Chest Wall Tumors, Benign Skeletal

Fibrous Dysplasia

• • Accounts for 33% of benign skeletal tumors

  • Involves ribs 50% of time

  • Not associated with hyperparathyroidism

  • Usually single tumor, associated with trauma

Chondromas, Osteochondromas, Myxochomdromas

• • Combined equal 30-45% of benign skeletal tumors

Eosinophilic Granuloma

• • Occurs in clavicle and scapula usually; rarely in sternum

  • Lung infiltrates are common

  • Benign form of Litterer-Siwe disease or Hand-Schuller-Christian disease

  • Cavernous hemangioma of ribs

  • -Painful mass during childhood

  • Multiple radiolucent areas or single trabeculated cyst seen on radiograph

Epidemiology

Chondroma

• • Occurs equally among males and females, between childhood and fourth decade

Symptoms and Signs

• • Most often painless

  • Swelling and tenderness may occur with fibrous dysplasia

  • Chondromas occur along anterior costal margin

  • Lung infiltrates—consider eosinophilic granuloma

  • Fever, malaise, leukocytosis—consider eosinophilic granuloma

  • Bone pain—consider eosinophilic granuloma

Imaging Findings

• • X-ray often diagnostic

  • Lung infiltrates—consider eosinophilic granuloma

• • Can be difficult to distinguish from malignant lesions

• • Physical exam to assess skin involvement

  • CT scan of thorax including bone windows

  • Bone scan

  • Incisional biopsy for large mass (> 4 cm)

  • Excisional biopsy if small and amenable

• • Wide local excision often necessary for cure

References