Review of chest wall tumors: a diagnostic, therapeutic, and reconstructive challenge

Abstract

Chest wall tumors are a heterogeneous group of lesions that provide an interesting diagnostic and therapeutic challenge for surgeons. They make up less than 5% of thoracic malignancies and vary widely in pathology as they arise from all anatomic structures of the chest wall. In general, treatment is wide local excision, the margins for malignant disease are necessarily wider, and adjuvant radiation is typically given for those with positive margins. Chemotherapy is rarely effective. Local control is the most important prognostic factor. Disease-free survival for malignant disease is limited by positive margins; therefore full oncologic resection with 4-cm margins should be attempted. For small lesions, the resection and reconstruction is usually straightforward. For more advanced disease or those lesions that require significant functional loss, preoperative planning using a multidisciplinary approach, incorporating thoracic surgery, plastic surgery, neurosurgery, radiation medicine, oncology, and physical medicine and rehabilitation, may be essential.

Keywords: Chest wall tumor; chest wall resection; primary chest wall tumor.

Figure 1

Anterior chest wall mass in an 80-year-old farmer.

Figure 2

(A) CT image of a posterior chest wall sarcoma presenting as a painless growing mass in a 61-year-old man. (B) MRI scan of chest wall mass demonstrating heterogeneity. (C) PET CT image of an isolated metastatic left anterior chest wall lesion from breast cancer.

Figure 3

Methyl methacrylate and mesh reconstruction of the right anterior chest wall seen on a follow-up CT.

Figure 4

(A) CT image of a desmoid tumor arising in a young woman below an augmentation mammoplasty implant. (B) Intraoperative photograph of the resection of the anterior chest wall ribs with the underlying lung. (C) Intraoperative photograph of the methyl methacrylate and mesh reconstruction. (D) Postreconstruction, the approach through an inframammary incision with an additional lateral wound excision of the biopsy site.

Figure 5

(A) Sternectomy specimen from an excision of chest wall metastasectomy, after radiation therapy. (B) Intraoperative photograph of the bed of resection demonstrating the lung and underlying pericardium. (C) Reconstruction created from mesh and methyl methacrylate. (D) Reconstruction being secured in place.

Figure 6

Follow-up CT image of anterior sternal reconstruction.