Chest wall Desmoid tumor…A multidisciplinary care

Abstract

Desmoid tumors, though rare, can present challenges, especially when occurring in the chest. This case involves a 44-year-old woman with a parietal swelling, initially painless but progressively growing. “Café au lait” spots were noted, along with a left paraspinal mass. Imaging revealed an infiltrating parasternal mass extending to adjacent structures. An ultrasound-guided biopsy confirmed the diagnosis of desmoid type fibromatosis. After initial monitoring, surgery became indicated due to tumor growth. The patient had a total en bloc resection of the tumor process taking out the anterior arches of the 3^rd to the 5^th left rib with their intercostal spaces, the lower and left part of the sternal body as well as the xiphoid appendage. A polypropylene plate was used to construct the parietal defect. In order to cover the loss of soft tissue, a myoplasty with a pure and pedicle left pectoralis major muscle flap was performed. The final anatomo-pathological examination of the specimen concluded to a complete resection of the tumor with healthy margins. The patient’s postoperative course was uncomplicated with no local recurrence after 12 months. Despite the benignity of desmoid tumors, they do represent a real local danger considering their aggressiveness. The tumor resection must be complete with adequate margins in order to decrease the risk of local recurrence.