Benign primary tumours of the ribs

High PSMA Avidity, Yet Still Benign: The Importance of CT Morphology for Diagnosing Fibrous Dysplasia on PSMA-Targeted PET/CT

ABSTRACT

A 64-year-old man with newly diagnosed prostate cancer underwent 18 F-Piflufolastat PET/CT. Radiotracer avidity localized to the primary prostate malignancy and to a left rib (SUV max , 9.0). The high 18 F-Piflufolastat avidity may have been mistaken for a metastasis if not for the corresponding CT images demonstrating a well-circumscribed sclerotic rim at the site of the PET focus. This CT finding is uncommon for osseous malignancy, but common in benign fibrous dysplasia. Biopsy confirmed benign fibrous dysplasia. This case emphasizes that benign CT morphology may supersede even high avidity on PSMA-targeted PET imaging. Physicians interpreting PET/CT must recognize CT findings that supersede PET findings.

Pediatric Ribs at Chest Radiography: Normal Variants and Abnormalities

Normal variants and abnormalities of the ribs are frequently encountered on chest radiographs. Accurate identification of normal variants is crucial to avoid unnecessary investigations. A meticulous evaluation of rib abnormalities can provide valuable insights into the patient's symptoms, and even when no osseous condition is suspected, rib abnormalities may offer critical clues to underlying conditions. Rib abnormalities are associated with various conditions, including benign tumors, malignant tumors, infectious and inflammatory conditions, vascular abnormalities, metabolic disorders, nonaccidental injuries, malformation syndromes, and bone dysplasias. Abnormalities of the ribs are classified into three groups based on their radiographic patterns: focal, multifocal, and diffuse changes. Focal lesions are further subdivided into nonaggressive lesions, aggressive lesions, and infectious and inflammatory disorders. Radiologists should be aware of individual disorders of the pediatric ribs, including their imaging findings, relevant clinical information, and underlying pathogenesis. Differential diagnoses are addressed as appropriate. Since chest radiographs can suffice for diagnosis in certain cases, the authors emphasize a pattern recognition approach to radiographic interpretation. However, additional cross-sectional imaging may be necessary for focal lesions such as tumors or inflammatory conditions. Awareness of disease-specific imaging findings helps ascertain the nature of the lesion and directs appropriate management. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

A Rare Case of Monostotic Fibrous Dysplasia of the Femoral Neck With Pathological Fracture: A Case Report

Fibrous dysplasia is a rare benign bone disorder characterized by the replacement of normal bone with fibroblastic and osteoblastic tissue. We present a case of monostotic fibrous dysplasia in a 25-year-old male patient. The case highlights the clinical presentation, radiographic features, and management approach for this condition. This report aims to contribute to the understanding of fibrous dysplasia and its management options. A 25-year-old male presented with a chief complaint of persistent left hip pain. The pain was described as a dull ache, associated with difficulty in weight-bearing activities. There was no history of trauma or constitutional symptoms. Physical examination revealed externally rotated left lower limb. Range of motion of the left hip could not be assessed due to pain, with no neurological deficits noted. Initial imaging included plain radiographs of the right femur, which demonstrated a radiolucent lesion with a ground-glass appearance and cortical thinning. Magnetic resonance imaging of both hip joints reveals an irregular T2 hyperintense and T1 hypointense lesion involving the left femoral neck; moreover, few tiny cystic spaces are seen within the lesion. Part of the lesion is extending into the superior-lateral aspect of the femoral head and surrounding bone marrow edema with minimal left hip joint effusion, features suggestive of a primary bony tumour. Plain computed tomography (CT) of the hip joint and pelvis was suggestive of an expansile lytic lesion with thin bony septation within and thick sclerotic margin in the left femoral head and greater trochanter associated with sub-capital femoral neck fracture suggestive of bone neoplasm (? giant cell tumour > simple bone cyst). A bone biopsy was performed, and histopathological examination confirmed the diagnosis of fibrous dysplasia, with characteristic woven bone and fibrous stroma. In this case, after confirming the diagnosis, the patient was managed with total hip arthroplasty on the left side. Monostotic fibrous dysplasia is a rare benign bone disorder that can present with various clinical manifestations. Timely diagnosis through a combination of clinical, radiographic, and histopathological assessments is crucial. Management should be tailored to the patient's symptoms.

Osteoid osteoma of the rib masquerading as pain due to trauma: Removed by rib resection using preoperative CT-scan guidance

Osteoid osteomas (OO) are benign bone tumors that are prevalent in young adults. The typical clinical picture of the disease is pain that worsens at night, which may be alleviated by Non-Steroidal Anti Inflammatory Drugs (NSAIDs). The most common imaging finding of OO is a lytic lesion, known as a nidus, with variable intralesional mineralization, accompanied by bone sclerosis, cortical thickening and surrounding bone marrow edema, as well as marked post-contrast enhancement. The most commonly affected sites are the long bones of the lower limbs, but the ribs are rarely reported sites. The present study describes a case of osteoid osteomas located in the rib which was removed by rib resection using CT-scan guidance.

Osteoid osteoma of the rib: A report of an extremely rare condition

INTRODUCTION

Osteoid osteoma (OO) is a type of benign bone tumor that usually affects long bones of the lower extremities. In this case report, we describe a successful surgical resection of an OO located in the rib which is an extremely rare location.

CASE PRESENTATION

This is a 23-year-old man, referred to our thoracic surgery department for a very intense nocturnal right chest pain for over two months, the physical examination was normal without clinically palpable chest mass. The CT scan showed an osteocondensing lesion at the junction of the middle and posterior arches of the right 6th rib suggesting Ewing's sarcoma, a PET CT was then requested showed an appearance of a regular non-hypermetabolic inhomogeneous condensation at the junction of the middle and posterior arcs of the 6th right rib. After multidisciplinary concertation, a CT-guided biopsy of the lesion was performed, the histological examination of which revealed an osteoid osteoma, then a complete resection of the lesion was performed under posterolateral thoracotomy which histology confirmed a costal osteoid osteoma. The patient is currently in good health condition with complete disappearance of chest pain after one month of the operation and does not present any complications for the long-term follow-up.

DISCUSSION

Osteoid osteoma (OO) is a benign primary bone tumor with unknown pathogenesis. That occurs in patients during the first two decades of life in about 60 to 75% of cases with a strong predilection for long bones, in 60 to 70% of cases. Flat bones, such as the skull, jawbones, innominate bones, and ribs are rarely described (McDermott et al., 1996 [1]). The standard treatment for OO is complete surgical excision, which is offered to the patient when the pain is chronic and not relieved by medical treatment (Osteoid osteoma: the results of surgical treatment [Internet] [2]).

CONCLUSION

The osteoid osteoma of the rib is a very rare entity of bone neoplasms, this is the first case in our department that demonstrates that the OO of the rib must be suspected affront any painful rib and that complete surgical excision when it's possible, is a safe and effective treatment.

Grade 1 and 2 Chondrosarcomas of the Chest Wall: CT Imaging Features and Review of the Literature

The purpose of our retrospective article is to review the CT imaging features of chondrosarcomas of the chest wall with pathologic correlation. For 26 subjects with biopsy-proven chondrosarcomas of the chest wall, two musculoskeletal radiologists retrospectively reviewed 26 CT scans in consensus. Descriptive statistics were performed. The mean tumor size was 57 mm. Twenty (20/26, 77%) chondrosarcomas were located in the ribs and six (6/26, 23%) in the sternum. The majority were lytic (19/26, 73%) with <25% calcification (15/26, 58%), and with a soft tissue mass (22/27, 85%). In this study CT features of grade 1 chondrosarcoma overlapped with those of grade 2 tumors. In conclusion, chondrosarcomas of the chest wall are generally lytic with an associated soft tissue mass, showing little calcified matrix and low-to-intermediate grade.

Benign rib tumors: a case series from tertiary care Centre of Nepal and review of literature

Rib tumors are rare. They can present with wide varieties of symptoms and differentiating benign from malignant lesions is challenging. A careful history and supporting investigations can help to reach the definite diagnosis. Surgical resection is the treatment of choice with excellent prognosis. A total of four patients were operated for the management of rib tumors over a period of 5 years at our institution. All four were benign lesions and included simple bone cyst, fibrous dysplasia with aneurysmal bone cyst, aneurysmal bone cyst and enchondroma. There were three male and one female. None of them is having recurrence till now. Surgical resection is the treatment of choice for benign rib tumors as it provides diagnostic and curative treatment.

Pediatric rib pathologies: clinicoimaging scenarios and approach to diagnosis

Pathologies involving the ribs are diverse in nature, including entities specific to the pediatric population as well as shared pathologies with adults. These can be either localized within or adjacent to the rib, but may also cause rib alteration as a component of a systemic process. To better understand these disorders, we discuss several common rib pathologies in the context of their clinical presentation and pertinent imaging findings. In addition, we review the imaging modalities that may be used to evaluate the ribs. Encompassing both the clinical and imaging aspects of pediatric rib pathologies, this review aims to increase pediatric and musculoskeletal radiologists' awareness of the spectrum of disease and how to leverage a pattern-based approach.

Costal Osteoma: Report of a Case in an Unusual Site

BACKGROUND Osteoma is a benign bone tumor that typically arises in facial bones and less frequently in the long bones. It rarely occurs in the appendiceal skeleton. Pathologic findings are similar to those for parosteal osteosarcoma, periostitis ossificans, and osteoid osteoma. Diagnosing osteoma at an unusual site is always problematic. Here, we present a case of costal osteoma that was found incidentally on screening and produced mild symptoms in the patient. CASE REPORT A 53-year-old man was examined because of a rib mass in the eighth rib on his left side, which had been present for 2 years. A computed tomography scan revealed that the intensely dense mass arose from the external surface of the eighth rib. Microscopic examination showed that the lesion consisted of mature lamellar bone with several Haversian systems, typical of an osteoma. No atypical spindle cells or necrosis were identified. The diagnosis was osteoma. CONCLUSIONS Because the anatomy of the ribs poses a challenge when performing needle biopsy, diagnosing bony lesions solely based on that technique is difficult. The diagnosis of costal osteoma should be made carefully, based on clinical, radiological, and pathological findings. To the best of our knowledge, ours is the first case report about a costal osteoma. It is useful for chest surgeons, pathologists, and radiologists as an example of a rare presentation of this tumor.

Osteoid Osteoma Masquerading as Cholelithiasis: A Case Report

CASE

We present a case report of an 18-year-old woman who presented to a general surgeon with a several month history of intermittent right upper quadrant pain, strongly suggestive of symptomatic cholelithiasis and underwent a laparoscopic cholecystectomy. She was eventually found to have an osteoid osteoma (OO) of the right eighth rib. She was treated with radiofrequency ablation with complete resolution of symptoms 1 month after treatment.

CONCLUSIONS

In cases where a patient's age and risk factors would make the diagnosis of cholelithiasis less likely, OO should be added to the differential diagnosis of symptomatic right upper quadrant pain.

A large aneurysmal bone cyst of the rib

An aneurysmal bone cyst is a very rare benign tumor of the ribs. It mainly involves the long bones and vertebrae, and requires histopathological examination for definitive diagnosis. We present a case of large aneurysmal bone cyst of the left 6th rib in young adult male. The diagnosis of aneurysmal bone cyst should be kept in mind in young patients presenting with an expansile lytic lesion of the rib, because it has an excellent outcome after complete surgical resection.

MR Imaging of Primary Chest Wall Neoplasms

Primary chest wall neoplasms are uncommon and comprise a heterogeneous group of lesions that may be challenging to classify and diagnose. These tumors may be primary or secondary, malignant or benign, and arise from cartilaginous/osseous structures or soft tissues. The role of magnetic resonance (MR) imaging in the evaluation of chest wall tumors continues to expand given its superior soft tissue contrast relative to computed tomography. MR imaging can facilitate differentiation of neoplasms from normal chest wall structures and other disease processes due to infection and inflammation, and can fully characterize abnormalities by demonstrating the various internal components of complex lesions. It is important that radiologists be able to identify key features of primary chest wall neoplasms on MR imaging to provide focused differential diagnoses and guide patient management.

Post-traumatic fibrous dysplasia of the parietal bone: A rare entity

Fibrous dysplasia (FD) is a rare fibro-osseous lesion in which normal bone is replaced by abnormal fibrous tissue. Although a congenital disorder, a single case report of traumatic etiology had been described in the literature. We report a case of monostotic FD of the parietal calvarium in a 21-year-old female patient who presented to us with a single swelling in the parietal region been noticed after head injury sustained at the age of 7 years. After imaging investigations, the lesion was excised via craniotomy followed by cranioplasty in the same sitting. The histopathological evidence was suggestive of FD. To the best of our knowledge, this is the second case of a posttraumatic cranial FD and the first case describing the growing mass in the parietal bone secondary to head injury.

[Conventional radiological diagnosis of benign none neoplasms]

BACKGROUND

Benign bone tumors are of special clinical importance because they might be confused with malignant bone tumors.

OBJECTIVES

The aim of this article it to present the characteristics of benign bone tumors. The focus is orientated towards conventional x‑ray as the essential pillar for primary diagnosis. Consequently, the description of signal intensities of benign bone tumors in magnetic resonance images or less helpful clues like male-female ratios are deliberately omitted.

RESULTS

The classification of bone tumors introduced by Lodwick allows the identification of benign growth patterns. Growth patterns will not help, for example, in case of dedifferentiation of benign chondroid tumors towards chondrosarcomas. Therefore, each diagnosis has to incorporate the patient's clinical scenario. Furthermore, benign bone tumors might also cause aggressive growth patterns. Tumors classified as Lodwick Ic or higher should not be automatically regarded as malignant. Naturally, further clarification is mandatory for these tumors.

CONCLUSIONS

Differentiation between definitely benign bone tumors and those which need further work up is a critical diagnostic step. In the majority of cases, this is possible based on the appearance in conventional x‑ray images. In case of possibly malignant lesions, both the patient's symptoms and the x‑ray morphology have to be considered by orthopedic surgeons, pathologists, and radiologists to determine the optimal diagnostic strategy.

Monostotic fibrous dysplasia of the metacarpal: a case report

Fibrous dysplasia is a bone disease characterized by abnormal differentiation of fibrous tissue in the bones; it is often asymptomatic. It may affect one bone (monostotic) or several bones (polyostotic). The monostotic form primarily affects the ribs, but hardly ever affects the hand. It is important to make the differential diagnosis with malignant bone tumors. This article describes the treatment and outcome of a rare case of a patient admitted with a history of tumor growth in the right hand, diagnosed as fibrous dysplasia of the right second metacarpal. Male patient, 14 years of age, admitted to the Sarah Hospital with lesion on the dorsum of the right hand without pain complaints, previous history of trauma, nor local signs of inflammation. Physical examination revealed swelling on the dorsum of the second metacarpal, painless, with unaltered mobility and sensitivity. Radiography, computed tomography, and magnetic resonance imaging indicated the involvement of the entire length of the second metacarpal: only the distal epiphysis was preserved, with areas of bone lysis. After biopsy confirmation, the patient underwent surgery, using a long cortical graft for reconstructing the metacarpal. During the follow-up period of five years there were no signs of recurrence, and proper digital growth and functionality of the operated hand were observed.

Aneurysmal Bone Cyst Arising from the First Rib: A Rare Cause of Thoracic Outlet Syndrome

Aneurysmal bone cyst is a rare benign cystic bone lesion with an incidence of only 0.14 per 100,000 individuals and most commonly affects the metaphyses of long bones, spine, and pelvis. We present a very rare case of a 17-year-old boy with a rapidly expanding aneurysmal bone cyst arising from the first rib, resulting in neurogenic thoracic outlet syndrome secondary to its compression of the brachial plexus. The patient's symptoms resolved after en bloc resection. To our knowledge there have been no other reports in the literature of thoracic outlet syndrome due to aneurysmal bone cyst arising from the first rib.

[Place of the microscopic examination in the diagnosis of costal fibrous dysplasia]

BACKGROUND

Fibrous dysplasia of bone is a rare benign lesion characterized by the coexistence of a fibrous tissue and an immature osteogenesis. Costal localization is rare and may be monostotic or polyostotic. The diagnosis may be suspected based on clinical and radiological findings. Facing the development of radiological investigations, we tried to highlight the diagnostic role of the microscopic examination through the experience of our department.

METHODS

We describe a retrospective study about 12 costal fibrous dysplasias diagnosed over a 17-year-period. Clinical records were retrieved from the department of thoracic surgery of the same hospital.

RESULTS

Costal fibrous dysplasia is equally observed in men and women with predominance in the third and fourth decades. Clinical symptoms consist mainly in chest pain. Physical examination was normal in almost all cases. Based on the radiological findings, the diagnosis was suspected in 33% of the cases. Microscopic examination highlighted the diagnosis in all cases but it was challenging in one case and necessitated a multi-disciplinary approach. The difficulties encountered were due to artifact decalcification.

CONCLUSION

Costal fibrous dysplasia is a benign lesion which diagnosis is based on microscopic features. Radiologic investigations show nonspecific features but allow to rule out a malignant tumor. The outcome of the patients is generally good except in rare cases with a malignant transformation.

Tumours and tumour mimics in the olecranon

Lesions in the olecranon are rare and may be identified during the investigation of a clinically suspected abnormality or as an incidental finding. This review describes the spectrum of tumours and tumour-like lesions that can involve the olecranon and illustrates the radiographic, CT, and MRI appearances that may facilitate diagnosis. A variety of pathological processes affecting the olecranon are presented and discussed including the epidemiology and imaging features.

Rib tumors: a 15-year experience

OBJECTIVE

A retrospective study of rib tumors was conducted to review their clinical, radiological, and pathological features, the difficulties in differentiating benign from malignant tumors, as well as the early and long-term results of surgical management.

METHODS

All patients with rib lesions evaluated by the Thoracic Surgery Department from 1998 to 2012 were studied. The patient's age, sex, symptoms, radiologic evaluation, surgical procedure, pathologic diagnosis and follow-up were assessed.

RESULTS

Ninety-one patients (81 male, 10 female, age range 16-80) with rib tumors underwent surgery in a period of 15 years (1998-2012). 64 patients (70.33 %) had benign lesions and 27 patients (29.67 %) had malignant tumors. In the group with malignant tumors, the main symptom was pain, and in the group with benign tumors the main symptom was swelling. Ten patients with benign rib tumor and two with malignant tumor were detected during routine chest radiograph. All patients were treated surgically with wide excision of the tumor and the diagnosis was established histologically. In the benign cohort, osteochondromas, fibrous dysplasia, enchondroma, eosinophilic granuloma and posttraumatic fibro-osseous lesion/dysplasia were among the most customary diagnoses. In the malignant cohort, 13 patients (48.15 %) had metastatic lesions, with the remaining 14 patients having primary malignant rib tumor.

CONCLUSIONS

Although radiographic imaging has evolved, all rib lesions must be considered as potentially malignant until proven otherwise. Prompt intervention is necessary and surgery must consist of wide resection with tumor-free margins to provide the best chance for cure in both benign and malignant lesions.

A giant aneurysmal bone cyst of the rib: Case report

An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which most frequently occurs in long bones. An ABC arising from the rib is extremely rare and it is difficult to distinguish from other types of rib tumors. The present study describes an unusual case of a large ABC in the rib of a 17-year-old male. The entity is discussed with particular emphasis on the clinicopathological features, differential diagnosis and treatment. Due to difficulties in the pre-operative diagnosis, a possible diagnosis of ABC should be made aware when confronting an expansile rib mass. An en bloc resection of the mass and the affected portion of the rib is mandatory to obtain a satisfactory outcome.

Tumors of the rib

The authors propose a pictorial review illustrating the imaging features of chest wall tumors and their specific features that discusses the main differential diagnoses. This review is based on published information and on our own experience.

Monostotic fibrous dysplasia of the rib: a case report

Fibrous dysplasia is a noninherited bone disease in which abnormal differentiation of osteoblasts leads to replacement of normal marrow and cancellous bone by immature bone with fibrous stroma. Monostotic fibrous dysplasia accounts for 28% in the ribs. It is often asymptomatic and incidentally detected on radiographs. As with many bone abnormalities, it can be superimposed by the formation of aneurysmal bone cysts. We report a case of a 70-year-old lady who presented with swelling on the chest wall of 20-ear duration and sudden increase in size for 8 months. Radiologically, X-ray and CT scan showed an expansible lesion of the medullary cavity with a ground-glass centre and thinning of cortex of the 5th rib. The resected lesion was a firm, well-defined solid, grey-white expansile mass replacing the medullary cavity. Histopathologically, benign fibrous spindle areas with disorganized irregular bony trabeculae were seen. Hemorrhagic spaces lined by osteoclast-like multinucleated giant cells were also noted. The diagnosis was fibrous dysplasia with aneurysmal bone cyst changes. Although fibrous dysplasia with aneurysmal bone cyst is rare, it should be taken into account in differential diagnosis of the rapidly growing solitary rib lesion.

Thoracic outlet syndrome caused by fibrous dysplasia of the first rib

Fibrous dysplasia causing thoracic outlet syndrome is rare. A 41-year-old woman presented with neurogenic thoracic outlet syndrome with imaging that demonstrated a large tumor of her proximal left first rib. Transaxillary excision was unsuccessful due to involvement of the subclavian vasculature and brachial plexus. Subsequent posterolateral thoracotomy and resection of her first rib revealed fibrous dysplasia. Thoracotomy should be considered in these cases for optimal vascular control and identification of thoracic outlet anatomy.

Monostotic fibrous dysplasia of the ribs

Fibrous dysplasia (FD) is a sporadic benign skeletal disorder that can affect one bone (monostotic form) or multiple bones (polyostotic bone). Around 6-20% of monostotic FD occurs in the ribs. The objective of this study was to report our experience in the management of the monostotic FD of the ribs. Between January 2004 and December 2009, seven cases of FD of the rib (six men and one woman, mean age 30.4 years, range 17-40 years) were operated on. The patients were evaluated with plain radiographs and computer tomography (CT). All our patients were symptomatic; two patients presented chest pain and swelling and other patients presented only chest pain. One rib was involved in all our patients (monostotic form): the site was fifth rib (four cases), sixth rib (two cases) or second rib (one case). Radiologically, plain films and CT showed an expansible lesion with a ground-glass centre and thinning of the cortex. Rib resection was performed in all patients; there were no postoperative complications and no recurrence in all cases at mean 43 month follow-up. In symptomatic monostotic FD of ribs, the involved segment of bone may be excised to rule out malignancy and for painful lesions.

Diagnostic difficulties and delays with chest wall chondrosarcoma: a Swedish population based Scandinavian Sarcoma Group study of 106 patients

BACKGROUND

Bone sarcomas in Sweden are generally referred to a multidisciplinary team at specialized sarcoma centers. This practice is strictly followed for sarcomas of long bones, but not for chest wall chondrosarcomas. Delay in diagnosis and treatment is often considerable for bone sarcomas. This report focuses on the symptoms and diagnostic problems of chest wall chondrosarcoma and factors related to long doctor's delay.

METHODS

The material included all 106 consecutive patients with chondrosarcoma of the chest wall diagnosed in Sweden 1980-2002. Pathological specimens were re-evaluated and graded by the Scandinavian Sarcoma Group pathology board. Files from the very first medical visit for symptoms related to the chondrosarcoma were traced and used to characterize the initial symptoms and calculate patient's and doctor's delay.

RESULTS

The most prominent initial symptom for the chest wall chondrosarcomas was a palpable mass found in 69% (73/106) of the patients at the first visit. Two-thirds of the patients experienced no local chest pain. A tumor was suspected at the first visit in 83% of the patients. Patients delay was median 3 (0-118) months and doctor's delay was 4.5 (0.1-197) months. Doctor's delay was >6 months for 40% of the patients. Patients with an initial plain chest radiograph interpreted as normal (35 patients), and/or normal or inconclusive results of a fine-needle aspiration biopsy had longer doctor's delay. Fine-needle aspiration cytology done at non-specialty units resulted in only 26% correct malignant diagnoses; at sarcoma centers 94% were correctly diagnosed. Long total delay was unfavorable. Patients who died from the chondrosarcoma had longer total delay (p<0.05).

CONCLUSION

Chest wall chondrosarcoma presents as a lump, usually painless. Plain chest radiographs and fine-needle aspiration cytology, when done at a non-specialty center, are often normal or inconclusive. Patients should be referred to sarcoma centers for diagnosis and treatment.

Primary chest wall tumors

The differential diagnosis of chest wall tumors is diverse, including both benign and malignant lesions (primary and malignant), local extension of adjacent disease, and local manifestations of infectious and inflammatory processes. Primary chest wall tumors are best classified by their primary component: soft tissue or bone. Work-up consists of a thorough history, physical examination and imaging to best assess location, size, composition, association with surrounding structures, and evidence of any soft tissue component. Biopsies are often required, especially for soft tissue masses. Treatment depends on histological subtype and location, but may include chemotherapy and radiotherapy in addition to surgical resection.

Tumors of the mediastinum and chest wall

Primary tumors of the mediastinum and chest wall comprise a diverse group of conditions with a wide range of presentations. A thorough knowledge of thoracic anatomy is essential for appropriate diagnosis and treatment. Given their proximity to critical structures, treatment of these tumors is often challenging. Although surgery is the mainstay of therapy for most mediastinal and chest wall tumors, a multidisciplinary approach is valuable in many cases.

Aneurysmal bone cyst of the rib: a case report

Introduction

An aneurysmal bone cyst is a benign, but expansile tumor like lesion that generally occurs in the long bones including the vertebral column. An aneurysmal bone cyst arising from the rib, especially in the elderly, is extremely rare.

Case presentation

We report a 58-year-old Turkish woman with an aneurysmal bone cyst of the right 3rd rib treated with chest wall resection. The pathologic findings confirmed the diagnosis of aneurysmal bone cyst. The patient has been followed up for 5 years with no evidence of recurrence.

Conclusion

En bloc resection can be curative and provide good results for this rare type of chest wall tumor.

[Fibrous dysplasia of the rib. Ten case reports]

PURPOSE OF THE STUDY

Fibrous dyplasia is a rare sporadic disease accounting for 0.8% of primary bone tumors. This benign pseudotumor results from proliferation of fibrous tissue in bone and the production of immature bone tissue without an osteoblastic crown. The disease can involve one or more bones, ribs are rarely involved. We report a series of 10 cases of costal fibrous dysplasia.

CASE REPORTS

This series of 10 cases was collected over a period of 10 years (1996-2005). There were five men and five women, mean age 38.4 years, range 27-52 years. One rib was involved in eight patients, two ribs in two. Pain was the most frequent symptom. Plain X-rays showed signs suggestive of fibrous dysplasia. To confirm the diagnosis, rib resection was performed in all ten patients. Pathology examination provided the diagnosis. The postoperative period was uneventful in all patients and all are recurrence free at mean 50 months follow-up.

DISCUSSION

Management of fibrous dysplasia can be simple surveillance in the majority of patients. Nevertheless, in the event of a single focus, particularly in a rib, fibrous dysplasia can raise a difficult problem of differential diagnosis with malignant tumors. Surgical resection is therefore required in selected cases.