Primary Chest Wall Tumors

Abstract

Patients with chest wall tumors present diagnostic and therapeutic challenges. The differential diagnosis of these tumors is broad, because they can represent a heterogeneous spectrum of diseases from primary benign or malignant tumors to metastases; local extension of adjacent tumors of the lung, mediastinum, pleura or breast; nonneoplastic infectious or inflammatory conditions; or even local manifestations of systemic disease. Primary chest wall tumors are best classified according to their tissue of origin, bone or soft tissue, and further subclassified according to whether or not they are benign or malignant. Most of these tumors are uncommon, with information garnered from individual case reports or institutional case series. Chest wall tumors are more commonly either metastases or local invasion of an underlying adjacent tumor. Primary chest wall tumors account for only 0.04% of all new cancers diagnosed and 5% of all thoracic neoplasms. The list of potential tumors is broad (Table 1), with nomenclature that is frequently overlapping and sometimes contradictory in the literature. Primary benign lesions of the chest wall can behave in a latent, active, or aggressive manner. Approximately 60% of primary chest wall tumors are malignant. Although primary chest wall tumors are diagnosed in every age group, they are more likely malignant in the extremes of age: in the young and the elderly. Certain tumors present predominantly in one age group. For example, Ewing sarcoma is