Editing Chest wall tumours (section)

== Bone and cartilage ==

* Benign
** Fibrous dysplasia
*** Most common benign lesion in the rib - progressive replacement of calcified bone and marrow with fibrous tissue due to abnormal proliferation of BM stromal cells
*** Usually either incidental finding or bone pain at site
*** CT is best for diagnosis, bone scans can be helpful
*** Biopsy can be performed if diagnostic uncertainty
*** Management guided by symptoms - can be resected if necessary
** Osteochondroma
*** Osseous growth with cartilaginous cap on the affected bone
*** Can present with pathological fracture or chronic pain
*** CT good for diagnosis
*** Malignant transformation rare
*** Indications for resection: chronic pain, impingement, cosmesis, fast growing tumour
**** Entire cartilaginous cap should be removed to prevent recurrence
*** If more than one osteochondroma, hereditary cause suspected
** Chondroma
*** Cartilaginous cyst that can arise completely within or on the surface of bone
*** Hyaline cartilage producing tumours
*** Usually incidental
*** MRI more sensitive than CT for detecting malignant degeneration
*** Resection reserved for pathologic fractures or a concern for secondary chondrosarcoma, although can do early resection if it's easily accessible
** Aneurysmal bone cyst
*** Not really a cyst, more of a benign skeletal tumour
*** Commonly presents with pain or pulmonary symptoms from compression
*** Can grow >10cm in size
*** CT or MRI are good for diagnosis
*** Biopsy usually inconclusive and just results in blood products
*** Curative treatment is resection - no huge urgency but can cause secondary symptoms
* Malignant
** Osteosarcoma
*** Most commonly a tumour of long bones in children and adolescents - uncommon in chest wall
*** Classically presents with pain severe enough to wake from sleep
*** CT diagnostic
*** WLE mainstay of treatment - can remove ribs/most of sternum with immediate reconstruction
*** Neoadjuvant CTX is effective
** Chondrosarcoma
*** Most common primary malignancy of sternum
*** Commonly causes pain and swelling
*** CT is best diagnosis, with MRI reserved for determining pattern of invasion
*** Histology is usually distinctive enough to be diagnostic
*** Complete resection desired for initially therapy with at least 4mm margins
*** Treatment of disseminated disease is essentially palliative
*** CTX and RTX is often given but not that effective
** Ewing's sarcoma
*** Most common chest wall tumour in paeds
*** Pathologic fracture, pain, swelling, fever, constitutional symptoms
*** CT good
*** Result of chromosome 22 translocation
*** Open biopsy is better than core needle, but imaging may be definitive enough to proceed with resection
*** Margin-free resection is critical with immediate reconstruction
*** Adjuvant CTX