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  • • Up to 50% of all malignant chest wall masses

    • Only 5% of all malignant soft-tissue sarcomas located in chest wall

    • Prognosis determined by histologic grade, completeness of resection, and metastatic disease

    • Metastasize commonly to lungs (75%)

    • Types of tumors:

    • -Desmoids: Low grade

      -Fibrosarcoma: Most common in this location, especially in young adults

      -Liposarcoma: 33% of all primary cancers of chest wall, especially in men

      -Neurofibrosarcomas: 2 × more common in this location than any other, often in Recklinghausen disease, originating from intercostals nerves

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Imaging Findings

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  • • US, CT, and MRI can be useful

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  • • Most often metastasize to lungs

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Rule Out

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  • • Metastatic disease with chest CT

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  • • Physical exam

    • Chest x-ray

    • Chest CT scan

    • Incisional or excisional biopsy depending on size and configuration

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  • • Resection goal is to achieve negative margins (1-2 cm)

    • Marlex mesh/methyl methacrylate to correct chest wall deformity

    • Soft-tissue flaps for coverage

    Positive margins: Radiation therapy

    • Adjuvant chemotherapy if high grade

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Surgery

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Indications

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  • • Resectable lesion

    • Localized metatstatic disease to lungs if amenable to negative margins

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Prognosis

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  • • Depends on histologic grade

    • -Low grade: 5-year survival, 90%

      -High grade: 5-year survival, 30-50%

    • Completeness of surgical resection helps determine

    • Metastases greatly decrease survival

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References

Burt M. Primary malignant tumors of the chest wall. The Memorial Sloan-Kettering Cancer Center experience. Chest Surg Clin North Am. 1994;4:137.  [PubMed: 8055278]

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Practice Guidelines

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