PMC6327331_01
CT chest with contrast, pre-chemotherapy. (a) Superior aortic arch. (b) Carina.. CT chest with contrast at the level of the superior aortic arch (a) and carina (b) prior to treatment demonstrates a large soft tissue mass (asterisk) within the left anterior hemithorax. There is invasion of the mass into the left upper lobe and the superior chest wall (arrows).
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CT showed a large left upper lobe necrotic soft tissue mass protruding through the chest wall between the first and the second ribs with underlying expansion of the left first rib and extension into the pectoral space and neck (Figure 1).
Undifferentiated spindle cell sarcoma. HE stained section; 200x.. Pathology: on the pretreatment needle core biopsy the tumor was composed of spindle cells with a mitotic count of 3/10 HPF. No necrosis was seen on the limited core needle biopsy. IHC stains performed showed the tumor cells to be negative for AE1/AE3, S100, desmin, smooth muscle actin, and CAM 5.2. Given the appearance and the IHC profile, the tumor was best classified as an undifferentiated spindle cell sarcoma, at least intermediate grade based on the FNCLCC grading system.
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It was classified as undifferentiated spindle cell sarcoma of at least intermediate grade according to FNCLCC (Figure 2).
CT chest with contrast, post two cycles of AIM. (a) Superior aortic arch. (b) Carina.. CT chest with contrast at the level of the superior aortic arch (a) and carina (b) following two cycles of AIM again demonstrates a soft tissue mass (asterisk) within the left anterior hemithorax. The mass is not significantly changed in size, but there is relative decreased enhancement reflecting treatment-related necrosis, as well as decreased invasion into the superior chest wall. There has been interval development of a small posteriorly loculated pleural effusion (arrowhead).
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August showed minimal decrease in the size of the tumor (Figure 3). After recovery from his side effects, he was given one dose of liposomal doxorubicin 30 mg/m2 with plan for surgical resection.
Area of fibrosis with no viable sarcoma seen HE stained section; 100x.. Pathology: on the post treatment, resection specimen there was marked therapy effect with approximately 95% fibrosis and necrosis with very few areas of residual tumor cells.
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The completely resected specimen showed negative margins and 95% necrosis within the remaining tumor measuring 9 x 7 x 4 cm3 (Figure 4).