R0 resection and reconstruction for a large, rapidly progressive chest wall sarcoma

Abstract

BackgroundChest wall sarcomas are a rare group of soft tissue malignancies with variable presentations. Here we describe the definitive management of a large, rapidly progressing chest wall sarcoma arising from the pectoralis major muscle.Case reportAn obese 42-year-old African American male with multiple medical comorbidities presented with new onset right-sided chest pain and a palpable right chest mass. Initial CT chest demonstrated a 9x9x9cm necrotic mass arising from the pectoralis major. CT-guided core biopsy was positive for high-grade spindle cell neoplasm (positive for smooth muscle actin, desmin, S100, and CD31; negative for CD34, PAX8, and beta-catenin). Staging imaging 2 months later demonstrated growth of the mass to 21.4 × 17.8 × 13.7 cm. The patient underwent neoadjuvant chemoradiation with surveillance CT imaging demonstrating a stable tumor. Then he underwent wide local excision of the mass followed by delayed local myocutaneous flap reconstruction and skin grafting. Final pathology was R0 resection, 38x20x18 cm tumor with 70% gross necrosis. Microscopic examination confirmed high-grade sarcoma with smooth muscle differentiation. Final pathologic staging was Stage III G3 pT2bNxMx.ConclusionsThis patient presented with a rare, rapidly enlarging high-grade leiomyosarcoma of the chest wall without metastases or violation of the thorax. We describe the definitive management including a multidisciplinary team to manage a complex and rapidly progressive sarcoma of the chest wall.

Evaluation of Clinical Performance of TiNi-Based Implants Used in Chest Wall Repair after Resection for Malignant Tumors

“…Our surgical treatment of chest wall tumors accords well, in all cases, with an approach on the reconstruction procedure of a post-excision defect in the sternocostal framework reported in [ 1 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Artificial rib constructs for thoracic osteosynthesis prepared pursuant to a 3D model were a proper fit when the defect was being reconstructed and did not require any intraoperative correction ( Figure 1 ), and thus the surgery time was shortened, as indicated in Table 3 .…”

“…Despite the significant progress made in various areas of oncosurgery, the surgical stage in treating chest wall tumors occupies the leading position [ 3 , 4 , 5 , 6 , 7 ]. Radical surgical intervention for chest wall tumors is typically accompanied by the lesion of osteochondral structures and the appearance of complex post-resection defects, which result in functional and aesthetic impairment.…”