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Cardiothoracic Surgery |

An Interesting Case of a Spindle Cell Sarcoma Involving the Chest Wall and Diaphragm and Invading the Liver

Danielle Pineda, MD; David Rittenhouse, MD; Michael Pucci, MD; Nathaniel Evans, MD; Ernest Rosato, MD; Scott Cowan, MD
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Thomas Jefferson University Hospital, Philadelphia, PA


Chest. 2013;144(4_MeetingAbstracts):105A. doi:10.1378/chest.1704228
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Abstract

SESSION TITLE: Surgery Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Soft tissue sarcomas are rare tumors occurring throughout the body, with only 17.5% originating in the thorax or trunk1. We present the diagnostic and surgical management of a 77-year old male with a spindle-cell sarcoma involving the chest wall, diaphragm and right lobe of the liver.

CASE PRESENTATION: A 77-year old male with a history of coronary artery disease, hypertension and a previous CABG presented to our center after noticing a painful mass in his right chest wall. Physical exam revealed a right inferolateral chest wall mass. CT abdomen/pelvis revealed a soft tissue tumor invading the right chest wall with displacement and possible invasion of the right lobe of the liver (Figure 1). Fine needle aspiration of the tumor was suggestive of a spindle cell neoplasm. In order to rule out disseminated disease, the operation commenced with a laparoscopic and thoracoscopic evaluation of both the abdominal and pleural cavities. No metastatic disease was appreciated in the abdomen. Thoracoscopy confirmed tumor invasion of the diaphragm and chest wall. The prior biopsy site was excised and ribs 10 and 11 and the lateral 1/3 of the diaphragm were removed circumferentially with the mass. The tumor remained tethered to the liver and was not able to be separated; therefore, a right subcostal incision was extended medially onto the abdominal wall. A right hepatectomy was performed and the tumor was removed. The diaphragmatic defect was repaired and the abdominal and chest wall incisions were closed. Post-operatively, the patient had an uneventful hospital course. Final pathology revealed an 11-cm intermediate grade spindle cell sarcoma involving the chest wall, diaphragm and liver with all margins negative (Figure 2).

DISCUSSION: We present an interesting presentation of a spindle-cell sarcoma. Sarcomas, while rare, can originate from either the chest wall or the retroperitoneum. Based on pathology, it is unclear where our patient's tumor arose. Interestingly, there has been only one other report of sarcoma invading the liver2. Spindle-cell sarcomas are extremely rare and there have been no reports of any involving the chest wall, diaphragm and liver. Standard oncologic principles of en-bloc resection of the tumor and involved organs remains treatment of choice.

CONCLUSIONS: Soft-tissue sarcoma has the potential to invade the liver but with careful planning, en bloc resection with negative margins can be achieved.

Reference #1: Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol. 2002;20:791-796.

Reference #2: Noiseux N, Ferraro P, Busque S, Harris P, Duranceau A. Chest wall and liver resection for chondrosarcoma. Ann Thorac Surg. 2002;74:598.

DISCLOSURE: The following authors have nothing to disclose: Danielle Pineda, David Rittenhouse, Michael Pucci, Nathaniel Evans, Ernest Rosato, Scott Cowan

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