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Resection of Axillary Sarcoma

January 01, 2013

Contributors: Brendan J Comer, BA; Brett Hayden, MD; Camilo E Villalobos, MD; James C Wittig, MD

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80 Year old white male presented with a right axillary mass. A soft tissue lesion was identified in the right/lateral proximal chest wall. The mass abuts the anteromedial aspect of the right subscapularis, a portion of the serratus anterior, right lateral intercostals muscles as well as portion of the right second through fourth ribs. The lesion appears well encapsulated without evidence for invasion of surrounding structures by MRI. The tumor abuts and minimally anteriorly displaces the right axillary vessel without encasement. Patient complained of right axillary pain but no tingling or numbness of right upper extremity. Preliminary diagnosis was performed outside institution as a high grade soft tissue sarcoma. Patient received preoperatively radiation therapy. An extensile surgical approach was used to remove the tumor. In order to remove a tumor safely in this location the neurological and vascular structures must be meticulously separated from the tumor and protected. Intraoperatively the axillary, radial, ulnar and medial nerves were found to be encased in scar tissue and meticulously dissected each from the scar tissue. The tumor was found to be mobile and not stuck to any underlying rib. The biopsy site and tract was left in continuity with the removed neoplasm. The reflected muscles were reattached to their insertions using heavy non-absorbable sutures. A brachial plexus catheter for postoperative analgesia was placed. The operation was completed with out any complications. Final pathology revealed a high grade pleomorphic sarcoma grade 3/3.

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