Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7117-7122
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7117
Reconstruction of the chest wall after resection of malignant peripheral nerve sheath tumor: A case report
Xiang Guo, Wei-Ming Wu, Lei Wang, Yi Yang
Xiang Guo, Wei-Ming Wu, Lei Wang, Yi Yang, Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
Author contributions: All authors substantially contributed to the manuscript; Guo X, Wu WM, Wang L, and Yang Y performed the surgery; Guo X and Yang Y took part in the diagnosis, treatment decision, and manuscript writing; Guo X and Yang Y were the major contributors in writing the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang Guo, MD, Surgeon, Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, China. guoxiangsjtu@163.com
Received: January 1, 2021
Peer-review started: January 1, 2021
First decision: May 24, 2021
Revised: May 27, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 26, 2021
Processing time: 234 Days and 14.9 Hours
Abstract
BACKGROUND

Malignant peripheral nerve sheath tumors (MPNSTs) are a group of rare and aggressive sarcomas that often arise from major peripheral nerves and represent a notable challenge to efficacious treatment. MPNSTs can occur in any body surface and visceral organs with nerve fiber distribution. The treatment options for MPNSTs include surgery, chemotherapy, and adjuvant radiotherapy.

CASE SUMMARY

A 26-year-old female cellist presented with chest pain on her left side when she squatted to lift the cello. One week later, a chest X-ray was performed and revealed fracture of the fourth rib on the left side. Three months later, the patient inadvertently touched a mass on the left side of the chest wall. Chest computed tomography (CT) three-dimensional reconstruction of the ribs revealed bone destruction of the fourth rib on the left side with a soft tissue mass shadow measuring 5.7 cm × 3.7 cm. CT-guided puncture biopsy of the tumor showed that heterotypic cells (spindle cells) tended to be nonepithelial tumor lesions. PET-CT demonstrated bone destruction and a soft tissue mass with avid 18F-fluorodeoxyglucose activity (SUVmax7.5) in the left fourth rib. The tumor of the left chest wall was resected under general anesthesia, and reconstruction of the chest wall was performed. The postoperative pathological report exhibited an MPNST.

CONCLUSION

MPNSTs are relatively chemo-insensitive tumors. The mainstay of treatment for MPNSTs remains resection with tumor-free margins.

Keywords: Malignant peripheral nerve sheath tumor; Chest wall; Reconstruction; Case report

Core Tip: Malignant peripheral nerve sheath tumors (MPNSTs) are a group of rare and aggressive sarcomas that often arise from major peripheral nerves and represent a notable challenge to efficacious treatment. We present a rare case of MPNST of the chest wall in a female cellist who initially presented with a pathological rib fracture. We used the Synthes MatrixRib Precontoured Plate system to reconstruct her chest wall and restore its appearance. The mainstay of treatment for MPNST remains resection with tumor-free margins. Furthermore, functional reconstructions can play an important role in improving functional status.