A Case of a Leiomyosarcoma (16cm in Longer Diameter) of the Chest Radically Resected after Preoperative Chemotherapy

Abstract

Leiomyosarcoma of the chest wall is a rare disease. Here, we report a case of a 16-cm leiomyosarcoma of the chest radically resected after preoperative chemotherapy. A 54-year-old man presented with a large mass on the left anterior chest. Percutaneous needle biopsy showed non-epithelial malignancy. On a preoperative CT scan and MRI images, the chest wall invasion was suspected. As the tumor poorly responded to the preoperative chemotherapy, an operation was performed. Since the chest wall invasion was visually inapparent during the operation, only tumor resection was performed. Considering the possibility for positive margin, we avoided a one-step approach to reconstruction, covered the defect with an artificial dermis and finished the operation. After negative margin was confirmed by histopathological examination, we performed reconstruction with pedicled latissimus dorsi musculocutaneous flap and split thickness skin graft. The histopathological diagnosis was leiomyosarcoma of the chest wall. About 50% of the tumor had degenerated and necrotized by the preoperative chemotherapy. Although another operation was needed for dorsi musculocutaneous flap and skin graft where partially failed to take, the wound was finally completely cured. He received adjuvant chemotherapy after discharge, and he is alive without any recurrence for 3 years and 5 months after the first operation.