Breath Restored: A Young Woman’s Courageous Battle with Chest Wall Leiomyosarcoma
Mrs M Vasava a 28-year-old female, presented with dyspnea on exertion and persistent pain over the left side of her chest. She was found to have low oxygen levels on evaluation. HRCT thorax revealed a large mass involving the left chest wall with moderate pleural effusion. Pleural tapping and USG-guided biopsy with IHC confirmed Leiomyosarcoma of the left chest wall. PET-CT for staging showed a heterogeneously enhancing mixed-density mass in the left pleural space of the lower lung zone, measuring approximately 10.6 x 8.0 x 11.3 cm (SUVmax 5.36), with moderate-to-severe pleural effusion and collapse of the left lung.
The lesion was eroding the left anterior 6th rib and infiltrating the 5th–6th intercostal muscles, bulging into the lower anterior chest wall without extension into the breast parenchyma. No abnormal FDG-avid lesions were seen in the bilateral lung parenchyma. Considering the extent of disease, a VATS-guided enbloc chest wall mass excision was planned.
She underwent excision of the mass with removal of three ribs, decortication of the left lower lobe, and defect reconstruction using Parietex mesh (allograft) along with a Latissimus dorsi flap (autograft). An ICD was inserted, and a Sinapi drain was used in the initial postoperative period to aid expansion of the collapsed lung. She recovered well and was discharged in stable condition on day five. The ICD was removed on day eight.
Final histopathology confirmed High-Grade Leiomyosarcoma, tumor size 14 cm (pT3), FNCLCC Grade 3 (score 7). Necrosis was 20–25%, mitosis >20/10 HPF, with no lymphovascular or perineural invasion. Rib margins were free of tumor and lymph nodes were reactive (pN0). This case emphasizes that breathing difficulty at any age should be thoroughly evaluated, as early expert oncological management ensures curative treatment and effective reconstruction for smooth recovery.
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