Surgery>>>>>Chest Wall, Pleura, and Mediastinum
Question 8#

Desmoid tumors:

a. Arise from the periosteum of the rib
b. Are treated with wide local excision with a 2- to 4-cm margin
c. Require radical excision (sacrificing neurovascular structures) to obtain 4-cm margins
d. Require chemotherapy to treat or prevent metastatic disease

Correct Answer is B


Because the lesions have low cellularity and poor yield with fine needle aspiration (FNA), an open incisional biopsy for lesions over 3 to 4 em is often necessary. Surgery consists of wide local excision with a 2- to 4-cm margin and intraoperative frozen section assessment of resection margins. Typically, chest wall resection, including the involved rib(s) and one rib above and below the tumor with a 4- to S-cm margin of rib, is required. A margin of less than 1 em results in much higher local recurrence rates. If a major neurovascular structure would have to be sacrificed, leading to high morbidity, then a margin of less than 1 em would have to suffice. Survival after wide local excision with negative margins is 90% at 10 years.