The surgery of a giant chest wall tumor with intrathoracic extension

The chest or thoracic cavity is a space that is enclosed by the spine, ribs and sternum and is separated from the abdomen below by the diaphragm. The chest cavity contains the heart, the thoracic aorta, lungs, and esophagus. Like any other structure, the chest wall can develop tumors. Desmoid tumors of the chest wall are uncommon fibromatosis tumors characterized by local invasion and frequent recurrence. They are considered low-grade malignant sarcomas. We share our experience with the successful management of a young man who presented with a giant chest wall tumor with extensive intrathoracic extension involving the esophagus, the trachea, the right bronchus, the heart and the great vessels. He underwent successful complete excision with the histopathological examination reporting of aggressive fibromatosis.
A 35-year-old man was referred from a peripheral hospital to our facility on account of a year’s history of a progressively increasing right anterior chest wall swelling which initially began in the right axilla and subsequently grew to involve the upper half of the right anterior chest. It was associated with progressive exertional dyspnoea, cough, chest pain, dysphagia to solids and weight loss. There was no prior history of trauma or surgery at the affected site. He resorted to herbal medications for the management of the condition but symptoms did not improve and so subsequently reported for further management especially when he started developing exertional dyspnea. On review by the cardiothoracic surgery team, he looked hemodynamically stable but was dyspneic and orthopneic on room air with a respiratory rate of 24 cycles per minute and saturating at 95% on room air. There was a hard, lobulated and well-defined mass on the right anterior chest wall measuring 20 cm × 15 cm in the greatest diameter. It was fixed to the underlying chest wall but not the overlying skin. There were palpable ipsilateral axillary lymph nodes with the largest measuring 1 cm × 1 cm. Air entry was absent on the right hemithorax.
Chest X-ray showed homogeneous opacification of the right hemithorax in the typical white-out syndrome phenomenon with contralateral mediastinal shift. A computed tomography chest scan revealed a large heterogeneously enhancing mass filling the right hemithorax measuring 20.5 cm × 13.3 cm and extending to the right anterior chest wall with chest wall extension measuring 12.7 cm × 10.9 cm. The mass was compressing and displacing the...


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