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Background. Giant cell tumor is a rare and locally aggressive neoplasm of the long bones in children. Rib is the least frequently affected site, seen in less than 1% of all cases and most of them occur at the posterior arc. Case. A 12-year-old girl presented with swelling and slight pain on the left inferior-anterior chest wall for two years. Physical examination revealed a giant, hard and fixed mass on the left chest wall. Hematological and biochemical test results were in normal limits but slight elevation of alkaline phosphatase level. Computed tomography of the chest showed a large expansive mass and lytic lesion with internal calcification arising from the anterior part of the 7th rib. En-bloc resection was performed including the 6th-8th ribs and a small part of the diaphragm. The pathological evaluation revealed giant cell tumor of bone. Conclusions. Herein, we aim to emphasize that giant cell tumor should be considered in the differential diagnosis of chest wall tumors in childhood whereby en-bloc resection and close follow up would be paramount. [ABSTRACT FROM AUTHOR]

Mesenchymal hamartoma of the chest wall is an extremely rare, benign chondro-osseous chest wall tumor which originates from one or more ribs, in newborns or infants. It usually appears as a solitary lesion but more rarely can be multifocal and bilateral. Sometimes it may mimic chest wall malignant tumors because of its destructive radiological nature. Herein, we aim to present the imaging characteristics of a 4-day-old boy with multifocal mesenchymal hamartoma of the chest wall. [ABSTRACT FROM AUTHOR]

• Intercostal hemangioma is an extremely rare disease, accounting for approximately 0.01% of all benign hemangiomas. • Hemangiomas are prone to bleed spontaneously or after minor traumatic injury. • Complete excision of the tumor is mandatory even after embolization to prevent recruitment of a collatera1 blood supply. Intercostal hemangioma is an extremely rare disease. It is difficult to distinguish intercostal hemangioma from other chest wall tumors. The difficulty in preoperative diagnosis may result in incomplete surgical resection and hence a high rate of recurrence. A 14-year-old boy who presented with asymptomatic right lateral chest wall mass with no history of trauma. Different radiological modalities were employed for diagnosis including computed tomography (CT) showed a soft tissue mass 6.5 × 4 × 5.6 cm in size abutting 5th and 6th ribs. Magnetic resonance imaging (MRI) revealed iso-intense signal in T1 and hyperintense signal in T2, that is higher than that of adjacent muscles in the inferolateral right chest wall which was compatible with intercostal hemangioma. The patient underwent surgery for excision of the mass. Through right posterolateral thoracotomy, there was a well-demarcated mass abutting 5th, and 6th ribs filling the right 5th interspaces. Histopathological examination confirmed the diagnosis of intercostal hemangioma. Chest wall hemangiomas are uncommon and mostly arise outside the rib cage. Hemangiomas rarely occur in the intercostal space, and most of these originate from intercostal muscles (Agarwal et al., 2006). Watson and McCarthy postulated two theories for the etiology of hemangiomas. The more widely supported theory claims that hemangiomas are of congenital origin. The other theory proposes a traumatic origin of hemangiomas. Complete surgical resection should not be compromised by the resultant chest wall defect to prevent recurrence. [ABSTRACT FROM AUTHOR]

Pediatric chest wall tumors are rare. Malignancies predominate of which sarcomas are the most common. Their resection and the subsequent reconstruction of the chest wall has been a surgical challenge since Dr. Frederick W. Parham published his first comprehensive account on the subject in 1898. Chest wall reconstruction is age, site and pathology dependent, must preserve long term function and cosmesis, must accommodate future growth and development, and must not be a hindrance to adjuvant radiotherapy. Bony reconstruction can be relatively simple or complex involving combinations of synthetic meshes, bioprosthetic materials, steel or titanium constructs, autografts, homografts and porcine or bovine xenografts. Soft tissue coverage can be achieved with direct closure, skin grafts, local advancement flaps, pedicled or free myocutaneous or osseomyocutaneous flaps or a combination of these. Complications to be avoided include scoliosis, pain and activity restriction, restrictive pulmonary deficits and interference with adjuvant radiotherapy which may result in tumor recurrence. Advances in cancer therapy have improved short- and long-term survival but significant functional and cosmetic challenges remain particularly for large chest wall defects in the very young. The future may lie with absorbable semi-rigid meshes, biointegratable acellular homografts and xenografts, demineralized bone matrices and bone marrow stromal cells, the patient's own lab-grown stem-cell based vascularized osseomyocutaneous chest wall grafts or the obsolescence of surgical resection altogether in the age of targeted anti-tumor and immune based therapy. [ABSTRACT FROM AUTHOR]

fibrous dysplasia is a slow-growing bone tumor and is caused by the failure of bone maturation. It is usually asymptomatic thus it is generally found incidentally in radiologic evaluations. Computed tomography is the best radiologic modality for its evaluation. The characteristic findings are ground-glass lesions surrounded by a rim or shell of reactive bone. This study presents a 52-year-old male patient with a huge chest wall tumor arising from the posterolateral aspect of the right fourth to seventh ribs measuring 38 cm. He underwent a thoracotomy and the tumor was resected. For safe margin, the third and eighth ribs were also resected. The defect was reconstructed with a prolene mesh patch and a pectoralis major flap. The final pathology report stated a tumor composed of spindle cells without pleomorphism or mitotic figures with intervening branching and anastomosing bone trabeculae. The margins were tumor-free and on the follow-up, the patient's condition was decent. Primary tumors of the rib account for 5 % to 7 % of all primary bone neoplasms. Fibrous dysplasia makes up 0.8 % of primary bone tumors. Fibrous dysplasia usually causes no symptoms although it can get massive enough to get symptomatic. Its diagnosis is made through clinical, radiological, and histopathological investigations. CT scan findings are the cornerstone for radiologic evaluations. An individualized approach based on the patient's age and symptoms should be considered. Considering that the malignant degeneration of the tumor is uncommon, early diagnosis and surgical resection of the tumor can be curative. • A 52-year-old male patient with a huge chest wall tumor arising from the right fourth to seventh ribs • Histology: spindle cells without pleomorphism or mitotic figures with intervening branching and anastomosing bone trabeculae • An intramedullary lesion with a ground-glass center and cortical thickening measuring 38 cm in diameter • Primary tumors of the rib constitute 5% to 7% of all primary bone neoplasms. • Fibrous dysplasia usually produces no symptoms. The lesions are detected accidentally during radiological investigations. [ABSTRACT FROM AUTHOR]

Extrapulmonary tuberculosis has increased in the last few decades, and establishing a diagnosis is still challenging. A 15 years old Indonesian adolescent complained of a lump on the right lung. The patient and his mother had a history of pulmonary tuberculosis and received the anti-tuberculosis drug. Chest inspection showed a soft consistency mass, smooth surface, poorly defined borders, and size of 7 × 7 cm in the posterolateral dextra region. Radiological examination showed a mass of 2 × 2.5 × 5.3 cm in the right anterior mediastinum. FNAB lymph nodes showed granulomatous inflammation consistent with tuberculosis. The patient had a wide excision tumor, and a GeneXpert MTB/RIF examination of the tumor excision material showed that Mycobacterium tuberculosis was detected very low. The patient received an anti-tuberculosis drug and had a good prognosis. Patients with a family history of tuberculosis should be examined for tuberculosis. Although in a patient with lung carcinoma signs and symptoms, it does not rule out chest wall tuberculosis. Enforcement of the correct diagnosis can increase the prognosis of extrapulmonary tuberculosis. • GeneXpert MTB/RIF examination should be performed on patients with a family history of tuberculosis. • Management of Chest wall tuberculosis included incision and anti-tuberculosis drugs. • Extrapulmonary tuberculosis does not have non-specific signs and symptoms. [ABSTRACT FROM AUTHOR]

This study presents the case of an 87-year-old male who developed a huge tumor at the chest wall that limited the range of motion of the upper limb. We performed a wide excision of the tumor with chest wall reconstruction. The tumor exhibited lobulated pattern with myxoid fluid and fibrous tissue, which was accumulated by a thin capsule. The final diagnosis was myxoinflammatory fibroblastic sarcoma (MIFS), a kind of uncommon low-grade malignant tumor that extremely develops rarely in the chest wall. At this moment, we review the epidemiology, histopathologic characteristics, similar cases, and the current treatment for MIFS. [ABSTRACT FROM AUTHOR]

Tumors of the bony thorax are rare and present unique challenges in achieving optimal oncologic results. Negative margins can be quite difficult to obtain because of the proximity to vital structures, hence rendering wide resection challenging. Chest wall resections are also complex because of the necessity for restoration of a functional chest wall with adequate soft tissue coverage to prevent paradoxical respiration and to mitigate pulmonary complications. Traditionally, thoracic surgeons have treated chest wall tumors. However, at some centers, orthopaedic oncologists have performed resections and reconstructions of these tumors with minimal perioperative morbidity. Previous studies have shown both an increase in the number of wide resections and a survival benefit for the treatment of these tumors when care is provided at a sarcoma center of excellence with a multidisciplinary team. We recommend a multidisciplinary treatment algorithm for these tumors with a musculoskeletal oncologist, thoracic surgeon, and plastic surgeon to bring about successful wide resection of the tumor, restoration of functional chest wall kinetics, and appropriate soft tissue coverage. [Copyright &y& Elsevier]

Abstract: Purpose: We have previously reported the use of the vertical expandable prosthetic titanium rib (VEPTR) for treatment of thoracic dystrophy. This report describes our experience with this device and other novel titanium constructs for chest wall reconstruction. Methods: This is a retrospective chart review of all children and adolescents undergoing chest wall reconstruction with titanium constructs between December 2005 and May 2010. Results: Six patients have undergone chest wall reconstruction with VEPTR or other titanium constructs. Four had chest wall resection for primary malignancy, 1 had metastatic chest wall tumor resection, and 1 had congenital chest wall deformity. There were no immediate complications, and all patients have exhibited excellent respiratory function with no scoliosis. Conclusions: Chest wall reconstruction after tumor resection or for primary chest wall deformities can be effectively accomplished with VEPTR and other customized titanium constructs. Goals should be durable protection of intrathoracic organs and preservation of thoracic volume and function throughout growth. Careful preoperative evaluation and patient-specific planning are important aspects of successful reconstruction. [Copyright &y& Elsevier]

Introduction Soft tissue sarcomas of the chest wall are exceptionally rare entities that present as painless slow growing masses. Resection is often precarious due to involvement of vital structures, and patients are left with large chest wall defects postoperatively requiring extensive reconstruction. Presentation of case We present a case report of a 29 year-old man who presented with a giant soft tissue sarcoma of the chest that had been growing slowly for one year prior to presentation. The patient had a biopsy that was positive for sarcoma, and PET CT demonstrated a large lobulated mass in the left chest wall with an SUV of 6.7. He received 50 Gy of radiation therapy; however, the mass continued to grow in size. He subsequently underwent an en-bloc resection of the mass with latissimus and serratus muscle primary reconstruction. Final pathology showed a 27 cm high-grade fibrosarcoma with prominent myxoid component. To our knowledge, this is the largest soft tissue sarcoma of the chest wall reported in the literature. Postoperatively, the patient received 6 cycles of adjuvant chemotherapy. Discussion Surgery is the mainstay of treatment, and chemotherapy and radiation are used in specific circumstances. Risk of recurrence is dependent on many factors, including histologic subtype, grade, and size of tumor. Long term surveillance with physical exam and imaging is recommended. Conclusion We feel that the multidisciplinary approach is crucial for optimal management of large soft tissue sarcomas. We recommend this approach to all patients with chest wall sarcomas. [ABSTRACT FROM AUTHOR]

Malignant triton tumor is a rare malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. Most of these tumors are located in the head, neck, and extremities, and about half of cases are associated with neurofibromatosis type 1 featuring cafe-au-lait spots or cutaneous neurofibromas. We present a 76-year-old man with an insidious chest wall tumor with late progressive painful enlargement and pleural and pulmonary involvement. Complete resection of the affected thoracic wall as well as single separate lesions in the parietal pleura and left upper lung was carried out. The pathological examination confirmed that it was a malignant triton tumor. The patient received adjuvant chemoradiotherapy but eventually succumbed to disease relapse and distant metastases 6 months after the surgery. [ABSTRACT FROM AUTHOR]

Chondrosarcoma of a rib is a very rare malignant tumor of the bone. Most patients were present with an enlarging painful anterior chest wall tumor. We present a case of an asymptomatic 29-years old female with a tumor size of 10 cm × 12 cm on the left anterior chest wall involving the 8th rib. CT scan with intravenous contrast is the gold standard for radiological imaging and planning for surgery. Since chondrosarcoma is less sensitive to chemotherapy and radiotherapy, surgical treatment with extensive resection with a sufficient margin is considered first line treatment. [ABSTRACT FROM AUTHOR]

Abstract: Chondromyxoid fibromas are benign tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms and display a hypermetabolic appearance on PET imaging. Oftentimes, they are misdiagnosed as chondrosarcomas and are excised due to concern for malignancy. We present a case of a condromyxoid fibroma originating from the second rib of a15-year-old girl. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: Subpleural lipomas are rare intrathoracic benign tumors. They are often discovered incidentally on plain chest radiographs and the diagnosis is usually established by computed tomography. PRESENTATION OF CASE: We report a case of subpleural lipoma, with enlargement during a period of two years. Pathology examination of the specimen confirmed the diagnosis of lipoma. DISCUSSION: For non-invasive diagnostic investigation, computed tomography enables the identification and quantification of subpleural lipoma due to their characteristic fat attenuation. Surgical resection with thoracotomy or VATS provides more accurate and firm diagnosis, and complete excision. CONCLUSION: This clinical entity needs attention due to difficult preoperative differentiation. Complete surgical excision of these lesions with the appropriate surgical approach is mandatory, for both diagnosis and treatment. [Copyright &y& Elsevier]

Abstract: Hydatidosis, caused by Echinococcus granulosus, is still an endemic parasitic disease in the Mediterranean area, South America, North Africa, and Australia. The most common anatomic location of hydatid disease is the liver, followed by the lung. Hydatidosis is located in the bones in 0.5% to 2% of all cases. A hydatid cyst can be seen in any part of the body. However, primary hydatid cyst of the rib in childhood is exceedingly rare. We report the first case of a pediatric hydatid cyst of the rib mimicking chest wall tumor. [Copyright &y& Elsevier]

The authors describe a newborn patient with mesenchymal hamartoma of the chest wall associated with pulmonary hypoplasia. A massive thoracic tumor was diagnosed by prenatal ultrasonography and magnetic resonance imaging at the 28th week of gestation. She was delivered through cesarean delivery at the 36th gestational week. Respiratory distress because of pulmonary hypoplasia necessitated neonatal intensive care. The tumor extensively involved the left hemithorax including all 12 ribs and the first 10 thoracic vertebrae, resulting in marked deformity of the thorax. At 5 days of age, she underwent the incisional biopsy through a left thoracotomy. Histopathology of biopsy specimens showed multiple components of mesenchymal origin including premature cartilage, bone, and cystic lesions resembling aneurysmal bone cyst. The tumor then showed a rapid overgrowth, but subsequently exhibited a self-limited growth for months, in which her respiratory condition gradually improved to spontaneous breathing without oxygenation support. The present case advocates perinatal preparations for associated pulmonary hypoplasia and conservative management for the neoplasm in fetuses prenatally diagnosed as having this unique pathological entity. [ABSTRACT FROM AUTHOR]