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General Thoracic Surgery > Chest Wall Tumors > Flashcards

Chest Wall Tumors Flashcards

1
Q

Primary malignant chest wall tumors

A
  • Chondrosarcomas (35%)
  • Plasmacytoma (25%)
  • Ewing’s sarcoma (15%)
  • Osteosarcoma (15%)
  • Lymphoma (10%)
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2
Q

Tumors that metastasize to chest wall

A
  • Melanoma
  • Breast carcinoma
  • Lung carcinoma
  • Mesothelioma
  • Renal cell carcinoma
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3
Q

Benign tumors of the chest wall

A
  • Fibrous dysplasia (40%)
  • Chondoroma (30%)
  • Osteochondroma
  • Desmoids
  • Lipoma
  • Neurofibroma
  • Giant cell tumor

*Characterized by slow growth

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4
Q

MC presentation of chest wall tumors

A

Painful, enlarging lesions (80%)

20% assymptomatic

*May also present with dyspnea, night sweats, fevers, generalized malaise

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5
Q

Imaging modalities used for diagnosis (and staging)

A
  • Diagnosis: chest CT or MRI
  • Staging: PET/CT
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6
Q

Diagnostic algorithm for chest wall tumors

A
  • Imaging/Staging:
    • Chest CT or MRI
    • PET/CT
  • Tissue diagnosis:
    • determine histopathology
    • determine candidate for neoadjuvant therapy
    • Options:
      • core needle biopsy
      • incisional biopsy
      • excisional biopsy (< 5cm)
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7
Q

MC primary malignant chest wall tumor

A

Chrondrosarcoma

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8
Q

MC location of chrondrosarcoma

A

Costochondral arches (80%)

(sternum 20%)

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9
Q

CXR appearance of chrondrosarcoma

A

lobulated mass (medullary portion of the rib or sternum)

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10
Q

TOC for chondrosarcoma

A

Wide resection

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11
Q

Prevalence of plasmacytoma

A

(a.k.a solitary plasma cell tumor myeloma)

Accounts for 20-30% of primary malignant chest wall tumors

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12
Q

MC location of plasmacytoma

A

Ribs and sternum

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13
Q

Primary malignant chest wall tumor associated with progression to multiple myeloma

A

Plasmacytoma

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14
Q

Presentation of plasmacytoma

A

Painless mass with osteolytic CXR appearance

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15
Q

TOC for plasmacytoma

A

XRT

  • Surgical resection (wide resection) for refractory cases
  • Chemotherapy used for disease progression
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16
Q

MC malignant lesion of the ribs in children

A

Ewing’s sarcoma

  • Aggressive, destructive tumors that invade and displace adjacent structures
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17
Q

Cell of origin of Ewing’s sarcoma

A

neural crest cells

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18
Q

MC presentation of Ewing’s sarcoma

A

Painful mass with fever and malaise

  • May have elevated WBC and ESR
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19
Q

CXR appearance of Ewing’s sarcoma

A

Lytic lesion with surrounding destruction and onion peel appearance (new bone formation)

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20
Q

TOC Ewing’s sarcoma

A

Wide resection + XRT

Neoadjuvant chemotherapy may be used to shrink tumor preoperatively

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21
Q

MC location of osteosarcoma

A

Ribs, scapula, clavicle (young adults)

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22
Q

Unique featurs of osteosarcoma of the chest wall compared to osteosarcoma of the extremity

A

More prone to recurrence and metastasis

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23
Q

MC presentation of osteosarcoma

A

Painful mass with elevated ALP

24
Q

CXR appearance of osteosarcoma

A

Sunburst pattern with elevation of periosteum (Codman’s triangle) due to new bone formation

25
Q

Prognosis for osteosarcoma determined by

A

response to chemotherapy

26
Q

Role of XRT for osteosarcoma

A

None to minimal (usually ineffective)

27
Q

Codman’s triangle

A

Osteosarcoma

Elevation of periosteum due to new bone formation

28
Q

MC type of chest wall lymphoma

A

Extranodal diffuse large B-cell lymphoma

29
Q

Demographics of chest wall lymphoma

A

Immunocompromised patients

(transplant, HIV)

30
Q

TOC chest wall lymphoma

A

CRT and chemotherapy (CHOP)

31
Q

MC chemotherapy for chest wall lymphoma

A

CHOP

  • Cytoxan (cycolphosphamide)
  • Adriamycin (doxarubicin)
  • Vincristine
  • Prednisone
32
Q

Workup for soft tissue sarcoma of the chest wall

A
  • CT: evalute for pulmonary mets
  • MRI: evaluate infiltration and relation to adjacent vital structures
33
Q

TOC for soft tissue sarcoma of chest wall

A

WLE ( 1 cm margin)

*include biopsy site in WLE

34
Q

Role of XRT for soft tissue sarcoma of the chest wall

A
  • Residual disease
  • Inadequate margins
  • Tumors > 5 cm
  • Highly invasive tumors (high-grade)
35
Q

TOC for local recurrence of soft tissue sarcoma of chest wall

A

Resection (WLE)

Solitary pulmonary lesions = resection

36
Q

TOC for XRT-induced sarcomas

A

WLE

(very aggressive tumors)

37
Q

Painless, slowly enlarging, violaceous chest wall mass that is associated with a history of XRT

A

Angiosarcoma

TOC = WLE

38
Q

TOC for solitary metastatic tumors to chest wall

A

Resection +/- XRT

  • Melanoma
  • Breast carcinoma
  • Lung carcinoma
  • Mesothelioma
  • Renal cell carcinoma
39
Q

MC benign rib lesion in children

A

Fibrous dysplasia of the bone

  • Maturation defect
  • May be associated with trauma
  • Painless mass
40
Q

CXR appearance of fibrous dysplasia of the bone

A

Fusiform mass with thinning of the cortex an no calcifications

41
Q

TOC for fibrous dysplasia of the bone

A

Resection whtere the deformity has occurred

42
Q

MC benign tumor of chest wall cartilage

A

Chondroma

  • Appear similar to chondrosarcoma (requires biopsy or resection to r/o malignancy)
43
Q

Benign chest wall tumor that typically presents as mass associated wtih rib fractures

A

Osteochondroma

  • Resection is performed to prevent further tissue displacement
44
Q

Benign tumor develooping from muscula aponeurosis

A

Desmoid tumor

45
Q

Demographics of desmoid tumors

A
  • MC in females
  • FAP association
  • Sites of prior trauma or scarring
46
Q

Histologic appearance of Desmoid tumors

A

Sheets of fibroblasts with abundant collagen

47
Q

MC presentation of Desmoid tumors

A

Painful mass fixed to deep tissues (but not skin)

48
Q

TOC Desmoid tumors

A

WLE with 2-4 cm margin

49
Q

Incidence of recurrence of Desmoid tumors following resection

A

25-50%

50
Q

Role of XRT and/or chemotherapy for Desmoid tumors of the chest wall

A
  • XRT: margin-positive resections
  • Chemotherapy: none to minimal (not supported by trials)
51
Q

Other less common benign chest wall tumors

A
  • Lipoma
  • Fibroma
  • Neurofibroma
  • Gangioneuroma
  • Schwannoma
  • Giant cell tumor
52
Q

Oveall treatment strategy for chest wall tumors

A

Multidisciplinary, multimodality approach

(primarily due to the infrequency with with most practitioners encounter them)

  • Most chest wall lesions are resected (including benign lesions)
53
Q

Chest wall reconstruction technique used for resection defects < 5 cm or posterior resections covered by scapula

A

None required

54
Q

Indications for chest wall reconstruction

A
  • Defects > 5 cm
  • Defects involving 2 or more adjacent ribs
55
Q

Surgical options for chest wall reconstruction

A
  • Methyl methacrylate/non-absorbable mesh “sandwich”
  • Tissue flaps (latissimus, rectus, pectoralis, myocutaneous)
    • Particularly useful in irradiated tissue beds
    • Plastic surgery consultation
56
Q

Sites of metastasis for primary malignant chest wall tumors

A

Lungs

Liver

  • Long-term surveillance warranted (serial chest CT)

General Thoracic Surgery (36 decks)

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