Chest Wall Tumor

Author: Utsav Soni, MD; Douglas J Mathisen, MD
Institution: Massachusetts General Hospital
Date Reviewed: April 2014
Learning Domain: General Thoracic
Learning Objective: Role of chemotherapy, different types of mesh in chondrosarcoma  of the sternum/costal cartilage
PowerPoint File: Chest Wall Tumor

Discussion Points for Conference

• What would the work up include?
  • CT Scan Chest with contrast, 
  • PET or Bone Scan looking for other abnormalities
  • MRI may help
  • Bone Scan positive for the known lesion only
• Surgical biopsy of the lesion
  • FNA in well differentiated tumors do not provide enough sample
  • Histologic Classification:  Grade 1 Chondrosarcoma.
  • Small lesions might be excised w/o biopsy  but incisional is preferred to know the diagnosis for the planning of treatment.
  • Incision of the margin from the biopsy is best excised with the removal of the specimen.
• Role of chemotherapy in Chondrosarcoma.
  • It is helpful in dedifferntiated chondrosarcoma of Grade 2 and higher.
•  Role of Radiation therapy: 
  • Adjuvant external beam radiation for all primary chest wall tumors typically is reserved for R1 or R2 resections or in cases where the margin, while negative, lies close to the tumor.

Learning Points

• Low grade Chondrosarcomas resistant to chemotherapy/XRT.
• Treatment of post op wound infection
• Biological mesh can be implanted at sites of contamination. Superior to synthetic meshes.
• Complete resection of the tumor along with margins reduces the incidence of recurrence.
• Role of PET vs Bone Scan.
• Primary vs Adjunct Chemotherapy?
• Role of MRI vs CT scan.