Case report on the approach to surgical management for a large chest wall chondrosarcoma

Primary chest wall tumours are uncommon. Challenges arise in management due to delays in diagnosis and timing of treatment. The mainstay of treatment remains complete resection as adjuvant therapy has a limited role. Choice of repair and materials for chest wall reconstruction vary depending on the size and location of the defect. There are no published reports on management of chondrosarcomas arising from the rib in the Caribbean.

A 61-year-old female was referred from a rural clinic with a 10-month history of a progressively enlarging, painless right anterior chest wall lump. Computed Tomography (CT) shows features of a conventional chondrosarcoma arising from the ribs and including surrounding soft tissue, muscle and pleura. Surgical specimen confirms a grade 2 chondrosarcoma.

This case illustrates the importance of a multidisciplinary team discussion. Differentiating a chondrosarcoma from a benign cartilaginous tumour requires consideration of clinical features, radiological characteristics and histological features. Chest wall reconstruction aims to preserve functional and structural integrity with adequate soft tissue coverage. The patient had good cosmesis as well as pulmonary function postoperatively and no recurrence at the 3 year follow up.

This case highlights that the MDT is essential to a good outcome for the surgical management of a chest wall chondrosarcoma. Wide en-bloc resection followed by reconstruction using polypropylene mesh and a latissimus dorsi flap as a one-stage procedure can be successful.