An Uncommon Case of a Chest Wall Mass: A True Medical Challenge

SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Chest wall primary malignant tumors are among the rarest cartilaginous tumors, accounting for 8% of cases. Overall, 5-year survival rates for grade 1 chondrosarcomas are 90% to 94%, while those for grade 3 are 43% to 44%. CASE PRESENTATION: A 66 year-old Hispanic male with medical history of hypertension treated with lisinopril, with a progressive growing mass on the right side of his chest since 5 years ago. Physical findings remarkable for a round mass measuring approximately 25 centimeters on the right chest wall. Chest imaging studies including computer tomography and magnetic resonance, showed a large right chest wall mass measuring 17 x 20 x 18 cm, which originated posterior to the right pectoralis major muscle with extension into the mediastinum and right middle lobe, producing complete destruction and encasement of the anterior chest wall on the right side including the anterior right ribs and right surface of the sternum. An open biopsy yielded positive results for high grade chondrosarcoma. Despite receiving treatment with chemotherapy regimen, no evidence of improvement was noted. An excision in block of 5 ribs, along with the left lateral portion of sternum was performed. Chondrosarcoma was excised with a final measurement of 27 x 24 x 17 cm and weighing 10 pounds.The chest wall was reconstructed with marlex mesh and methyl metacrylate. Final biopsy results for specimen were positive for p53 mutation. DISCUSSION: Primary chest wall Chondrosarcoma are uncommon. A chest wall mass and chest pain are the typical clinical presentation. Computed tomography and magnetic resonance imaging are useful to characterize the tumor and its extension. Procedures for tissue diagnosis have been diverse including fine needle aspiration cytology, core needle biopsy, mediastinoscopy, video assisted thoracoscopy and open biopsy. Mutations in p53, as in our patient, are associated with tumor progression. Wide surgical excision remains the best available treatment for intermediate to high grade tumors. CONCLUSIONS: It is generally believed that because of their extracellular matrix, low percentage of dividing cells, and poor vascularity, chondrosarcomas are relatively chemo and radiotherapy resistant. It is imperative to perform a prompt identification and correct treatment in order to improve mortality among these patients. Reference #1: Mukherjee K, Pal M, Saha E et al. Giant Chondrosarcoma of Chest Wall. The Indian Journal of Chest Diseases & Allied Sciences:2013;Vol.55. DISCLOSURE: The following authors have nothing to disclose: Michael Cruz Caliz, Iván González Cancel, Ricardo Fernandez, Modesto Gonzalez-del Rosario, Aixa Dones Rodriguez, Kelvin Rivera Manzano, Hiram Jose Maldonado Quintana, Joel Nieves Scharon No Product/Research Disclosure Information