Lung Images: Chondrosarcoma on the Chest Wall

Abstract

A 62-year-old presented with chest pain and a chest roentgenogram which showed a homogeneous mass with rounded boundaries on the right 4th rib (Fig. 1). A CT scan of the chest revealed that the mass was homogeneous, calcified, and appeared to arise from the right chest wall and protrude into the thoracic cavity (Fig. 2). A right anterior thoracotomy revealed a mass on the inner surface of the right 4th rib that did not adhere to lung parenchyma. The mass was excised and histopathologic examination indicated that it was a grade 1 chondrosarcoma. The patient then underwent more aggressive resection with 4 cm of normal tissue removed around the primary malignant lesion. In addition, parts of the 3rd, 4th, and 5th ribs were resected. The chest wall defect was repaired using 10-cm 9 10-cm prolene mesh (PMH, Prolene mesh, Ethicon, Gargrave, UK). Postoperative histologic examination revealed the lobulated mass was formed by atypical chondrocytes with pleomorphic dark nuclei in an area of chondroid matrix, an increase in the number of lacunae with more than one cell in some lacunae, binucleation of a few cells with mitotic activity, and spread of the tumor into bone (Fig. 3). Primary chest wall tumors comprise about 5% of all thoracic neoplasms and 1–2% of all primary tumors. Usually located on the costochondral junction of the ribs and the sternum, chondrosarcoma is the most common primary sarcoma of the bones of the chest wall [1]. Though characterized by slow growth, strong potential for invasive extension, and local recurrence, it is generally asymptomatic initially. Continuous growth and involvement of surrounding tissue cause pain, one of the first symptoms of the tumor. Diagnosis is suspected based on radiologic findings and confirmed by histopathologic examination [2]. Chest roentgenogram, computed tomography, and magnetic resonance imaging are used in such patients. Chest wall chondrosarcomas appear as a lobulated mass arising in the medullary portion of the bone, with destruction of the cortex and calcifications, as was in our case. Surgery is considered the primary treatment of chondrosarcoma. Extensive surgical resection with adequate margins is mandatory to achieve cure. Incomplete excision and positive margins lead to local recurrence and adversely