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Neoplasms of the Chest Wall

Cameron T. Stock Jr. , Karl F. Uy, Geoffrey M. Graeber, Albiruni Razak
Neoplasms of the Chest Wall is a topic covered in the Pearson's General Thoracic.

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Introduction

Chest wall tumors encompass a spectrum of bone and soft tissue pathologic conditions. Included are primary and metastatic neoplasms of both the bony skeleton and soft tissues and the primary neoplasms that invade the thorax from adjacent structures, such as the breast, lung, pleura, and mediastinum (Box 1; Table 1). Primary chest wall neoplasms, once considered unresectable because of their size or extension into adjacent structures, are now resected and there are several options for reconstruction of the chest wall with little morbidity. Overall, chest wall neoplasms are uncommon. There are only a limited number of case series reported in the literature and even large series have few patients compared with other types of thoracic malignancies. Moreover, most reports have included only patients with bone tumors.[1],[2],[3]When bone neoplasms are combined with primary soft tissue tumors, however, the soft tissues become a major source of chest wall neoplasms and account for nearly one half of these tumors treated surgically.[4],[5] The incidence of malignancy in these tumors is variable and has been reported to range from 50% to 80%. The higher malignancy rates are found in those series that include soft tissue tumors. When combined, undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma), chondrosarcoma and rhabdomyosarcoma are the most frequent primary malignant neoplasms that the thoracic surgeon is asked to manage. Cartilaginous tumors (osteochondroma and chondroma) and desmoid tumors are the most common primary benign tumors.

Box 1: Primary Chest Wall Neoplasms

Malignant

Myeloma

Undifferentiated pleomorphic sarcoma

Chondrosarcoma

Rhabdomyosarcoma

Ewing’s sarcoma

Liposarcoma

Neurofibrosarcoma

Osteosarcoma

Hemangiosarcoma

Leiomyosarcoma

Lymphoma

Benign

Osteochondroma

Chondroma

Desmoid

Lipoma

Fibroma

Neurilemmoma

Table 1: Estimates of Number of New Cases of Primary Malignant Chest Wall Tumors

Tumor

All Sites (No.)

Chest Wall (No.)

Soft tissue sarcoma

6000

360

Chondrosarcoma

400

60

Ewing’s sarcoma

300

45

Solitary plasmacytoma

125

25

Osteosarcoma

600

18

Total

7425

508

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Introduction

Chest wall tumors encompass a spectrum of bone and soft tissue pathologic conditions. Included are primary and metastatic neoplasms of both the bony skeleton and soft tissues and the primary neoplasms that invade the thorax from adjacent structures, such as the breast, lung, pleura, and mediastinum (Box 1; Table 1). Primary chest wall neoplasms, once considered unresectable because of their size or extension into adjacent structures, are now resected and there are several options for reconstruction of the chest wall with little morbidity. Overall, chest wall neoplasms are uncommon. There are only a limited number of case series reported in the literature and even large series have few patients compared with other types of thoracic malignancies. Moreover, most reports have included only patients with bone tumors.[1],[2],[3]When bone neoplasms are combined with primary soft tissue tumors, however, the soft tissues become a major source of chest wall neoplasms and account for nearly one half of these tumors treated surgically.[4],[5] The incidence of malignancy in these tumors is variable and has been reported to range from 50% to 80%. The higher malignancy rates are found in those series that include soft tissue tumors. When combined, undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma), chondrosarcoma and rhabdomyosarcoma are the most frequent primary malignant neoplasms that the thoracic surgeon is asked to manage. Cartilaginous tumors (osteochondroma and chondroma) and desmoid tumors are the most common primary benign tumors.

Box 1: Primary Chest Wall Neoplasms

Malignant

Myeloma

Undifferentiated pleomorphic sarcoma

Chondrosarcoma

Rhabdomyosarcoma

Ewing’s sarcoma

Liposarcoma

Neurofibrosarcoma

Osteosarcoma

Hemangiosarcoma

Leiomyosarcoma

Lymphoma

Benign

Osteochondroma

Chondroma

Desmoid

Lipoma

Fibroma

Neurilemmoma

Table 1: Estimates of Number of New Cases of Primary Malignant Chest Wall Tumors

Tumor

All Sites (No.)

Chest Wall (No.)

Soft tissue sarcoma

6000

360

Chondrosarcoma

400

60

Ewing’s sarcoma

300

45

Solitary plasmacytoma

125

25

Osteosarcoma

600

18

Total

7425

508

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Last updated: March 14, 2020