ANTERIOR CHEST-WALL MALIGNANCIES - A REVIEW OF 10 CASES

Objectives. To report the features of malignancies responsible for a c hest wall mass and involving the sternum, the sternocostal and/or ster noclavicular joints, the chondrocostal junction and/or the adjacent so ft tissues. Methods. The medical records of patients with a chest wall mass due to malignant disease were reviewed retrospectively. The foll owing data were abstracted from each record: characteristics of the pa in and mass, constitutional symptoms, physical findings, laboratory te st results, findings from imaging studies (plain radiographs, computed tomography and magnetic resonance imaging of the chest, radionuclide bone scan), histologic features of the biopsy specimen from the chest wall mass and origin of the mass. Results. Seven men and three women w ith a mean age of 53.1 years were included in the study. A single pati ent had a history of malignant disease (lymphoma); in the remaining ni ne patients the chest wall mass was the first manifestation of the mal ignancy. All ten patients had pain with a mixed time pattern. The mass was located on the sternum in half the patients and in a parasternal location in the other half. Erythrocyte sedimentation rate elevation w as found in seven patients, an increased serum level of lactate dehydr ogenase in one and a monoclonal immunoglobulin in three. Sternal lesio ns were visible on plain radiographs in four patients. Computed tomogr aphy of the chest consistently disclosed sternal or sternocostal lytic lesions with spread to the adjacent soft tissues; in five cases, enla rged lymph nodes were visible in the anterior part of the mediastinum. Magnetic resonance imaging of the chest did not add to the informatio n provided by computed tomography. Radionuclide uptake on the bone sca n was increased, decreased, or normal at the site of the lesion. The c ause was Hodgkin's disease in two cases, non-Hodgkin's lymphoma in thr ee, metastatic bone disease in two (from an adenocarcinoma of the lung and a hepatocarcinoma, respectively), multiple myeloma in one, and so litary plasmacytoma in two. Conclusion. A chest wall mass can be cause d by a known or as yet undiagnosed malignancy. Chest wall involvement due to malignant disease is rare, however. The specific features of st ernal metastases, lymphomas involving the sternum, and sternal plasmac ytomas are discussed. Nonmalignant chest wall lesions that can manifes t as a bulging or swelling of the chest wall are reviewed.