Chest Wall Tumors Flashcards
Most common primary malignancy of chest wall
Chondrosarcoma- surgery, adjuvant chemo for HG
Lobulated tumor from medullary portion of rib with cortical bone destruction
Chondrosarcoma - tx: - HG 4cm margin + adjuvant chemo, LG 2cm margin
Elevated alk phos
Osteosarcoma - neoadjuvant chemo then resection
Sunburst on CXR
Osteosarcoma - neoadjuvant chemo then resection
Elevation of periosteum
Codman’s triangle sign - Osteosarcoma - neoadjuvant then resection
Peds or young (5-30y)
Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision
“Onion peel”
Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision
Small blue round cell, elevated ESR/WBC
Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision
Elderly males, multiple myeloma
Plasmacytoma
Look for extrathoracic lesions
bone marrow biopsy
UA for Bence-Jones. T
Tx RT (surgery for refractory), chemo only if disease progression
Osteolytic process with paracostal opacities
Plasmacytoma
Look for extrathoracic lesions
bone marrow biopsy
UA for Bence-Jones. T
Tx RT (surgery for refractory), chemo only if disease progression
Chest wall tumor in immunocompromised
Lymphoma, most common is DLBC. Tx: RT + CHOP, not surgery
Chest wall tumor in von-Recklinghausen / Gardner’s / Werner
Soft tissue sarcoma - wide excision with 1cm margin and always include biopsy site. RT for + margins / >5cm / highly invasive components
Most common tumor of the chest wall
Chondroma (benign) - resect
Painful lobulated radiodense mass that DISPLACES bone without penetrating it
Chondroma (benign) - resect
Chest wall mass with mature hyaline cartilage with myxoid degeneration and calcification
Chondroma (benign) - resect
Chest wall tumor a/w trauma
Fibrous dysplasia (benign). resect
Posterior chest wall rib mass with “fish hook” on histology
Fibrous dysplasia (benign). resect
Chest wall tumor in women 40-50s at muscular aponeuroses
Desmoid (benign) - locally aggressive
biopsy first
Wide excision, RT to positive margins
Chest wall tumor dull aching pain, mass fixed to underlying tissue but not skin, women in 40s
Desmoid (benign) - locally aggressive
biopsy first
Wide excision, RT to positive margins
Rare, very young adults w/ chest wall tumor a/w previous fracture
Osteochondroma (benign). Resect
Benign chest wall tumor in young adult that grow in direct opposite to adjacent joint
Osteochondroma (benign). Resect
anterior costochondral angle
chondroma
medulla of mid rib or sternum
chondrosarcoma
