Multidisciplinary surgical intensive treatment of an extended thoracic wall infiltration by a giant breast sarcoma: a case report

Gian Maria Ferretti, Elisa Meacci, Dania Nachira, Maria Teresa Congedo, Elizabeth Katherine Anna Triumbari, Luca Pogliani, Edoardo Zanfrini, Amedeo Giuseppe Iaffaldano, Giuseppe Visconti, Alessandro Bianchi, Stefano Margaritora

Abstract

Primary breast sarcoma represents less than 0.1% of breast cancers and less than 5% of all sarcomas. It derives from the mesenchymal tissues of the breast and can originate a histologically heterogeneous group of neoplasms. It has a poor prognosis and the median 5-year overall survival is 63.5% (range, 55–73%). Currently, diagnosis and treatment of this neoplasm are a challenge for pathologists, surgeons and oncologists. We describe the case of a 56-year-old Macedonian woman, who presented with local recurrence of a high-grade chondrosarcoma of the right breast. She had been treated elsewhere six months earlier with radical mastectomy and ipsilateral axillary dissection. The actual heteroplasia was 29 centimeters wide, ulcerated and infected. The computed tomography (CT) scan documented infiltration of pectoralis muscles, of III and IV right ribs and sternal body, but no distant metastases. Considering the patient’s clinical conditions and stage of the disease, a multidisciplinary discussion lead to the decision to attempt surgery. A multidisciplinary surgical teamwork was indispensable for attempting such a highly complex and demolitive surgery and a challenging reconstruction of the thoracic wall and an intensive post- operative monitoring of the patient was needed to manage complications related to tissue loss. Nowadays it is difficult to find patients suffering from tumors of this size and consequently the treatment is made more complicated by the lack of experience. With this case report we share our experience in the treatment of an infrequent pathology that has presented itself to us with dimensions rarely reported in the literature.