A 61-year-old woman presented with a large central anterior chest wall mass that had first appeared 14 months previously. Initial growth was slow, followed by rapid enlargement in the two months prior to her referral to surgery. Core needle biopsy showed a poorly differentiated adenocarcinoma. The patient had a history of COPD, alcohol abuse and hepatitis C. Liver enzymes and alpha-fetoprotein were elevated. Tumor markers for colon (CEA), pancreas (CA1909), ovarian (CA125), mesenchymal (HMB45), neuroectodermal (S100), and breast (ER/PR, Her2-neu) were negative. Mammogram showed no lesions in the breast tissue that could be visualized around the tumor.
CT scan of the chest, abdomen and pelvis showed no pathology besides the chest wall mass. The tumor encompassed the body of the sternum from the lower manubrium to just above the xiphoid. Its deep extent impinged on the anterior mediastinum and there were multiple enlarged internal mammary nodes. The patient was treated with two cycles of neoadjuvant adriamycin and cytoxan during which time the tumor continued to grow. The origin of the tumor was assumed to be breast, and chest wall resection was proposed for local control. (Head is down.)
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