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Giant thoracic liposarcoma treated with induction chemotherapy followed by surgical resection.

Clinical Summary A 38-year-old man with no medical or smoking history presented with cough, night sweats, and intermittent chest pain. Computed tomography (CT) demonstrated a heterogeneous mass involving most of the right and extending into the left hemithorax (Figure 1A). Thoracoscopic biopsy showed myxoid liposarcoma (Figure 2A). Positron emission tomography/CT scan after three courses of ifosfamide (2 g/m over 96 hours) and adriamycin (25 mg/m over 72 hours) administered every 3 weeks showed no change in mass size but decrease in fluorodeoxyglucose activity from maximal standardized-uptake-value of 4.8 midtherapy to 3.3 posttherapy. A 4258 g, 29.3 25.8 14.1 cm tumor (Figure 1B) that originated from middle mediastinal pleura without direct involvement of lung, pericardium, or esophagus was resected via right thoracotomy. The mass had vascular branches from the aorta and the azygos venous system and was removed with sparing of all other structures by circumferential dissection. Microscopic examination showed a thinly encapsulated high grade myxoid liposarcoma with approximately 10% residual viable tumor and no histologically viable sarcoma at the margins (Figure 2B). The patient underwent redo thoracotomy and thoracic duct ligation on postoperative day 2 to repair a chylothorax and was discharged 5 days later. Six weeks postsurgery, the patient received two additional cycles of