En-bloc Chest-Wall Resection and Ipsilateral Latissimus Dorsi Flap for Well-Differentiated Leiomyosarcoma with Pleural Extension: A Case Report and Literature Review

Luis A. Lozano-Rodriguez, Reyes Tecuatzin-Munoz, Vanessa G. Galvan-Ruiz, Armando Ibarra-Fierro, Emmanuel Hernandez-Meza

Abstract: Introduction: Leiomyosarcoma (LMS) is an uncommon subtype of soft tissue sarcoma (STS) that originates in smooth muscle. Its management is complex and requires a multidisciplinary approach, with complete surgical resection as the mainstay of treatment. Case presentation: We present the case of a 23-year-old man with a well-differentiated leiomyosarcoma of the left chest wall with pleural invasion. The patient reported a 6-month history of progressive pain and a palpable mass. Imaging studies revealed a 9.2 x 13.1 cm mass with pectoralis muscle invasion and intrathoracic extension. En-bloc thoracic resection followed by polypropylene mesh reconstruction and ipsilateral latissimus dorsi pedicle flap was performed. Discussion: treatment of choice for localized LMS is en-bloc surgical resection with negative margins. Reconstruction of large chest wall defects is challenging. The latissimus dorsi flap is a versatile option for covering such defects. Conclusions: En-bloc resection with wide margins followed by adequate reconstruction is an effective treatment for extensive chest wall leiomyosarcomas, offering good local control and functional outcome. Management in specialized centers is essential.

Keywords: leiomyosarcoma, thoracic resection, latissimus dorsi flap, sarcoma, flap