Neglected huge chest wall mass. A case report of fibrous dysplasia

fibrous dysplasia is a slow-growing bone tumor and is caused by the failure of bone maturation. It is usually asymptomatic thus it is generally found incidentally in radiologic evaluations. Computed tomography is the best radiologic modality for its evaluation. The characteristic findings are ground-glass lesions surrounded by a rim or shell of reactive bone.

This study presents a 52-year-old male patient with a huge chest wall tumor arising from the posterolateral aspect of the right fourth to seventh ribs measuring 38 cm. He underwent a thoracotomy and the tumor was resected. For safe margin, the third and eighth ribs were also resected. The defect was reconstructed with a prolene mesh patch and a pectoralis major flap. The final pathology report stated a tumor composed of spindle cells without pleomorphism or mitotic figures with intervening branching and anastomosing bone trabeculae. The margins were tumor-free and on the follow-up, the patient's condition was decent.

Primary tumors of the rib account for 5 % to 7 % of all primary bone neoplasms. Fibrous dysplasia makes up 0.8 % of primary bone tumors. Fibrous dysplasia usually causes no symptoms although it can get massive enough to get symptomatic. Its diagnosis is made through clinical, radiological, and histopathological investigations. CT scan findings are the cornerstone for radiologic evaluations. An individualized approach based on the patient's age and symptoms should be considered.

Considering that the malignant degeneration of the tumor is uncommon, early diagnosis and surgical resection of the tumor can be curative.