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R0 resection and reconstruction for a large, rapidly progressive chest wall sarcoma
- Source :
- Journal of Cardiothoracic Surgery, Vol 13, Iss 1, Pp 1-4 (2018), Journal of Cardiothoracic Surgery
- Publication Year :
- 2018
- Publisher :
- BMC, 2018.
-
Abstract
- Background Chest 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 report An 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. Conclusions This 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.
- Subjects :
- Pulmonary and Respiratory Medicine
Thorax
Leiomyosarcoma
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
lcsh:Surgery
Case Report
Chest pain
lcsh:RD78.3-87.3
03 medical and health sciences
0302 clinical medicine
Medicine
Humans
Thoracic Wall
Soft tissue sarcoma
Wide local excision
business.industry
Pectoralis major muscle
Soft tissue
General Medicine
lcsh:RD1-811
Plastic Surgery Procedures
medicine.disease
030228 respiratory system
lcsh:Anesthesiology
030220 oncology & carcinogenesis
Surgery
Radiology
Sarcoma
Chest wall sarcoma
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Tomography, X-Ray Computed
Chest wall reconstruction
Subjects
Details
- Language :
- English
- ISSN :
- 17498090
- Volume :
- 13
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiothoracic Surgery
- Accession number :
- edsair.doi.dedup.....c95d1a4007099de08de8c8c6b37e1cc4