Chest wall tumors constitute 5 percent of thoracic tumors and less than 1 percent of all primary tumors; between 40 and 60 percent are malignant. Tumors may originate primarily in the chest wall, may metastasize to it, or extend into it via local invasion from adjacent structures. Morbidity and mortality are specific to the particular tumor type.
After initial history and physical examination, radiographic imaging can reveal anatomic location, tissue of origin, involvement or invasion of adjacent structures, and ultimately the response to therapy or recurrence. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography-CT (PET-CT) are useful, dependent on the tissue type and location. Needle, incisional, or excisional biopsy is usually necessary to determine tissue type and aids in further management.
Multidisciplinary management is helpful given the rarity and diverse nature of chest wall tumors. Medical treatment varies with different tumor types. Chemotherapy and radiation therapy may be used.
Surgical treatment varies with different tumors types. In general, malignant tumors should be resected to negative margins including the uninvolved rib above and below the tumor. Chest wall reconstruction is necessary for defects greater than 5 cm and those resulting in exposure of vulnerable underlying structures, and aims at stabilizing the chest wall during respiration and excursion.
Tumors involving the chest wall are uncommon, constituting 5 percent of all thoracic masses and less than 1 percent of all primary tumors.1 Tumors may originate primarily in the chest wall, may metastasize to it, or extend into it via local invasion from adjacent structures. As a group, chest wall tumors can be organized by their tissue of origin or occurrence and further divided into malignant and benign tumors. Chest wall tumors are listed in Table 18-1. In characterizing these tumors, we have identified them based on the tissue of origin in the chest wall, moving from the parietal pleura through the chest outward to the skin.
Chest Wall Tumor Types by Tissue of Origin
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Table 18-1: Chest Wall Tumor Types by Tissue of Origin
|Tissue of Origin ||Benign ||Malignant |
|Soft-tissue tumors || || |
|Parietal pleura ||Benign localized solitary fibrous tumor ||Malignant localized solitary fibrous tumor |
| || ||Mesothelioma |
|Bone, cartilage, and connective tissue ||Fibrous dysplasia ||Chondrosarcoma |
| ||Chondroma ||Osteosarcoma |
| ||Osteochondroma ||Ewing sarcoma and primitive neuroectodermal tumor |
| ||Chondromyxoid fibroma ||Primary pleuropulmonary synovial sarcoma |
| ||Langerhans cell histiocytosis ||Adamantinoma |
| ||Aneruysmal bone cyst || |
| ||Ossifying fibromyxoid tumor || |
| ||Giant cell tumors || |
|Muscle ||Leiomyoma ||Leiomyosarcoma |
| ||Rhabdomyoma ||Rhabdomyosarcoma |
|Nerve ||Neurofibroma ||Neurofibrosarcoma |
| ||Schwannoma (benign peripheral nerve sheath tumor) ||Malignant peripheral nerve sheath tumor (malignant schwannoma) |
| ||Paraganglioma ||Ganglioneuroblastoma |
| ||Ganglioneuroma ||Neuroblastoma |
|Lymphovascular ||Cavernous hemangioma ||Angiosarcoma |
| ||Glomus tumor...|
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