Case of an unusual clinical and radiological presentation of pulmonary metastasis from a costal chondrosarcoma after wide surgical resection: a transbronchial biopsy is recommended

Abstract

Chondrosarcomas are the most frequently occurring primary malignant chest wall tumors. Furthermore, the lungs serve as the most frequent sites for metastases. Pulmonary metastases from sarcomas usually appear as round nodules of varying sizes on roentgenograms. Here, we report an unusual clinical and radiographic presentation of pulmonary metastasis from a costal chondrosarcoma. Bilateral pulmonary metastases developed soon after wide surgical resection. Thoracic computed tomography revealed unusual radiological findings: consolidation accompanied with ground-glass opacity. To confirm the metastasis, we recommend a transbronchial biopsy in cases where unusual pulmonary findings are detected.

Figure 1

Preoperative radiological examinations. (a) X-ray showing a mass with coarse calcification located in the right eighth rib, expanding beyond the irregular cortex. (b) CT scan showing a low -density mass with coarse calcification along the right eighth rib; the mass arose at the bone-cartilage border. (c) 3D-CT scan showing destruction of bone and cartilage destruction, with expansive growth of the tumor at the right eighth rib.

Figure 2

Chest CT scan. (a) Preoperative CT scan showing no pulmonary metastasis. (b) Postoperative CT scan showing pulmonary non-segmental consolidation, predominantly in the peripheral lung field, with surrounding ground-glass opacities; no bronchovascular bundle thickness or interlobular septal thickness was observed. The tumor was resected together with the right seventh, eighth, and ninth ribs.

Figure 3

Resected tumor specimen. Hematoxylin and eosin staining of the resected tumor showed a mild increase in cellularity and nuclear atypia. Doubly nucleated cells were seen in the field.

Figure 4

Chest X-ray. Chest roentgenogram showed air-space consolidation with an air bronchogram, predominantly in the right upper and left lower lung fields.

Figure 5

Bronchoscopy. (a) Transbronchial biopsy was performed through the left S8 bronchus. (b) Hematoxylin and eosin staining of the biopsy sample showed a bone tumor in the lumen structure, with the same histological features as the primary bone tumor.