Chest Wall Tumors

Question 1

Most common primary malignancy of chest wall

Answer 1

Chondrosarcoma- surgery, adjuvant chemo for HG

Question 2

Lobulated tumor from medullary portion of rib with cortical bone destruction

Answer 2

Chondrosarcoma - tx: - HG 4cm margin + adjuvant chemo, LG 2cm margin

Question 3

Elevated alk phos

Answer 3

Osteosarcoma - neoadjuvant chemo then resection

Question 4

Sunburst on CXR

Answer 4

Osteosarcoma - neoadjuvant chemo then resection

Question 5

Elevation of periosteum

Answer 5

Codman’s triangle sign - Osteosarcoma - neoadjuvant then resection

Question 6

Peds or young (5-30y)

Answer 6

Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision

Question 7

“Onion peel”

Answer 7

Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision

Question 8

Small blue round cell, elevated ESR/WBC

Answer 8

Ewing sarcoma
bone marrow aspiration
NEOadjuvant chemo + resection +/-RT
Whole rib + 1 above + 1 below whole excision

Question 9

Elderly males, multiple myeloma

Answer 9

Plasmacytoma
Look for extrathoracic lesions
bone marrow biopsy
UA for Bence-Jones. T
Tx RT (surgery for refractory), chemo only if disease progression

Question 10

Osteolytic process with paracostal opacities

Answer 10

Plasmacytoma
Look for extrathoracic lesions
bone marrow biopsy
UA for Bence-Jones. T
Tx RT (surgery for refractory), chemo only if disease progression

Question 11

Chest wall tumor in immunocompromised

Answer 11

Lymphoma, most common is DLBC. Tx: RT + CHOP, not surgery

Question 12

Chest wall tumor in von-Recklinghausen / Gardner’s / Werner

Answer 12

Soft tissue sarcoma - wide excision with 1cm margin and always include biopsy site. RT for + margins / >5cm / highly invasive components

Question 13

Most common tumor of the chest wall

Answer 13

Chondroma (benign) - resect

Question 14

Painful lobulated radiodense mass that DISPLACES bone without penetrating it

Answer 14

Chondroma (benign) - resect

Question 15

Chest wall mass with mature hyaline cartilage with myxoid degeneration and calcification

Answer 15

Chondroma (benign) - resect

Question 16

Chest wall tumor a/w trauma

Answer 16

Fibrous dysplasia (benign). resect

Question 17

Posterior chest wall rib mass with “fish hook” on histology

Answer 17

Fibrous dysplasia (benign). resect

Question 18

Chest wall tumor in women 40-50s at muscular aponeuroses

Answer 18

Desmoid (benign) - locally aggressive
biopsy first
Wide excision, RT to positive margins

Question 19

Chest wall tumor dull aching pain, mass fixed to underlying tissue but not skin, women in 40s

Answer 19

Desmoid (benign) - locally aggressive
biopsy first
Wide excision, RT to positive margins

Question 20

Rare, very young adults w/ chest wall tumor a/w previous fracture

Answer 20

Osteochondroma (benign). Resect

Question 21

Benign chest wall tumor in young adult that grow in direct opposite to adjacent joint

Answer 21

Osteochondroma (benign). Resect

Question 22

anterior costochondral angle

Answer 22

chondroma

Question 23

medulla of mid rib or sternum

Answer 23

chondrosarcoma