Primary Chondrosarcoma of the Chest Wall— A Case Report

Cyriac George,T Rose,J Fontaine,D Diallo,F Velez-Cubian,M Bui

doi:10.4236/ojrad.2018.83017

Abstract

A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Initial work up of the finding included a CT scan of the chest which revealed a non-calcified, solid right anterior chest wall mass with invasion of the anterior fifth rib and intercostal space. The patient was presented at multidisciplinary conference with the patient’s primary physician, a medical oncologist, radiologist, pathologist and oncologic surgeon in attendance. The decision was to perform surgical resection of the mass to treat this primary mesenchymal malignancy. The anterior aspect of the fifth rib and intercostal muscles were resected with negative margins. Pathology confirmed the mass to be a low-grade chondrosarcoma. Due to the low-grade nature, low metastatic potential and negative margins of the tumor, the decision was made not to pursue adjuvant chemotherapy or radiation therapy. The patient made full recovery.

Highlights

Chondrosarcomas are the most common primary chest wall malignancies and the second most common malignant bone tumors
A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass
Radiologic screening of chondrosarcomas involves multimodality characterization which is determined according to the American College of Radiology (ACR) appropriateness criteria [4]

Summary

Introduction

Chondrosarcomas are the most common primary chest wall malignancies and the second most common malignant bone tumors. A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Physical examination revealed an asymptomatic 4 cm soft tissue palpable mass of the right anterior chest wall. Radiology work up included CT chest, MRI of the chest and PET/CT. His CT chest axial series on bone windows demonstrated a 2.8 × 3.8 × 2.9 cm pleural based soft tissue mass eroding through the right anterior fifth rib (Figure 1). Further characterization of the mass by MRI contrast enhanced images of the chest revealed a well-circumscribed pleural based T1 hypo-intense avidly enhancing soft tissue mass in the right anterior chest wall involving the right anterior fifth rib and into the overlying sub-pectoral soft tissues (Figure 2). PET/CT imaging revealed mild hypermetabolic activity of the mass with maximum SUV of 1.9 (Figure 5)

Results

Discussion

Conclusion