Thoracic Surgery - Chest Wall Tumors

Question 1

What are the most common benign chest wall tumors and their typical presentation?

Answer 1

1. Osteochondroma (30-50%) - painless mass on the rib metaphysis
2. Fibrous dysplasia (20-30%) - painful rib lesion or pathologic fracture
3. Chondroma (15-20%) - slowly enlarging, painless mess at the costochondral junction

[4. Eosinophilic granuloma]

Question 2

What are the most common primary chest wall malignancies?

Answer 2

1. Chondrosarcoma (most common)
2. Osteosarcoma
3. Ewing’s sarcoma and primitive neuroectodermal tumor or PNET (aggressive form of Ewing)
4. Solitary plasmacytoma

Question 3

Which chest wall tumor demonstrates a classic “onion-peel” appearance on x-ray?

Answer 3

Ewing’s sarcoma

Question 4

Which chest wall tumor demonstrates a classic “sunburst” appearance on x-ray?

Answer 4

Osteosarcoma

Question 5

What is the treatment for malignant chest wall tumors?

Answer 5

Wide resection with 4-5 cm margins

Question 6

___% of all chest wall tumors are primary tumors. Of these, ___% are malignant. The rest are metastatic arising from what 4 sources?

Answer 6

50; 60; lung, thyroid, GI, GU

Question 7

True or false - all chest wall tumors should be considered malignant until proven benign.

Answer 7

True