Chest Wall Tumors, Malignant Soft Tissue

• • 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

Imaging Findings

• • US, CT, and MRI can be useful

• • Most often metastasize to lungs

Rule Out

• • Metastatic disease with chest CT

• • Physical exam

  • Chest x-ray

  • Chest CT scan

  • Incisional or excisional biopsy depending on size and configuration

• • 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

Surgery

Indications

• • Resectable lesion

  • Localized metatstatic disease to lungs if amenable to negative margins

Prognosis

• • 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

References

Practice Guidelines

• • The National Comprehensive Cancer Network

  • http://www.nccn.org/