Sakurai Teiko, Kusumoto Hidenori, Wakasa Tomoko, Ohta Yoshio, Konishi Eiichi, Shiono Hiroyuki
Department of General Thoracic Surgery, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan.
Diagnostic Pathology and Laboratory Medicine, Kindai University Nara Hospital, Otoda-cho 1248-1, Ikoma, Nara, 630-0293, Japan.
Surg Case Rep. 2018 Jul 13;4(1):77. doi: 10.1186/s40792-018-0483-7.
Epithelioid sarcoma (ES) is a rare variant of soft tissue sarcoma. The proximal type of ES occurs in various locations. We present a resected case with proximal-type ES that occurred in the chest wall and discuss the relevant literature.
A 47-year-old woman was referred for a 6-month history of a right anterior chest mass with tenderness. Chest computed tomography showed an invasive chest wall mass with calcification surrounding the third rib. Aspiration biopsy cytology suggested malignancy. We performed wide resection, including the middle part of the pectoralis major muscle, the pectoralis minor muscle, the third and fourth ribs, and reconstruction of the chest wall, using a 2-mm polytetrafluoroethylene patch. Severe deformation of the chest wall was avoided. Postoperative physical therapy of the shoulder was effective for the continuous pain and weakness of the arm. She has remained alive for 1 year and 10 months without recurrence. Our literature review showed five previously reported cases of ES in the chest wall, and all of these were surgically resected. Two of these patients suffered from frequent local recurrence and died of disease.
ES in the chest wall is rare. Previous reports have indicated that surgical resection with tumor-free margins is essential for treatment. We performed complete resection of the tumor in our case, and a polytetrafluoroethylene patch was effective for reconstructing the deficit in the chest wall.
上皮样肉瘤（ES）是软组织肉瘤的一种罕见变体。近端型ES可发生于多个部位。我们报告一例发生于胸壁的近端型ES切除病例并讨论相关文献。
一名47岁女性因右前胸肿物伴压痛6个月前来就诊。胸部计算机断层扫描显示一个侵袭性胸壁肿物，第三肋骨周围有钙化。穿刺活检细胞学检查提示为恶性。我们进行了广泛切除，包括胸大肌中部、胸小肌、第三和第四肋骨，并使用2毫米聚四氟乙烯补片进行胸壁重建，避免了胸壁严重变形。术后肩部物理治疗对缓解手臂持续疼痛和无力有效。她已存活1年10个月，无复发。我们的文献回顾显示，此前有5例胸壁ES报道，均接受了手术切除。其中2例患者局部复发频繁，死于该病。
胸壁ES罕见。既往报道表明，切缘无肿瘤的手术切除对治疗至关重要。我们的病例中进行了肿瘤的完整切除，聚四氟乙烯补片对修复胸壁缺损有效。
