-neck tumour: An unusual association causing a reconstruction dilemma. Eur Arch Otorhinolaryngol 2007;264:553-6.
Santra G, Sinha PK, Bhattacharya K, Phaujdar S. Poland Syndrome. The Journal of the Association of Physicians of India. 2012; June;60: 40-42
Mutlu H, Sildiroglu O, Basekim C, Kizilkaya E. A Variant of Poland Syndrome Associated With Dextroposition. J Thorac Imaging. 2007; 22:341–342
Kabukcu H, Sahin N, Kanevetci BN, Titiz T, Bayezid O. Anaesthetic Management of Patient with Poland Syndrome and Rheumatic Mitral Valve Stenosis: A Case Report Annals of Cardiac Anaesthesia. 2005; 8: 145–147
Kamburoglu HO, Sönmez E, Aksu AE, Evrenos MK, Safak T, Keçik A. A rare Poland syndrome deformity: Humero-pectoral band. J Hand Microsurg 2011;3:28-30.
Drebov RS, Katsarov A. Poland Syndrome: Use of Vertical Expandable Prosthetic Titanium Rib System before Walking Age—A Case Report. The Surgery Journal. 2016; 2;3;91-92
Koizumi T, Mitsukawa N, Saiga A, Satoh K. Clinical application of Nuss procedure for chest wall deformity in Poland syndrome. Kardiochir Torakochirurgia Pol .2014; Dec;11(4):421-3
Lasko D, Thompson WR, Buckner D M, Sola JE. Titanium mesh prosthesis repair of symptomatic Poland syndrome in a premature infant. J Pediatr Surg. 2008; Jan;43(1):234-7.
Lee SH, Kim JB, Park NH, Keum DY, Kim YH. A rare combination of dextrocardia with right-sided Poland syndrome. Ann Thorac Surg. 2012; Oct;94(4):e103-4
Li W, Zhang L, Zhang Q, Du J, Zhang S, Liu X. Poland syndrome associated with ipsilateral lipoma and dextrocardia. Ann Thorac Surg. 2011; Dec;92(6):2250-2
Lieber J, Kirschner HJ, Fuchs J. Chest wall repair in Poland syndrome: Complex single-stage surgery including vertical expandable prosthetic titanium rib stabilization – A case report. J Pediatr Surg 2012;47:e1-5.
Gocmen H, Akkas Y, Doganay S. Poland syndrome: rare presentation in two cases. Journal of the New Zealand Medical Association. 2010; 27 August, Vol 123 No 1321
Gupta HM, Yashvant S, Hemant T, Arti M. Poland syndrome: Atypical presentation and review of the literature. Indian J Child Health.2017; 268 Vol 4 | Issue 2 | Apr-Jun
Junior JLB, Matta ES, Bortoli LD, Raasch F. Poland's syndrome: radiologic findings. Radiol Bras. 2012; Mai/Jun;45(3):173–174
Martinez-Ferro M, Fraire C, Saldaña L, Reussmann A, Dogliotti P. Complete videoendoscopic harvest and transposition of latissimus dorsi muscle for the treatment of Poland syndrome: A first report. J Laparoendosc Adv Surg Tech A 2007;17:108-13.
Masia J, Pons G, Loschi P, Sanchez Porro-Gil L, Nardulli ML, Olivares L. Autologous reconstruction of a complex form of Poland syndrome using 2 abdominal perforator free flaps. Ann Plast Surg 2015;74:580-3.
Baltayiannis N, Ifantidis F, Gavressea T, Papatheodorou H, Kayianni E, Rizos S. A very unusual case of Poland syndrome with amastia-athelia and dextrocardia. Hellenic J Surg 2011;83:1.
Riyaz N, Riyaz A. Poland syndrome (anomaly) with congenital hemangioma: A new association. Indian J Dermatol Venereol Leprol 2006;72:222-3.
] [Full text]
Çalpur OU, Aktas S. Poland syndrome. Acta Orthop Traumatol Turc 1993;27:280-1.
Iyer RS, Parisi MT. Multimodality imaging of Poland syndrome with dextrocardia and limb anomalies. Clin Nucl Med 2012;37:815-6.
Raval J, Nagaraja V, Burgess D, Eshoo S, Sadick N, Denniss AR. A rare association of pulmonary hypertension and dextrocardia with Poland syndrome. Heart Lung Circ 2013;22:778-80.
Rodriguez IE, Heare T, Bruny J, Deleyiannis FW. Customized titanium implant for chest wall reconstruction in complex Poland syndrome. Plast Reconstr Surg Glob Open 2014;2:e112.
Rocha RP, Daher PF, Souza P
B, Saldaña O, Sousa J E, Pacheco RB et al.
Complication After Breast Implantation in Poland Syndrome. Aesthetic Surgery Journal.2008; Volume 28, Number 5, Sep/Oc;589-93
Rosa RF, Travi GM, Valiatti F, Zen PR, Pinto LL, Kiss A et al.
Poland syndrome associated with an aberrant subclavian artery and vascular abnormalities of the retina in a child exposed to misoprostol during pregnancy. Birth Defects Res A Clin Mol Teratol.2007; 79:507–511
Rupam KT, Kaushik S, Arnab S, Santanu G, Mrinmoy M. Poland syndrome with absent ribs. Medical Journal of Dr. D.Y. Patil University.2014; January-February 2014 | Vol 7.
Seifarth FG, Cruz Pico CX, Stromberg J, Recinos VM, Burdjalov VF, Karakas SP. Poland syndrome with extracorporeal intercostal liver herniation and thoracic myelomeningocele. J Pediatr Surg 2012;47:e13-7.
Sepulveda W. Poland syndrome: A rare cause of cardiac dextroposition in the fetus. Prenat Diagn 2009;29:903-5.
Sethuraman R, Kannan S, Bala I, Sharma RK. Anaesthesia in Poland syndrome. Can J Anaesth 1998;45:277-9.
Sinopidis X, Panagidis A, Alexopoulos V, Tzifas S, Dimitriou G, Georgiou G. Liver exstrophy in a neonate with Poland syndrome. Pediatr Neonatol 2017;58:558-9.
Srivastava V, More R, Tang A. Off-pump coronary artery bypass in Poland syndrome with dextrocardia: Case report. J Cardiothorac Surg 2011;6:75.
Sucuoglu H, Aslan H, Aslan AA, Öz V. Poland syndrome: Two case reports. Turk J Phys Med Rehab 2016;62:264-8.
Hacıevliyagil SS, Gülbaş G, Mutlu LC, Yetkin Ö, Ulutaş H, Günen H. Poland Syndrome Due to a Case. Journal of Inönü University Medical Faculty. 2006;13(4) 275-277
Samuels TH, Haider MA, Kirkbride P. Poland's syndrome: A mammographic presentation. AJR Am J Roentgenol 1996;166:347-8.
Deveci U, Çivilibal M, Ataoglu E, Elevli M. Coexistence of Poland syndrome and isolated dextrocardia. Çocuk Sagligi ve Hastaliklari Dergisi. 2003;46:50-3.
Yiyit N, Saygin H. Anomalies of Biceps Brachii Muscle as a Potential Component of Poland's Syndrome. Respiratory Case Reports 2015;4:64-6.
Yoo WH, Bae MH, Han YM, Byun SY, Park KH. Poland syndrome in one dizygotic twin: A case report. Korean J Perinatol 2015;26:4
Torre M, Baban A, Buluggiu A, Costanzo S, Bricco L, Lerone M, et al.
Dextrocardia in patients with Poland syndrome: Phenotypic characterization provides insight into the pathogenesis. J Thorac Cardiovasc Surg 2010;139:1177-82.
Brent AE, Tabin CJ. Developmental regulation of somite derivatives: Muscle, cartilage and tendon. Curr Opin Genet Dev 2002;12:548-57.
Brent AE, Braun T, Tabin CJ. Genetic analysis of interactions between the somitic muscle, cartilage and tendon cell lineages during mouse development. Development 2005;132:515-28.
Vinagre T, Moncaut N, Carapuço M, Nóvoa A, Bom J, Mallo M. Evidence for a myotomal Hox/Myf cascade governing nonautonomous control of rib specification within global vertebral domains. Dev Cell 2010;18:655-61.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]