Chest wall tumours can be divided into benign or malignant tumours of soft tissue or bone. Common benign soft tissue tumours include haemangioma and lymphangioma, while fibrous dysplasia and aneurysmal bone cyst are benign bone tumours. Primary malignant lesions are often metastases. Primary chest wall cancers include chondrosarcoma, osteosarcoma, and Ewing's sarcoma. Surgical resection is the main treatment, with reconstruction of large defects using mesh or flaps.

1. CHEST WALL TUMOURS
• The chest wall plays host to a
variety of tumours, some of which
are found most often in this region.
They can be divided into benign and
malignant tumours and into those
which arise in the rib cage and those
of soft tissue density.

2. Benign
• Benign tumours include :
• soft tissue
• haemangioma : common
• lymphangioma : common
• lipoma
• schwannoma
• neurofibroma
• ganglioneuroma
• paraganglioma

3. Skeletal (ribcage)
• fibrous dysplasia : common
• aneurysmal bone cyst (ABC) : common
• giant cell tumour (GCT)
• ossifying fibromyxoid tumour
• chondromyxoid fibroma
• osteochondroma
• mesenchymal hamartoma of chest wall -
sometimes even considered a developmental
anomaly

4. Malignant
• The most common malignant lesions are metastases.
Classification of Lesions include :
• soft tissue
• rhabdomyosarcoma : common
• Ewing sarcoma :
• ganglioneuroblastoma
• neuroblastoma
• angiosarcoma
• leiomyosarcoma
• malignant fibrous histiocytoma (MFH)
• malignant peripheral nerve sheath tumour
• dermatofibrosarcoma protuberans

5. • Skeletal (ribcage)
• chest wall metastases : common
• myeloma
• chondrosarcoma
• osteosarcoma

6. MAIN POINTS
• Primary Chest wall tumors are rare
• Metastases to the chest wall from a variety of
primaries( including– Breast, Thyroid, Renal,
Lung and Prostate) are common place.
• Malignant tumors can arise from any of the
elements of chest wall, but most arise from
bone or cartilage
• Benign disorders occur as often as Primary
Malignant Tumors, the commonest being
Chondro -Sarcoma

7. PRESENTATION
• Tumors of the Chest wall usually present with
pain and a palpable mass , although some are
found incidentally on chest radiography
• Most require further imaging with CT and/or
MRI
• These can be combined with per cutaneous
biopsy but often the diagnosis is made from
an open Biopsy

8. • For small tumours an excision Biopsy
can be both diagnostic and curative
• Larger tumors may need to have the
diagnosis confirmed by an incision
biopsy before an radical excision is
undertaken

9. • The incision biopsy site should be fully
excised at subsequent surgery to avoid
the risk of tumor seeding.
• If the incision biopsy is inconclusive a
radical resection is performed, because
this is the only effective method of
treating those tumors that ultimately
turn out to be malignant.

10. BENIGN TUMOURS
• Chondromas develop in ribs and costal
cartilages, occasionally becoming huge( giant
chondromas)
• They usually appear as rounded
homogenous masses on chest x ray, although
they can contain stippled calcification
• All chondromas should be excised, because
differentiation from a chondro sarcoma is
rarely possible

11. FIBROUS DYSPLASIA
• Fibrous Dysplasia affects the ribs , producing
typical radiological appearances of an
expanded thin bone cortex with a
trabeculated radioluscent core . Exscisional
biopsy is however almost always indicated
because percutaneous needle biopsy is
unreliable and resection is usually warranted
to alleviate symptoms
• Recurrence is extremely rare

12. MALIGNANT TUMOURS
• Chondrosarcoma is the commonest primary
chest wall tumours
• Its clinical,radiological,and incision biopsy
features are often identical to those of benign
cartilaginous tumours
• Treatment is by Surgical Resection, because the
tumour is not radiosensitive
• The prognosis is dependent primarily upon the
histological grade and its completeness of
resection

13. FIBROSARCOMAS
• Often produce radiolucent erosions of the ribs.
• Per cutaneous or incision biopsy is diagnostic
when the characteristic features of disorganized
collagen formation are present
• The prognosis is poor, but reasonable survival
can follow wide excision of a low grade tumour.
• Post operative irradiation may be given to try
and provide local control of the tumour.

14. EWING’S SARCOMA
• Ewing Sarcoma of chest wall is rare
• It is a radiosensitive tumor, and the best
management probably combines wide excision
and a histologically clear margin with
radiotherapy and multi agent chemotherapy.
• All malignant tumors should be widely excised
and this will often include the whole of the
involved ribs and one further rib on either side.,
because these tumors may extend through the
inter costal space

15. • Frozen section may be sent to confirm
tumor free margins.
• Sternal tumors should be treated by
excision of the whole sternum and its
attached costal cartilages
• The method of reconstruction depends
on the size and site of the defect and the
chest wall vascularity, because this may
be affected by previous surgery or
radiotherapy.

16. • Small defects don't usually need
to be reconstructed , especially
those that underlie the scapula.
• Larger defects should be closed
to protect the underlying
structures and to maintain the
chest wall mechanics and correct
shape.

17. • POLYPROPYLENE mesh is often used and this can
be constucted in two layers with methyl
methacrylate cement between.
• The bone cement is shaped to the contour of the
chest wall and the marlesh mesh is sutured to the
surrounding structures.
• The soft tissue defect can be closedby pectoralis
major, latissimus dorsi or rectus abdominis
myocutaneous flaps.
• Peducled greater omentum or microvascular flaps
have been used for this purpose.

18. TUMOURS OF PLEURA
• BENIGN TUMOURS
• Benign fibrous tumors of the pleura are
sometimes called solitary fibrous tumors.
They make up approximately 78% to 88% of
non-mesothelioma tumors of the pleura.
Fibrous tumors of the pleura are much less
common than mesothelioma tumors of the
pleura.
• Benign fibrous tumors of the pleura are
confined to the surface of the lung, where
they start.

19. MALIGNANT TUMOURS OF PLEURA
• PRIMARY
• MALIGNANT MESOTHELIOMA
• SECONDARY
• DIFFUSE SEEDLING OF THE PARIETAL AND
VISCERAL PLEURA IS A COMMON PATTERN
OF DISSEMINATION OF CANCERS ,
PARTICULARLY ADENOCARCINOMA OF ANY
ORIGION

20. MEDIASTINAL TUMOURS
• The mediastinum is divided into three sections:
• The anterior (front)
• The middle
• The posterior (back)
• Mediastinal tumors are benign or cancerous
growths that form in the area of the chest that
separates the lungs. This area, called the
mediastinum, is surrounded by the breastbone
in front, the spine in back, and the lungs on
each side. The mediastinum contains the
heart, aorta, esophagus, thymus and trachea.
•

21. MEDIASTINUM

22. • Mediastinum tumors are mostly made
of reproductive (germ) cells or develop
in thymic, neurogenic (nerve), lymphatic
or mesenchymal (soft) tissue.
• In general, mediastinal tumors are rare.
Mediastinal tumors are usually
diagnosed in patients aged 30 to 50
years, but they can develop at any age
and form from any tissue that exists in
or passes through the chest cavity.

23. • Anterior (front) mediastinum
• Germ cell - The majority of germ cell
neoplasms (60 to 70%) are benign and
are found in both males and females.
• Lymphoma – Malignant tumors that
include both Hodgkin’s disease and non
Hodgkin’s lymphoma.
• Thymoma - The most common cause
of a thymic mass, the majority of
thymomas are benign lesions that are
contained within a fibrous capsule.

24. • However, about 30% of these
may be more aggressive and
become invasive through the
fibrous capsule.
• Thyroid mass mediastinal –
Usually a benign growth, such as
a goiter, these can occasionally
be cancerous.

25. • Middle mediastinum
• Lymphadenopathy mediastinal –
An enlargement of the lymph
nodes.
• Pericardial cyst – A benign
growth that results from an "out-
pouching" of the pericardium (the
heart’s lining).
• Thyroid mass mediastinal –
Usually a benign growth, such as a
goiter.

26. • These types of tumors can
occasionally be cancerous.
• Tracheal tumors – These
include tracheal neoplasms and
non-neplastic masses, such as
tracheobronchopathia
osteochondroplastica (benign
tumors).

27. • Posterior (back) mediastinum
• Lymphadenopathy mediastinal – An
enlargement of the lymph nodes.
• Neurogenic neoplasm mediastinal – The
most common cause of posterior mediastinal
tumors, these are classified as nerve sheath
neoplasms, ganglion cell neoplasms, and
paraganglionic cell neoplasms.
• Approximately 70% of neurogenic neoplasms
are benign. Oesophageal neoplasm can be
there

28. • Paravertebral abnormalities
including infectious, malignant and
traumatic abnormalities of the
thoracic spine.
• Thyroid mass mediastinal – Usually
a benign growth, such as a goiter,
which can occasionally be
cancerous.
• Vascular abnormalities – Includes
aortic aneurysm