Malignant soft tissue tumors of chest wall

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Malignant soft tissue tumors of chest wall

• CS morning meeting

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• Fibrous Desmoid, fibrosarcoma
• Fibrohistiocyte Malignant fibrous
  histiocytomaAdipose LiposarcomaNerve
  Neurofibrosarcoma , Schwann cell sarcoma
• Muscle Rhadomyosarcoma

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• Malegt Female 21
• Rhadomyosarcoma most prevalent in children and
  young adult
• Liposarcoma 50-60y/o female

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s/s

• Usually non_painful mass
• Pain 10 High dose R/T can induce soft tissue
  sarcoma after 5-10 years
• Finding on CXr bone invasion, metastasis to lung
  and intrthoracic involved

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Prognostic indicators

• Tumor grade
• distal metastasis and
• margin

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• Low grade 5 years survival 80-90
• High grade 40-50 after complete resection
• Histopathology did not influence survival (NCI)
• Some report muscle type worse than fibrous type
• Tumor size and age not had been found to
  influence survival

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Pseudocapsule

• OFTEN CONTAIN MICROSCOPIC DISEASE CONTACT THIS
  PSEUDOCAPSULE MUST BE AVOID DURING RESECTION
• CAN SPREADE ALONG BLOOD VESSELS NERVE SHEAT AND
  FASCIAL PLANE

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• MFH can spreade into the marrow so the affected
  rib or portion of the rib above and below need to
  be resectd

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• MFH spindle cell with round pleomorphic nucleoli
  arrange in a cartwheel pattern
• Can be radiation induce
• Wide excision
• Positive margin R/T
• C/T is usually ineffective
• 5 years survival 35

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Rhadomyosarcoma

• Wide excision
• R/T C/T
• 5 years survival 70

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Liposarcoma

• Low grade
• Wide excision
• Local recurrence repeat resection
• R/T is not particularly effective
• 5 years survival 80

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• Hight grade more easy metastaiss than lower grade
  51 10
• R/T may decrease the necessity for radical
  surgical procedure
• Adj C/T for high grade tumor is controversial

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• Long term f/u is required to detect local
  recurrence and possible metastatic disease to
  lungs

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Margin of soft tissue sarcoma

• Cs morning meeting 2007 Dec

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• New method of evaluating the surgical margin and
  safety margin for musculoskeletal sarcoma,
  analysed on the basis of 457 surgical cases
• ??Journal of Cancer Research and Clinical
  Oncology
• Cancer Institute Hospital, Kamiikebukuro 1-37-1,
  Toshima-ku, 170 Tokyo, Japan

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• The evaluation of surgical margin is useful in
  determining the curative success of surgical
  treatment of musculoskeletal sarcoma.

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• However, until recently no reliable evaluation
  method has been developed for these purposes.

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• Soft Tissue Tumour Committee of the Japanese
  Orthopaedic Association (JOA). in this method,
  surgical margin was classified into four types
  based on the distance between the surgical margin
  and the reactive zone of the tumour.

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• surgical margin was classified into four types
  based on the distance between the surgical margin
  and the reactive zone of the tumour.

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• These classifications of surgical margin (in
  order of surgical extent) are
• curative wide margin (curative margin),
• wide margin,
• marginal margin, and
• intralesional margin..

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• The surgical margin is said to be curative if the
  margin is more than 5 cm outside the reactive
  zone. It is referred to as wide if the margin is
  less than 5 cm

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• Similarly, a margin that is in the reactive zone
  is considered as marginal, and a margin passing
  through a tumour as intralesional.

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• Moreover, wide margin is classified as adequate
  (at least 2 cm outside the reactive zone) or
  inadequate (1 cm)

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• In our evaluation, a thin barrier is considered
  to be a 2-cm thickness of normal tissue, a thick
  barrier as a 3-cm thickness, and joint cartilage
  is said to be equivalent to a 5-cm thickness

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• a surgical margin that is outside a barrier, with
  normal tissue between the barrier and the
  reactive zone of the tumour, is considered to be
  curative.

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• This method was applied in 457 cases (involving
  499 surgeries) at the Cancer Institute Hospital
  to determine clinical significance in the
  treatment of musculoskeletal sarcoma

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• From the results of this study we were able to
  conclude that this evaluation method can be
  highly useful in clinical practice for
  establishing optimum surgery.

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• Moreover, we found that the safety margin for
  high-grade musculoskeletal sarcoma is a curative
  margin providing an adequate wide margin of 3 cm
  or more when preoperative therapy is not
  performed or is not effective

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• while the safety margin for high-grade sarcoma
  that responds to preoperative chemo- or
  radiotherapy seems to be an adequate wise margin
  of 2 cm

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• Here, radiotherapy is more effective compared to
  chemotherapy for reducing surgical margin. An
  inadequate wide margin, however, combined with
  radiotherapy, is not enough to ensure local
  curative success following surgery for
  musculoskeletal sarcoma.

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• Therefore, we have determined that these
  procedures should be used only when establishing
  a safety margin is difficult, even if ablasion or
  various reconstructive modalities are applied.
• On the other hand, for low grade sarcoma, an
  inadequate wide margin can be considered as safe.

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Completely wide resection of malignant fibrous
histiocytoma of the chest wall expect for long
survival.

• Ann Thorac Cardiovasc Surg. 2006 Apr12(2)141-4.
  Links
• Department of Surgery and Science, Graduate
  School of Medical Sciences, Kyushu University,
  Fukuoka, Japan.

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• Malignant fibrous histiocytoma (MFH) rarely
  occurs in the chest wall. A case of MFH
  originating from the chest wall is herein
  reported.
• We performed radical en-block resection of the
  whole chest wall together with the tumor and
  reconstructed it with Marlex mesh.
• There was no recurrence 4 years after operation.
  We consider radical en-block resection for MFH
  and reconstruction with Marlex mesh a safe
  operation and may provide a long-term survival.

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Successful treatment of malignant fibrous
histiocytoma originating in the chest wall
report of a case.

• Surg Today. 200636(8)714-21

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• Malignant fibrous histiocytoma (MFH) rarely
  originates in the chest wall, so its clinical
  features are not well defined.
• We report a case of MFH that recurred locally 3
  years after primary resection.
• The patient, a 59-year-old woman, underwent wide
  excision, and is alive without recurrence 7
  months after the operation.

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• We reviewed the clinical features and treatment
  strategies of the total 39 cases of MFH
  originating in the chest wall reported from
  Japan.
• The fact that all patients who underwent wide
  excision with negative margins at the primary
  operation were alive without recurrence at the
  time of each report,

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• despite a local recurrence rate as high as 40,
  shows the importance of this operative strategy.
• Thus, early diagnosis of MFH of the chest wall is
  essential for improving the outcome of these
  patients.
• Neoadjuvant chemotherapy plus radiation therapy
  may be worthwhile for patients with advanced
  disease.

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Kyobu Geka. 2007 Mar60(3)221-4

• Long-term survival of malignant fibrous
  histiocytoma of the chest wall by
  multidisciplinary treatment

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• A 70-year-old man admitted for recurrent chest
  wall tumor diagnosed for MFH histologically and
  resected 7 months and 13 months before admission.
  Chest computed tomography (CT) revealed a tumor
  located at right posterior chest wall. In May
  1997

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• resection of the tumor was done (the 3rd
  operation), but metastasis to the ribs (the 4th
  operation), subcutaneous tissue (the 5th
  operation), and local recurrence (the 6th
  operation) was found within 4 years
  postoperatively

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• Resection was done for each metastasis, and
  postoperative radiotherapy (66 Gy) and
  chemotherapy (CYVADIC) were done

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• The patient is doing well without apparent
  recurrence 57 months after last surgery, and
  survives 113 months after initial surgery.
  Multidisciplinary treatment may provide longer
  survival for patients with MFH of the chest wall.