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Preoperative radiological examinations. (a) X-ray showing a mass with coarse calcification located in the right eighth rib, expanding beyond the irregular cortex. (b) CT scan showing a low -density mass with coarse calcification along the right eighth rib; the mass arose at the bone-cartilage border. (c) 3D-CT scan showing destruction of bone and cartilage destruction, with expansive growth of the tumor at the right eighth rib.
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Figure 1: Preoperative radiological examinations. (a) X-ray showing a mass with coarse calcification located in the right eighth rib, expanding beyond the irregular cortex. (b) CT scan showing a low -density mass with coarse calcification along the right eighth rib; the mass arose at the bone-cartilage border. (c) 3D-CT scan showing destruction of bone and cartilage destruction, with expansive growth of the tumor at the right eighth rib.

Mentions: A 62-year-old woman was admitted to our hospital because of a mass that grew gradually in the right lateral chest wall for 1 year. Physical examination revealed a tumor (5 × 3.5 cm) in the right eighth rib. The mass was hard with an unclear border, no mobility, redness, or local heat, but it was tender. An X-ray revealed a mass with coarse calcification located on the right eighth rib, expanding beyond the irregular cortex. Thoracic CT revealed a 70 × 60 × 30 mm low-density mass (CT value, +18 HU) along the right eighth rib; it arose at the bone-cartilage border and destroyed these tissues (Figure 1a-c). No pulmonary metastasis was observed (Figure 2a). Other metastatic workup, including PET scan, was negative. The physical examination and imaging findings strongly indicated primary chondrosarcoma. Therefore, wide surgical resection was performed without performing a biopsy; the tumor was resected together with the right seventh, eighth, and ninth ribs. Transverse rib resection was performed >4 cm from the tumor in both directions. The chest wall was reconstructed using a Dexon mesh® (US Surgical, Connecticut, USA). Histological examination revealed a grade II chondrosarcoma with increased cellularity and myxoid stroma (Figure 3). All resected surgical margins were wide. The postoperative course was uneventful, and the patient was discharged 2 weeks after the operation.

Case of an unusual clinical and radiological presentation of pulmonary metastasis from a costal chondrosarcoma after wide surgical resection: A transbronchial biopsy is recommended

Emori M, Hamada K, Kozuka T, Nakanishi K, Tomita Y, Naka N, Araki N - World J Surg Oncol (2011)

Bottom Line: Bilateral pulmonary metastases developed soon after wide surgical resection.Thoracic computed tomography revealed unusual radiological findings: consolidation accompanied with ground-glass opacity.To confirm the metastasis, we recommend a transbronchial biopsy in cases where unusual pulmonary findings are detected.

Affiliation: Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan. emrmkt@yahoo.co.jp

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