Chest Wall Mass Research Articles

Sudden Appearance of a Palpable Chest Wall Mass Secondary to Macrocystic Lymphatic Malformation: A Case Report

Chest wall lymphatic malformations are rare and can pose a diagnostic dilemma, particularly if they present abruptly. This case report describes a 15-month-old male toddler presenting with a left lateral chest mass. Histopathology of the surgically excised mass confirmed the diagnosis of a macrocystic lymphatic malformation. Furthermore, there was no recurrence of the lesion in the two-year follow-up period.

Primary Diffuse Large B Cell Lymphoma Presenting as Chest Wall Mass: A Case Report

Primary chest wall masses or tumors can be of two types, either benign or malignant. Diffuse large B cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL). Though an aggressive malignancy, with timely and appropriate treatment, approximately two-third of all patients can be cured. We present a rare case of DLBCL presenting as chest wall mass. This case suggests the possibility of the presence of primary malignant B cell lymphoma, with the presentation as a chest wall lesion.
 Keywords: Chest mass, Diffuse large B cell lymphoma, Mass, Non- Hodgkin’s lymphoma.

UNVEILING FOLLICULAR THYROID CARCINOMA: A CASE OF EXTENSIVE CHEST WALL METASTASIS

Follicular thyroid carcinoma (FTC) typically presents with distant metastases, commonly involving the lungs and bones. However, extensive chest wall metastasis as the initial presentation of FTC is rare and poses diagnostic and therapeutic challenges. Here, we report a case of extensive chest wall metastasis revealing FTC in a 54-year-old female patient. The patient presented with a rapidly growing chest wall mass associated with pain and discomfort. Imaging studies revealed multiple lytic lesions involving the ribs and sternum. Fine-needle aspiration cytology (FNAC) of the chest wall mass confirmed the diagnosis of FTC. The patient underwent total thyroidectomy followed by adjuvant radioiodine therapy. Despite aggressive management, the disease progressed rapidly, highlighting the aggressive behavior of FTC with chest wall involvement. This case underscores the importance of considering FTC in the differential diagnosis of chest wall masses and the need for comprehensive staging and management strategies in such cases.

Imaging of Bifid Fourth Rib Presenting as a Chest Wall Mass in an Infant

Imaging of Bifid Fourth Rib Presenting as a Chest Wall Mass in an Infant

A case of incidental multiple Myeloma presenting with pathologically proven large frontal skull plasmacytoma and review of therapeutic targets: Case report

Introduction: Multiple myeloma and plasmacytoma are both plasma cell malignancies that belong to the family of blood dyscrasias. They are thought to be different entities but can occur simultaneously in some patients. Case Report: We present a unique case of a large plasmacytoma heralding the diagnosis of multiple myeloma with a preceding history of trauma which makes this case peculiar as this is an important addition to the limited existing scientific literature. The index patient was largely asymptomatic despite having a massive frontal skull/lobe lesion measuring approximately 8 × 6 cm in size alongside a chest wall mass involving the anterior left 6th rib, and a mildly displaced acute pathological fracture of the left clavicle. A primary diagnosis of multiple myeloma was made following serum protein electrophoresis with pathological confirmation of frontal skull plasmacytoma. After multidisciplinary discussion, radiotherapy was administered for plasmacytoma with complete resolution of the frontal skull mass without the need for resection and chemotherapy for multiple myeloma with daratumumab in combination with lenalidomide-dexamethasone—chosen due to anticipated poor outcome at the time of diagnosis. Autologous stem cell transplantation was subsequently instituted for multiple myeloma with a good outcome to date. Conclusion: Solitary plasmacytoma can co-exist with multiple myeloma and the prognosis remains poor in such circumstance. Patients should be followed up closely with yearly imaging—magnetic resonance imaging (MRI)/computed tomography (CT), and positron emission tomography (PET) scans. A pivotal lesson from this case report emphasizes the atypical presentation of plasmacytoma and multiple myeloma with the peculiarity of a prior history of trauma which is believed to be associated with plasma dyscrasias. Over the last decade, novel therapeutic agents such as chimeric antigen receptor T-cell therapy, which is the first approved cell-based therapy for multiple myeloma, antibody-drug conjugates, and a dozen of bi-specific antibodies/immunotherapy have been developed and shows promising outcome in the future, especially for refractory cases of multiple myeloma.

Erythematous Chest Wall Mass in a 2-week-old Neonate.

Erythematous Chest Wall Mass in a 2-week-old Neonate.

PSAT279 Thyroid Oncocytic tissue: Presenting as metastatic thyroid carcinoma

Abstract Case A 76-year-old male with status post thyroidectomy in 2017 for compressive multi-nodular goiter. Pathology reported as benign thyroid tissue with follicular hyperplasia. In 2020, he presented with incidental finding of left neck mass on MRI. Ultrasound neck confirmed two extra-thyroidal masses left neck largest dimension of 2.9 cm. FNA reported as benign follicular cells favoring benign thyroid tissue. Surgical resection of the neck masses revealed benign thyroid tissue with focal oncocytic features and two benign lymph nodes. In 2021, he presented with left chest mass. Biopsy reported benign thyroid tissue, no evidence of papillary cancer. PET CT confirmed hypermetabolic chest mass, multiple lytic bone lesions and pulmonary nodules. Referred to Endocrinology for further evaluation, Thyroglobulin level elevated at >4500 ng/mL (Tg Ab <1.0 IU/mL). Molecular testing of chest wall mass was positive for TERT and HRAS mutations, loss of 22q and gain of 17q on microarray consistent with changes found in thyroid cancer. Surgical resection of the chest wall mass not feasible due to size and location. External beam radiation for cytoreduction of the sternal mass planned and radioactive iodine therapy if tumor RAI (radioactive iodine) avid. He is currently not a candidate for tyrosine kinase inhibitor (TKI) as he recently had acute coronary event. Zoledronic acid infusions initiated for bone involvement. Discussion Thyroid carcinomas that exhibit vascular invasion, or anaplastic dedifferentiation are readily and consistently diagnosed. However, the morphology of primary oncocytic thyroid tumors is similar to their non-oncocytic counterparts posing a huge challenge for the pathologist. This controversial and often confusing area of thyroid pathology requires careful evaluation for accurate diagnosis and management for patients with oncocytic thyroid lesions. Molecular and microarray testing should be considered when in doubt. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

T-INVERTED SHAPED RECTUS ABDOMINIS MYOCUTANEOUS (TI-RAM) FLAP FOR CHEST WALL RECONSTRUCTION

We present a case report of a 46-year-old man with a chest wall mass suspected for sarcoma who underwent wide surgical resection and reconstruction. The patient was treated with a large mass chest wall resection followed by a reconstruction using the myocutaneous rectus abdominis flap with a T-inverted shape skin paddle (Ti-RAM flap). This original flap design allowed us to cover a large chest wall defect due to a very extensive oncological resection while achieving an easier closure of the abdominal donor area.

Photoacoustic Tomography Appearance of Fat Necrosis: A First-in-Human Demonstration of Biochemical Signatures along with Histological Correlation.

A 50-year-old woman with no past medical history presented with a left anterior chest wall mass that was clinically soft, mobile, and non-tender. A targeted ultrasound (US) showed findings suggestive of a lipoma. However, focal “mass-like” nodules seen within the inferior portion suggested malignant transformation of a lipomatous lesion called for cross sectional imaging, such as MRI or invasive biopsy or excision for histological confirmation. A T1-weighted image demonstrated a large lipoma that has a central fat-containing region surrounded by an irregular hypointense rim in the inferior portion, confirming the benignity of the lipoma. An ultrasound-guided photoacoustic imaging (PA) of the excised specimen to derive the biochemical distribution demonstrated the “mass-like” hypoechoic regions on US as fat-containing, suggestive of benignity of lesion, rather than fat-replacing suggestive of malignancy. The case showed the potential of PA as an adjunct to US in improving the diagnostic confidence in lesion characterization.

Metastatic triple negative breast adenocarcinoma presenting as a fungating chest wall mass

A 60-year-old female with no previous medical history presented with progressive left sided weakness. Examination demonstrated a large, fungating chest wall mass with mucopurulent drainage and necrotic odor. The patient stated this lesion was worsening for multiple years and was associated with a 90-pound weight loss; however, she was hesitant to seek medical care until the onset of weakness. Comprehensive imaging, biopsy, and tissue analysis revealed the wound was consistent with fungating triple-negative breast adenocarcinoma with lung and frontal lobe metastasis (Figure 1).

Comparative Role of MDCT and FDG-PET/CT in the Diagnostic Evaluation of Mediastinal Mass Lesions: An Institutional Experience.

Background Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum. Objective The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions. Materials and Methods Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUV max ) of mediastinal and chest wall lesions were determined on FDG-PET/CT. Results This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum ( n = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum ( n = 37, 35.9%) and middle mediastinum ( n = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUV max , HU mean, and size were higher in malignant cases ( p = 0.001, p = 0.003, and p = 0.004, respectively). The current study found a cutoff value of 4.61 for SUV max to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793–0.965, p = 0.0001). The values of SUV max and HU mean were higher in solid benign lesions than those of cystic benign lesions ( p = 0.007 and p = 0.003, respectively). Conclusion In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.

Case Report: Upper limb dysfunction may be caused by chest wall mass excision: An enlightenment from a special case

Of all the thoracic surgical procedures, chest wall surgery is probably the lowest-risk type. In fact, it is not so. Clinical work also often has the trap of chest wall surgery. An operation to remove a mass in the axilla may result in upper limb disability on the affected side. Here, we report the case of a 47-year-old female patient with a left chest wall adjacent axillary mass, which was considered an abnormal structural lymph node on color ultrasound examination and chest CT. Otherwise, she felt no discomfort. The left upper limb moved freely without being affected by the mass. A routine resection of the tumor was performed after the preoperative examination was completed. After the operation, the incision recovered well. However, the day after the surgery, she developed numbness and pain in her left little finger and ring finger, pain that often kept her from sleeping. The mass was confirmed to be a schwannoma with cystic degeneration by pathology slicing after the operation. By this time, doctors were alerted to the fact that the removal of the chest wall mass had nearly disabled the left upper limb of the patient, which was a great warning to the thoracic surgeon. In this case report, we hope that all surgeons will be cautious and careful and will not trust the imaging diagnosis too much. It is also hoped that the patient understands that some procedures may lead to unexpected complications.

Primary diffuse large b-cell lymphoma presenting as a chest wall mass: A case report

Chest wall lymphoma is a rare entity and often confused with the more common sarcoma. We report a case of diffuse large B-cell non-Hodgkin lymphoma patient presented with a sole chest wall mass. Chest computed tomography revealed an abnormal mass with well-defined borders below the pectoralis major muscle with contrast enhancement. The excisional biopsy revealed diffuse large B-cell non-Hodgkin lymphoma, confirmed by immunohistochemistry. The patient was then treated with six cycles of R-CHOP and achieved complete response. She is currently free from malignancy for 12 months after treatment. This paper illustrates the rarity of this entity, the need for distinguishing it from sarcoma, and briefly reviews its current management.

Chest Wall Mass as the Dominant Presentation of Low-Grade B-Cell Non-Hodgkin's Lymphoma: A Case Report.

Low-grade B cell non-Hodgkin's lymphoma with dominant presentation of chest wall mass is presented in this report. The patient, a 65-year-old woman, presented with pain, rising skin temperature and redness, and swelling on the right lower chest wall. The histopathological examination revealed non-Hodgkin's lymphoma; the staging fluorodeoxyglucose-positron emission tomography/computed tomography demonstrated stage IVE disease, with hypermetabolic active disease in the right anterolateral chest wall in the form of large soft tissue mass and subcutaneous tissue with underlying bony erosion with extension into right anterior cardiophrenic space and superiorly up to right second costosternal region along the right internal mammary vessels. This was along with hypermetabolic active right axillary, right supraclavicular and left inguinal lymphadenopathy, and thickened hypermetabolic posterior right pleura with ametabolic right-sided pleural effusion. Bone marrow biopsy revealed uninvolved bone marrow. On follow-up after eight cycles of R-CHOP chemotherapy, the mass had completely resolved on contrast-enhanced computed tomography.

Clinical Manifestations and Surgical Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Beyond the NCCN Guidelines.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon peripheral T cell lymphoma arising in response to textured-surface breast implants. Frequently, BIA-ALCL is indolent and typically presents with peri-implant swelling after breast reconstruction or cosmetic augmentation. However, patients can present with an invasive breast or chest wall mass, palpable lymphadenopathy, or metastatic disease. The current literature is limited regarding surgical recommendations for patients with a more aggressive presentation of BIA-ALCL. This report aims to review the various clinical manifestations of BIA-ALCL, including the more advanced and less frequently encountered presentations, with an emphasis on a multidisciplinary approach, with early involvement of a surgical oncologist.

A Rare Aneurysmal Bone Cyst of the Rib in an Infant: A Case Report

An aneurysmal bone cyst (ABC) is a rare benign expansile lesion of the bone that consists of hemorrhagic cystic spaces separated by fibrous connective tissue containing osteoid and multinucleated giant cells. The lesion may be primary or secondary. We present a case of ABC in a 7-month-old girl who had a growing, antibiotic-refractory mass in the left chest wall. A computed tomography of the chest confirmed the anatomic location of the mass, but a percutaneous image-guided biopsy and video-assisted thoracoscopic surgery performed during work-up were nondiagnostic. The patient ultimately had a partial rib resection via left thoracotomy. On histologic examination, the mass was found to be an ABC. To our knowledge, this is the second case reported on aneurysmal bone cyst of the rib in an infant. The presented case confirms that ABCs can affect any bone and suggests that the inclusion of an expansile osteolytic lesion of the ribs in differential diagnosis is necessary to facilitate timely treatment that warrants excellent results.

Coincidence of Undifferentiated Pleomorphic Sarcoma and Epithelioid Leiomyosarcoma in a Patient; A Case Report

Introduction: Soft tissue sarcoma (STS) is a rare tumor with mesodermal origin. There are more than 100 different types of histology in sarcoma, which present different clinical behaviors. Liposarcoma, leiomyosarcoma, and undifferentiated pleomorphic sarcoma are among the most common pathologies Case Presentation: The patient was a 46-year-old man with 2 masses. The pathology of chest-wall mass (250 × 187 mm) was compatible with undifferentiated pleomorphic sarcoma (UPS). Arm mass (42 × 29 mm) pathology was suggestive of low-grade epithelioid leiomyosarcoma with smooth muscle differentiation. He received two cycles of mesna and doxorubicin and ifosfamide (MAI) regimen chemotherapy due to large and multiple masses, but the tumor size did not change. After consultation with an orthopedic oncosurgeon, wide masses resection was done. Adjuvant chemotherapy with an MAI regimen was continued for a total of 6 courses and radiation with a 60 Gy total dose to the posterior aspect of the chest wall. No recurrence or complications was observed after 4 months of follow-up. Conclusions: Multiple STS is rare; nevertheless, its probability, either synchronous or metachronous, should be considered during patient examine and follow-up. In the case of a secondary lesion, different histology is probable, and the patient should be biopsied and imaged.

Pericardial and pulmonary actinomycosis, simulating inflammatory myofibroblastic tumor: the role of surgery

Background: Pericardial and pulmonary actinomycosis is a rare disease that remains undiagnosed during life due to a lack of clinical manifestations and a low positive culture rate. Actinomycosis can involve any part of the body. Thoracic actinomycosis is the second most common site after the cervicofacial. Patients with pulmonary actinomycosis usually present with a history of chest pain, cough, fever, shortness of breath on exertion, and sometimes massive hemoptysis. Pericardial involvement has been reported in the medical literature. It is written in line with process case series criteria. Method: From 2008 to 2021, 8 patients, 6 men, and 2 women (mean age 59 y) underwent surgical resection for thoracic lesion initially diagnosed as myofibroblastic tumor on true cut biopsy, but the final histopathologic report revealed actinomycosis. We reviewed preoperative clinical manifestations. Computed tomographic (CT) findings, preoperative true-cut biopsy report, surgical indications, and outcomes. Results: Five patients (62.5%) had poor oral hygiene; 2 patients (25%) had sinusitis, and 1 patient had bronchiectasis (12.5%). Seven patients were symptomatic (87.5%), with hemoptysis, shortness of breath, and weakness. One patient, 12.5%, presented with chest wall mass, chest pain, and fever. The basis of the imaging study (CT thorax). Six patients (87.5%) had CT guided biopsy that revealed a myofibroblastic tumor. In 2 patients (25%), CT scans showed the mass was close to the heart, so a biopsy was not done. We panned a surgical procedure based on the history of hemoptysis and a true cut-biopsy report. Four patients (50%) had a lobectomy, 2 patients (25%) had pericardial resection with a wedge of lung tissues, and 1 patient had chest wall resection enblock with right upper lobectomy. Conclusion: In patients with radiographic findings of pulmonary neoplasm and initial true cut biopsy report showing myofibroblastic tumor, surgery is mandatory. The final histopathology report showed actinomycoses. If the preoperative histopathologic diagnosis is available, then surgery has no role. The ideal treatment is the administration of systemic penicillin therapy. All our patients postoperatively received systemic antimicrobial therapy; they fully recovered and resumed back to everyday life.

Oncoplastic reconstruction of a large chest wall defect using dual fasciocutaneous flaps: A case report.

Introduction and importanceLarge chest wall defects in the context of breast cancer or its sequelae can be challenging to address. Oncoplastic techniques have been demonstrated to be safe and feasible options for immediate reconstruction. We describe the use of dual fasciocutaneous flaps for coverage following resection of a large chest wall mass in an area with a remote history of radiation therapy.Case presentationA 67-year-old woman with a distant history of bilateral mastectomies and adjuvant chemoradiation for Stage IIB triple negative invasive ductal carcinoma presented with an enlarging left chest wall mass and chronic wound. The mass was excised with adequate margins, and the resulting defect was reconstructed with two locoregional fasciocutaneous flaps. Pathology returned negative for malignancy and follow-up demonstrated viable flaps that were healing well.Clinical discussionFasciocutaneous flaps are one of many techniques for breast reconstruction and offer advantages of a relatively superficial dissection, shorter operative time, and decreased risk of functional impairment. They are consequently an attractive option for patients with multiple comorbidities and high risk of perioperative complications. Historically used for immediate reconstruction at the time of oncologic resection, we present its successful use decades after the index cancer operation to manage a chest wall defect secondary to radiation injury.ConclusionsOncoplastic reconstruction with dual fasciocutaneous flaps is a feasible option for a large chest wall defect in the setting of previous radiation.

Woman with chest wall mass and abnormal ECG.

Woman with chest wall mass and abnormal ECG.