Tumors of the chest wall refer to neoplasms originating from the deep soft tissues, muscles, or bones of the chest wall. They can be classified into two categories: primary and metastatic. Primary chest wall tumors are further divided into benign and malignant types. Among bone-originating primary tumors, 80% arise from the ribs and 20% from the sternum. Tumors are more commonly found in the anterior and lateral chest wall than in the posterior chest wall. Common benign skeletal tumors include fibrous dysplasia, osteomas, chondromas, and osteochondromas. Among malignant tumors, sarcomas are the most frequent, with chondrosarcomas accounting for approximately 30% to 40% of cases. Tumors arising from deep soft tissues include nerve tumors, lipomas, fibromas, hemangiomas, and various types of sarcomas. Metastatic chest wall tumors originate from malignancies in other locations and most commonly metastasize to the ribs. This often leads to localized bone destruction or pathological fractures of the ribs, resulting in pain, though visible masses are usually absent.
Diagnosis
Diagnosis primarily depends on the patient’s medical history, symptoms, and the characteristics of the mass. Rapid growth, indistinct borders, surface vascular dilation, and pain are often indicative of malignancy. Hard, bone-like masses with distinct borders and slow growth are typically benign bone or cartilage tumors. Chest CT scanning helps facilitate diagnosis and differential diagnosis. For further confirmation, tumor needle biopsy or incisional biopsy may be performed when necessary. Biopsy can be combined with surgery during the same session in certain cases.
Treatment
Small, asymptomatic, clearly diagnosed benign primary chest wall tumors may be managed with regular follow-up and observation. Primary chest wall tumors of uncertain nature require surgical removal for diagnostic confirmation. For metastatic chest wall tumors, surgical treatment may be considered if the primary tumor has already been removed. Malignant tumors require en bloc removal of involved chest wall tissues, including affected muscles, bones, intercostal tissues, parietal pleura, and regional lymph nodes. For large chest wall defects following resection, simultaneous chest wall reconstruction is necessary. Radiotherapy and chemotherapy may offer some benefit for certain inoperable malignant tumors and are generally considered as part of comprehensive treatment plans.