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

Area of Science:

• Oncology
• Surgical Oncology
• Pathology

Background:

• Chest wall sarcomas are rare soft tissue malignancies with diverse clinical presentations.
• This report focuses on the management of a large, fast-growing sarcoma originating in the pectoralis major muscle.

Observation:

• A 42-year-old male presented with chest pain and a palpable mass, diagnosed as a high-grade spindle cell neoplasm.
• Imaging revealed significant tumor growth over two months, from 9x9x9cm to 21.4x17.8x13.7cm.
• The patient received neoadjuvant chemoradiation, followed by wide local excision and myocutaneous flap reconstruction.

Findings:

• Final pathology confirmed a high-grade leiomyosarcoma (Stage III G3 pT2bNxMx) with smooth muscle differentiation.
• The surgical resection achieved R0 status (complete tumor removal).
• The tumor measured 38x20x18 cm with 70% gross necrosis post-neoadjuvant therapy.

Implications:

• This case highlights the importance of a multidisciplinary team in managing complex chest wall sarcomas.
• Effective treatment involved neoadjuvant chemoradiation, surgical resection, and reconstruction.
• Successful outcomes are achievable even with large, rapidly progressing tumors.