J Thorac Cardiovasc Surg 2005;129:1189-1190
© 2005 The American Association for Thoracic Surgery
Giant soft tissue liposarcoma of chest wall
Y. Altemur Karamustafao
lu, MD*,
Ahmet Güngör, MD
Department of Thoracic Surgery, Kirikkale State Hospital, Kirikkale, Turkey.
Received for publication June 28, 2004; revisions received August 14, 2004; accepted for publication August 20, 2004.
* Address for reprints: Y. Altemur Karamustafaolu, MD, Yaylacik mah. 61. sok No:1 Daire:11 Halil Çetin apartmani, 71100 Kirikkale, Turkey (E-mail: altemurk{at}hotmail.com).
Primary soft tissue sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. Two thirds of the patients are older than 40 years. Complete surgical excision is the preferred treatment when possible. Subtotal resection is of short-term, palliative benefit only. Radiation therapy can be used palliatively for early recurrence. Survival of patients with primary soft tissue sarcomas of the chest wall after resection is similar to that of patients with sarcomas of the extremities.1
Clinical summary
A 73-year-old woman presented with a 25-year history of an enlarging, painless, huge mass in the back (Figure 1, A). She visited our hospital on December 8, 2003. A well-defined abnormal shadow was seen in the middle and lower fields of the left hemithorax on the chest x-ray film. Computed tomography showed a large fatty mass having a solid density and including calcifications in the posterior left hemithorax (Figure 1, B). She was treated by a wide, local, complete excision that excluded the ribs and was covered with a partially prolonged latissimus dorsi flap. Histologic diagnosis was reported as a well-differentiated liposarcoma 33 x 30 x 17 cm in size. She was referred for radiotheraphy after the resection for prevention of early recurrence (Figure 2).
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Figure 1. A, Photograph showing a huge mass in the patient’s back. B, Computed tomographic scan showing a large fatty mass having a solid density and including calcifications in the posterior left hemithorax.
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Discussion
Liposarcomas most often originate in the extremities and on the retroperitoneum, less frequently in the head and neck, and rarely in the thorax. Liposarcoma accounts for 15% of primary chest wall soft tissue sarcomas.1 There is an equal incidence in men and women. Schweitzer and Aguam2 reported that 85% of patients with a liposarcoma are symptomatic and that 15% have an asymptomatic liposarcoma discovered on a routine chest radiograph. Liposarcomas are usually large. The cases reported by Klimstra and associates3 ranged from 6 to 40 cm, with a mean weight of 1500 g. Enzinger and Weiss4 divided liposarcomas into the following 5 major morphologic subtypes: well differentiated, myxoid, round cell, dedifferentiated, and pleomorphic. Myxoid liposarcomas account for 40% to 50% of these tumors. Well-differentiated liposarcomas are a less-aggressive neoplasm and can produce metastases. Complete surgical excision is the preferred therapeutic choice. Recurrence can occur in a subtotal resection despite adjuvant therapy. The pseudoencapsulated lesions that can be completely removed have a better prognosis than the noncapsulated and less well-differentiated tumors; however, most primary chest wall soft tissue sarcomas (70%) are low grade. Local recurrence was reported in 33% of patients in the study by Greager and colleagues.5 The presence of local recurrence has no significant effect on the overall survival.1 Radiotherapy may be effective in the control of local recurrence, but its role is unclear.
References
- Gordon MS, Hajdu SE, Bains MS, Burt ME. Soft tissue sarcomas of the chest wall. J Thorac Cardiovasc Surg 1991;101:843-854.[Abstract]
- Schweitzer DL, Aguam AS. Primary liposarcoma of the mediastinum. Report of a case and review of the literature. J Thorac Cardiovasc Surg 1977;74:83-97.[Abstract]
- Klimstra DS, Moran CA, Perino G, Koss MN, Rosai J. Liposarcoma of the anterior mediastinum and thymus. a clinicopathologic study of 28 cases. Am J Surg Pathol 1995;19:782-791.[Medline]
- Enzinger FM, Weiss SW. Soft tissue tumors. 3rd ed. St Louis: CV Mosby; 1995. pp. 431.
- Greager JA, Patel MK, Briele HA, Walker MJ, Wood DK, Gupta TK. Soft tisue sarcomas of the adult thoracic wall. Cancer 1987;59:370-373.[Medline]
