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General Thoracic Surgery Notecards > Chest Wall Tumors > Flashcards

Chest Wall Tumors Flashcards

1
Q

Primary malignant chest wall tumors

A
  • Chondrosarcomas (35%)
  • Plasmacytoma (25%)
  • Ewing’s sarcoma (15%)
  • Osteosarcoma (15%)
  • Lymphoma (10%)
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2
Q

Tumors that metastasize to chest wall

A
  • Melanoma
  • Breast carcinoma
  • Lung carcinoma
  • Mesothelioma
  • Renal cell carcinoma
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3
Q

Benign tumors of the chest wall

A
  • Fibrous dysplasia (40%)
  • Chondoroma (30%)
  • Osteochondroma
  • Desmoids
  • Lipoma
  • Neurofibroma
  • Giant cell tumor

*Characterized by slow growth

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4
Q

Most common presentation of chest wall tumors

A

Painful, enlarging lesions (80%)

20% assymptomatic

*May also present with dyspnea, night sweats, fevers, generalized malaise

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5
Q

Imaging modalities used for diagnosis (and staging)

A
  • Diagnosis: chest CT or MRI
  • Staging: PET/CT
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6
Q

Diagnostic algorithm for chest wall tumors

A
  • Imaging/Staging:
    • Chest CT or MRI
    • PET/CT
  • Tissue diagnosis:
    • determine histopathology
    • determine candidate for neoadjuvant therapy
    • Options:
      • core needle biopsy
      • incisional biopsy
      • excisional biopsy (< 5cm)
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7
Q

Most common primary malignant chest wall tumor

A

Chrondrosarcoma

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8
Q

Most common location of chrondrosarcoma

A

Costochondral arches (80%)

Costochondral junction (sternum 20%)

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9
Q

CXR appearance of chrondrosarcoma

A

lobulated mass (medullary portion of the rib or sternum)

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10
Q

Treatment for chondrosarcoma

A

Treatment therefore should be wide local excision with wide margins for malignant lesions. Adjuvant therapy is rarely indicated because these tumors are resistant to chemotherapy and RT.

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11
Q

Prevalence of plasmacytoma

A

(a.k.a solitary plasma cell tumor myeloma)

Accounts for 20-30% of primary malignant chest wall tumors

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12
Q

Most common location of plasmacytoma

A

Ribs and sternum

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13
Q

Primary malignant chest wall tumor associated with progression to multiple myeloma

A

Plasmacytoma

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14
Q

Presentation of plasmacytoma

A

Painful mass with osteolytic CXR appearance

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15
Q

TOC for plasmacytoma

A

Treatment id definitive XRT

  • Surgical resection (wide resection) for refractory cases
  • Chemotherapy used for disease progression
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16
Q

Most common chest wall malignancy in children

A

Ewing’s sarcoma

  • Aggressive, destructive tumors that invade and displace adjacent structures
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17
Q

Cell of origin of Ewing’s sarcoma

A

neural crest cells

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18
Q

Most common presentation of Ewing’s sarcoma

A

Painful mass with fever and malaise

  • May have elevated WBC and ESR
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19
Q

CXR appearance of Ewing’s sarcoma

A

Lytic lesion with surrounding destruction and onion peel appearance (new bone formation)

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20
Q

Treatment of choice for Ewing’s sarcoma?

A

Treatment is wide excision of the lesion. The entire rib is removed along with the adjacent rib above and below the tumor.

This is followed by adjuvant RT.

Chemotherapy is used for patients with systemic disease and has been shown to improve survival.

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21
Q

Most common location of osteosarcoma

A

Ribs, scapula, clavicle (young adults)

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22
Q

Unique featurs of osteosarcoma of the chest wall compared to osteosarcoma of the extremity

A

More prone to recurrence and metastasis

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23
Q

MC presentation of osteosarcoma

A

Painful mass with elevated ALP

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24
Q

CXR appearance of osteosarcoma

A

Sunburst pattern with elevation of periosteum (Codman’s triangle) due to new bone formation

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25
Prognosis for osteosarcoma determined by
response to chemotherapy
26
Role of XRT for osteosarcoma
None to minimal (usually ineffective)
27
Codman's triangle
Osteosarcoma Elevation of periosteum due to new bone formation
28
MC type of chest wall lymphoma
Extranodal diffuse large B-cell lymphoma
29
Demographics of chest wall lymphoma
Immunocompromised patients | (transplant, HIV)
30
TOC chest wall lymphoma
CRT and chemotherapy (CHOP)
31
MC chemotherapy for chest wall lymphoma
CHOP * Cytoxan (cycolphosphamide) * Adriamycin (doxarubicin) * Vincristine * Prednisone
32
Workup for soft tissue sarcoma of the chest wall
* CT: evalute for pulmonary mets * MRI: evaluate infiltration and relation to adjacent vital structures
33
TOC for soft tissue sarcoma of chest wall
WLE ( 1 cm margin) \*include biopsy site in WLE
34
Role of XRT for soft tissue sarcoma of the chest wall
* Residual disease * Inadequate margins * Tumors \> 5 cm * Highly invasive tumors (high-grade)
35
TOC for local recurrence of soft tissue sarcoma of chest wall
Resection (WLE) Solitary pulmonary lesions = resection
36
TOC for XRT-induced sarcomas
WLE | (very aggressive tumors)
37
Painless, slowly enlarging, violaceous chest wall mass that is associated with a _history of XRT_
Angiosarcoma TOC = WLE
38
TOC for _solitary_ metastatic tumors to chest wall
Resection +/- XRT * Melanoma * Breast carcinoma * Lung carcinoma * Mesothelioma * Renal cell carcinoma
39
MC benign rib lesion in children
Fibrous dysplasia of the bone * Maturation defect * May be associated with trauma * Painless mass
40
CXR appearance of fibrous dysplasia of the bone
Fusiform mass with thinning of the cortex an no calcifications
41
TOC for fibrous dysplasia of the bone
Resection whtere the deformity has occurred
42
MC benign tumor of chest wall cartilage
Chondroma * Appear similar to chondrosarcoma (requires biopsy or resection to r/o malignancy)
43
Benign chest wall tumor that typically presents as mass associated wtih rib fractures
Osteochondroma * Resection is performed to prevent further tissue displacement
44
Benign tumor develooping from muscula aponeurosis
Desmoid tumor
45
Demographics of desmoid tumors
* Most common in females (2:1) * Familial adenomatous polyposis association * Sites of prior trauma or scarring Gardner’s syndrome is a genetic disorder characterized by multiple colonic polyps and tumors outside the colon. The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts. The multiple colon polyps predispose to development of colon cancer. Gardner’s syndrome is caused by mutation in the APC gene located in chromosome 5q21 and is recognized as a phenotypic variant of FAP.
46
Histologic appearance of Desmoid tumors
Sheets of fibroblasts with abundant collagen
47
MC presentation of Desmoid tumors
Painful mass fixed to deep tissues (but not skin)
48
TOC Desmoid tumors
WLE with 2-4 cm margin
49
Incidence of recurrence of Desmoid tumors following resection
25-50%
50
Role of XRT and/or chemotherapy for Desmoid tumors of the chest wall
* XRT: margin-positive resections * Chemotherapy: none to minimal (not supported by trials)
51
Other less common benign chest wall tumors
* Lipoma * Fibroma * Neurofibroma * Gangioneuroma * Schwannoma * Giant cell tumor
52
Oveall treatment strategy for chest wall tumors
Multidisciplinary, multimodality approach (primarily due to the infrequency with with most practitioners encounter them) * Most chest wall lesions are resected (including benign lesions)
53
Chest wall reconstruction technique used for resection defects \< 5 cm or posterior resections covered by scapula
None required
54
Indications for chest wall reconstruction
* Defects \> 5 cm * Defects involving 2 or more adjacent ribs
55
Surgical options for chest wall reconstruction
* Methyl methacrylate/non-absorbable mesh "sandwich" * Tissue flaps (latissimus, rectus, pectoralis, myocutaneous) * Particularly useful in irradiated tissue beds * Plastic surgery consultation
56
Sites of metastasis for primary malignant chest wall tumors
Lungs Liver * Long-term surveillance warranted (serial chest CT)
57
Aneurysmal Bone Cyst
58
Cavernous Hemangioma
59
60
Chondromyxoid fibroma
61
Chondrosarcoma
62
Ewing Sarcoma
63
fibrous dysplasia
64
Ganglioneuroma
65
Giant cell tumor
66
Lipoma
67
Osteochondroma
68
Osteosarcoma
69
Paraganglioma
70
plasmacytoma
71
Spindle cell lipoma
72
The most common presentation is that of a slow-growing painful mass. Imaging demonstrates a lobulated mass arising in the medullary portion of the rib or sternum often with cortical bone destruction. These are often missed on standard chest radiography but CT scan of the chest will easily identify a lesion and help characterize both local and metastatic extent of disease.
Chondrosarcoma

General Thoracic Surgery Notecards (38 decks)

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