Chest wall tumors. A review of clinical experiences with 30 cases.
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We report a case of a 62-year-old woman with primary leiomyosarcoma of the chest wall which was successfully resected under the video-assisted thoracoscopic approach. The disease was found during the treatment for a malignant melanoma of the left heel. On the preoperative CT images, the lesion was suspected to be a metastasis of the malignant melanoma. The thoracoscopic surgery revealed that the tumor originated from the parietal pleura, and it was resected with a 5-mm margin of normal pleura. Histopathologically, the tumor was diagnosed as low-grade leiomyosarcoma. Since no residual tumor cells were proven in the resected margins histologically, further resection was not performed. At present, she is alive and well with no sign of recurrence of leiomyosarcoma two years and one month after operation. Thoracoscopic surgery is worth trying for accurate diagnosis of and effective treatment for a chest lesion without apparent invasion of the chest wall on the preoperative CT images.
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The Askin tumor, a primitive malignant small-cell tumor of the chest wall, is mostly seen among children and adolescents. It is closely related to Ewing's sarcoma of the same location, both tumors showing a chromosomal translocation t(11;22). Its origin from neuroectodermal cells is deducted from several ultrastructural details and from the expression of specific markers like NSE. Pain and deformation of the chest wall are the cardinal clinical signs of the tumor. Chest X-rays will frequently show destruction of ribs and pleural effusions. Effective therapy consists of radical surgery, local radiation and adjuvant chemotherapy. This multimodal concept allows minority of patients to remain disease-free but the overall outcome is rather unfortunate.
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