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* This is the Professional Version. *

Chest Wall Tumors

By Anne S. Tsao, MD

Chest wall tumors are benign or malignant tumors that can interfere with pulmonary function.

Primary chest wall tumors account for 5% of all thoracic tumors and 1 to 2% of all primary tumors. Almost half are benign. The most common benign chest wall tumors are

  • Osteochondroma

  • Chondroma

  • Fibrous dysplasia

A wide range of malignant chest wall tumors exist. Over half are metastases from distant organs or direct invasions from adjacent structures (breast, lung, pleura, mediastinum). The most common malignant primary tumors arising from the chest wall are sarcomas; about 45% originate from soft tissue, and 55% originate from cartilaginous tissue or bone.

Chondrosarcomas are the most common primary chest wall sarcoma and arise from the anterior tract of ribs and less commonly from the sternum, scapula, or clavicle. Bone tumors include osteosarcoma and small-cell malignant tumors (eg, Ewing sarcoma, Askin tumor).

The most common soft-tissue primary malignant tumors are fibrosarcomas (desmoids, neurofibrosarcomas) and malignant fibrous histiocytomas. Other primary tumors include chondroblastomas, osteoblastomas, melanomas, lymphomas, rhabdomyosarcomas, lymphangiosarcomas, multiple myeloma, and plasmacytomas.

Symptoms and Signs

Soft-tissue chest wall tumors often manifest as a localized mass without other symptoms. Some patients have fever. Patients usually do not have pain until the tumor is advanced. In contrast, primary cartilaginous and bone tumors are often painful.

Diagnosis

  • Imaging

  • Biopsy

Patients with chest wall tumors require chest x-ray, CT, MRI, and sometimes PET–CT to determine the original site and extent of the tumor and whether it is a primary chest wall tumor or a metastasis. Biopsy and histologic evaluation confirm the diagnosis.

Prognosis

Prognosis varies by cancer type, cell differentiation, and stage; firm conclusions are limited by the low incidence of any given tumor. Sarcomas have been the most well studied, and primary chest wall sarcomas have a reported 5-yr survival of 17%. Survival is better with early-stage disease.

Treatment

  • Surgery

  • Sometimes combination chemotherapy, radiation therapy, and surgery

Most chest wall tumors are treated with surgical resection and reconstruction. Reconstruction often uses a combination of myocutaneous flaps and prosthetic materials. The presence of a malignant pleural effusion is a contraindication to surgical resection.

In cases of multiple myeloma or isolated plasmacytoma, chemotherapy and radiation therapy should be the primary therapy.

Small-cell malignant tumors such as Ewing sarcoma and Askin tumor should be treated with a multimodality approach, combining chemotherapy, radiation therapy, and surgery.

In cases of chest wall metastasis from distant tumors, a palliative chest wall resection is recommended only when nonsurgical options do not alleviate symptoms.

Key Points

  • Almost half of chest wall tumors are benign.

  • Less than half of malignant chest wall tumors are primary.

  • Consider the diagnosis if patients have a chest mass or unexplained chest wall pain, with or without fever.

  • Diagnose chest wall tumors with imaging, followed by biopsy.

  • Treat most with surgical resection and reconstruction (unless malignant pleural effusion is present), and sometimes chemotherapy and/or radiation therapy.

* This is the Professional Version. *