Chest wall – a structure underestimated in ultrasonography. Part III: Neoplastic lesions

Abstract

Chest wall neoplasms mainly include malignancies, metastatic in particular. Differential diagnosis should include clinical data; tumor location, extent, delineation; the degree of homogeneity; the presence of calcifications; the nature of bone destruction and the degree of vascularization. The aim of the paper is to present both the benefits and limitations of ultrasound for the diagnosis of chest wall neoplasms. The neoplastic process may be limited to the chest wall; it may spread from the chest wall into the intrathoracic structures or spread from the inside of the chest towards the chest wall. Benign tumors basically originate from vessels, nerves, bones, cartilage and soft tissues. In this paper, we briefly discuss malformations of blood and lymphatic vessels, glomus tumor as well as neurogenic tumors originating in the thoracic branches of the spinal nerves and the autonomic visceral system. Metastases, particularly lung, breast, kidney cancer, melanoma and prostate cancer, are predominant tumors of the osteocartilaginous structures of the chest wall. Plasma cell myeloma is also relatively common. The vast majority of these lesions are osteolytic, which is reflected in ultrasound as irregular cortical defects. Osteoblastic foci result only in irregular outline of the bone surface. Lipomas are the most common neoplasms of the chest wall soft tissue. Elastofibroma is another tumor with characteristic echostructure. Desmoid fibromatosis, which is considered to be a benign lesion with local aggressivity and recurrences after surgical resection, represents an interesting tumor form the clinical point of view. Ultrasonography represents an optimal tool for the monitoring of different biopsies of pathological lesions located in the chest wall. Based on our experiences and literature data, this method should be considered as a preliminary diagnosis of patients with chest wall tumors.

Histological, epidemiological and anatomical analysis of 193 bone tumours of the scapula

“…Several studies have reported on bone tumours in other flat bones, like the skull, pelvis, sternum, and ribs [24], [25]. Bone metastases mainly from lung, breast, kidney and prostate cancer, as well as plasma cell myeloma are relatively common bone tumours of the ribs and sternum, while primary malignant bone tumours are rare [24], [25]. The most frequent primary malignant tumour of the ribs and sternum is chondrosarcoma [24], [25].…”

“…Bone metastases mainly from lung, breast, kidney and prostate cancer, as well as plasma cell myeloma are relatively common bone tumours of the ribs and sternum, while primary malignant bone tumours are rare [24], [25]. The most frequent primary malignant tumour of the ribs and sternum is chondrosarcoma [24], [25]. Less common primary malignant tumours are Ewing sarcoma and Osteosarcoma [24].…”

“…Less common primary malignant tumours are Ewing sarcoma and Osteosarcoma [24]. Other rare bone tumours of the ribs and sternum, which should be considered, include fibrous dysplasia, chondroma, aneurysmal bone cyst, and giant cell tumor [25]. In a series of 270 patients with pelvic bone tumours, who were treated by surgical resection, the authors found that chondrosarcoma was the most common bone tumour (149 cases), followed by Ewing sarcoma (40 cases), osteosarcoma (27 cases), benign bone tumours (25 cases), other malignant tumours (18 cases), and bone metastases (11 cases) [26].…”

Chest pain without a clue-ultrasound to rescue occult multiple myeloma: A case report

“…The vast majority of such tumors are osteolytic. Ultrasound detection of osseous defects is possible only after the damage of the anterior compact substance[9].…”