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Chest Wall Tumors: Radiologic Findings and Pathologic Correlation

Part 1. Benign Tumors¹

¹ From the Divisions of Diagnostic Radiology (U.T., M.K., N.M.), Pathology (T.H.), Orthopedics (R.Y.), and Thoracic Surgery (R.T.), National Cancer Center Hospital and Institute, 5-1-1, Tsukiji, Chuo-Ku, 104-0045, Tokyo, Japan; Division of Diagnostic Imaging, M. D. Anderson Cancer Center, Houston, Tex (G.W.G.); and Division of Orthopedics, National Kyushu Cancer Center, Fukuoka, Japan (R.Y.). Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received December 20, 2001; revision requested February 22, 2002; final revision received April 22, 2003, and accepted April 25. Supported in part by grant for Scientific Research Expenses for Health and Welfare Programs, the Foundation for the Promotion of Cancer Research, and 2nd-term Comprehensive 10-year Strategy for Cancer Control. Address correspondence to U.T. (e-mail: utateish@ncc.go.jp).

View larger version (165K): [in a new window]   Figure 1a.  Cavernous hemangioma in a 46-year-old man. (a) Axial T1-weighted (repetition time msec/echo time msec = 600/12) magnetic resonance (MR) image obtained with a surface coil at the level of the liver (L) shows an ill-defined soft-tissue mass in the right chest wall. The tumor appears as an area of heterogeneous hyperintense signal relative to the signal intensity of adjacent muscle (arrows). (b) Axial gadolinium-enhanced T1-weighted (600/12) fat-suppressed MR image shows heterogeneous enhancement and distended vessels (arrow) in the tumor.

View larger version (171K): [in a new window]   Figure 1b.  Cavernous hemangioma in a 46-year-old man. (a) Axial T1-weighted (repetition time msec/echo time msec = 600/12) magnetic resonance (MR) image obtained with a surface coil at the level of the liver (L) shows an ill-defined soft-tissue mass in the right chest wall. The tumor appears as an area of heterogeneous hyperintense signal relative to the signal intensity of adjacent muscle (arrows). (b) Axial gadolinium-enhanced T1-weighted (600/12) fat-suppressed MR image shows heterogeneous enhancement and distended vessels (arrow) in the tumor.

View larger version (140K): [in a new window]   Figure 2.  Glomus tumor in a 61-year-old man. Coronal gadolinium-enhanced T1-weighted (570/12) MR image at the level of the tracheal bifurcation (T) shows multiple enhancing masses (arrows) with ill-defined margins in the chest wall.

View larger version (106K): [in a new window]   Figure 3.  Schwannoma in a 43-year-old man. Axial nonenhanced CT scan of the right side of the chest wall depicts an extrapleural nodule that originated from intercostal soft tissue along the course of an intercostal nerve. The presence of heterogeneous attenuation (arrowhead) indicates myxoid degeneration, which is found occasionally in small lesions like this one.

View larger version (101K): [in a new window]   Figure 4.  Neurofibroma in a 26-year-old man with type 1 neurofibromatosis. Coronal T2-weighted (6,000/112) MR image of the thoracic inlet shows intraforaminal and perineural extension of a tumor (arrows) that has a targetlike appearance (ie, a center with signal intensity lower than that in the periphery).

View larger version (111K): [in a new window]   Figure 5a.  Ganglioneuroma in an asymptomatic 57-year-old woman. (a) Axial T2-weighted (6,000/112) MR image of the left ventricle (LV) shows curvilinear areas of low signal intensity (arrowheads) in the tumor, which give it a septated appearance. The tumor had a broad base and was attached to several vertebral bodies. (b) Photograph of the cut surface of the resected specimen shows fibrous septa (arrowheads) that correspond to the curvilinear areas of low signal intensity on the T2-weighted MR image.

View larger version (89K): [in a new window]   Figure 5b.  Ganglioneuroma in an asymptomatic 57-year-old woman. (a) Axial T2-weighted (6,000/112) MR image of the left ventricle (LV) shows curvilinear areas of low signal intensity (arrowheads) in the tumor, which give it a septated appearance. The tumor had a broad base and was attached to several vertebral bodies. (b) Photograph of the cut surface of the resected specimen shows fibrous septa (arrowheads) that correspond to the curvilinear areas of low signal intensity on the T2-weighted MR image.

View larger version (105K): [in a new window]   Figure 6.  Paraganglioma in a 23-year-old man. Coronal reformatted image from a contrast-enhanced multidetector CT study of the thoracic spine shows an extrapleural spindle-shaped mass (M) with relatively homogeneous attenuation in the left paravertebral region. The apparently noninvasive well-demarcated mass was discovered at resection to be attached to the sympathetic nerve (arrow).

View larger version (110K): [in a new window]   Figure 7a.  Osteochondroma in a 39-year-old woman. (a) Axial contrast-enhanced CT scan at the level of the left atrium (A) shows a dense calcification (arrowhead) that projects medially from a right rib. (b) Axial T2-weighted (6,000/112) MR image of the right side of the chest wall obtained with a surface coil shows a cartilaginous apical cap (arrow), which has a slightly higher signal intensity than does muscle.

View larger version (124K): [in a new window]   Figure 7b.  Osteochondroma in a 39-year-old woman. (a) Axial contrast-enhanced CT scan at the level of the left atrium (A) shows a dense calcification (arrowhead) that projects medially from a right rib. (b) Axial T2-weighted (6,000/112) MR image of the right side of the chest wall obtained with a surface coil shows a cartilaginous apical cap (arrow), which has a slightly higher signal intensity than does muscle.

View larger version (113K): [in a new window]   Figure 8a.  Aneurysmal bone cyst in a 54-year-old woman. (a) Nonenhanced CT scan at the level of the clavicle (C) shows an expansile lytic mass (M) in the medial left area of the clavicle. The mass is not well differentiated from the overlying muscle. (b) Axial T2-weighted (6,000/112) MR image shows a mass with overall signal intensity higher than that of fat. The mass contains regions with the signal intensity of fluid (arrow), as well as multiple septa with low signal intensity (arrowheads). (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows osteoclast-like giant cells and fibroblasts with blood-filled spaces (arrows) that account for the fluid-fluid level seen on MR images.

View larger version (125K): [in a new window]   Figure 8b.  Aneurysmal bone cyst in a 54-year-old woman. (a) Nonenhanced CT scan at the level of the clavicle (C) shows an expansile lytic mass (M) in the medial left area of the clavicle. The mass is not well differentiated from the overlying muscle. (b) Axial T2-weighted (6,000/112) MR image shows a mass with overall signal intensity higher than that of fat. The mass contains regions with the signal intensity of fluid (arrow), as well as multiple septa with low signal intensity (arrowheads). (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows osteoclast-like giant cells and fibroblasts with blood-filled spaces (arrows) that account for the fluid-fluid level seen on MR images.

View larger version (156K): [in a new window]   Figure 8c.  Aneurysmal bone cyst in a 54-year-old woman. (a) Nonenhanced CT scan at the level of the clavicle (C) shows an expansile lytic mass (M) in the medial left area of the clavicle. The mass is not well differentiated from the overlying muscle. (b) Axial T2-weighted (6,000/112) MR image shows a mass with overall signal intensity higher than that of fat. The mass contains regions with the signal intensity of fluid (arrow), as well as multiple septa with low signal intensity (arrowheads). (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows osteoclast-like giant cells and fibroblasts with blood-filled spaces (arrows) that account for the fluid-fluid level seen on MR images.

View larger version (148K): [in a new window]   Figure 9a.  Fibrous dysplasia of bone in a 28-year-old man. (a) Axial nonenhanced CT scan at the level of the pulmonary artery (P) shows an expansile mass (M) with areas of ground-glass attenuation in a left rib that indicate mineralization. (b) Axial T2-weighted (5,000/120) MR image shows heterogeneous signal intensity in the tumor (arrow). (c) Photograph of the cut surface of a resected rib specimen reveals a dense fibrous lesion (L) that has not invaded the surrounding structures. (d) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows immature osteoblasts and osteoid formation (arrowheads).

View larger version (146K): [in a new window]   Figure 9b.  Fibrous dysplasia of bone in a 28-year-old man. (a) Axial nonenhanced CT scan at the level of the pulmonary artery (P) shows an expansile mass (M) with areas of ground-glass attenuation in a left rib that indicate mineralization. (b) Axial T2-weighted (5,000/120) MR image shows heterogeneous signal intensity in the tumor (arrow). (c) Photograph of the cut surface of a resected rib specimen reveals a dense fibrous lesion (L) that has not invaded the surrounding structures. (d) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows immature osteoblasts and osteoid formation (arrowheads).

View larger version (60K): [in a new window]   Figure 9c.  Fibrous dysplasia of bone in a 28-year-old man. (a) Axial nonenhanced CT scan at the level of the pulmonary artery (P) shows an expansile mass (M) with areas of ground-glass attenuation in a left rib that indicate mineralization. (b) Axial T2-weighted (5,000/120) MR image shows heterogeneous signal intensity in the tumor (arrow). (c) Photograph of the cut surface of a resected rib specimen reveals a dense fibrous lesion (L) that has not invaded the surrounding structures. (d) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows immature osteoblasts and osteoid formation (arrowheads).

View larger version (133K): [in a new window]   Figure 9d.  Fibrous dysplasia of bone in a 28-year-old man. (a) Axial nonenhanced CT scan at the level of the pulmonary artery (P) shows an expansile mass (M) with areas of ground-glass attenuation in a left rib that indicate mineralization. (b) Axial T2-weighted (5,000/120) MR image shows heterogeneous signal intensity in the tumor (arrow). (c) Photograph of the cut surface of a resected rib specimen reveals a dense fibrous lesion (L) that has not invaded the surrounding structures. (d) High-power photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows immature osteoblasts and osteoid formation (arrowheads).

View larger version (115K): [in a new window]   Figure 10a.  Ossifying fibromyxoid tumor in a 32-year-old man. (a) Axial T2-weighted (4,500/160) MR image at the level of the stomach (S) shows a well-defined mass with multiple septa and an overall signal intensity higher than that of muscle, as well as a focal nodule of relatively low signal intensity (arrow). (b) Photograph of a resected specimen reveals myxoid components (white areas) separated by bands of fibrous tissue (arrowheads), as well as a soft-tissue nodule (arrow) that corresponds to the low-signal-intensity area seen on MR images. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows the trabecular or lacy arrangement of tumor cells in the myxoid matrix, with areas of marked ossification (arrow) that exhibited low signal intensity on MR images.

View larger version (91K): [in a new window]   Figure 10b.  Ossifying fibromyxoid tumor in a 32-year-old man. (a) Axial T2-weighted (4,500/160) MR image at the level of the stomach (S) shows a well-defined mass with multiple septa and an overall signal intensity higher than that of muscle, as well as a focal nodule of relatively low signal intensity (arrow). (b) Photograph of a resected specimen reveals myxoid components (white areas) separated by bands of fibrous tissue (arrowheads), as well as a soft-tissue nodule (arrow) that corresponds to the low-signal-intensity area seen on MR images. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows the trabecular or lacy arrangement of tumor cells in the myxoid matrix, with areas of marked ossification (arrow) that exhibited low signal intensity on MR images.

View larger version (166K): [in a new window]   Figure 10c.  Ossifying fibromyxoid tumor in a 32-year-old man. (a) Axial T2-weighted (4,500/160) MR image at the level of the stomach (S) shows a well-defined mass with multiple septa and an overall signal intensity higher than that of muscle, as well as a focal nodule of relatively low signal intensity (arrow). (b) Photograph of a resected specimen reveals myxoid components (white areas) separated by bands of fibrous tissue (arrowheads), as well as a soft-tissue nodule (arrow) that corresponds to the low-signal-intensity area seen on MR images. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows the trabecular or lacy arrangement of tumor cells in the myxoid matrix, with areas of marked ossification (arrow) that exhibited low signal intensity on MR images.

View larger version (179K): [in a new window]   Figure 11a.  Giant cell tumor in a 54-year-old woman. (a) Sagittal T2-weighted (6,000/112) MR image of the ribs (R) shows a mass (M) with overall signal intensity higher than that of muscle but with small foci of low signal intensity in the periphery. (b) Photograph of a resected specimen shows extensive vascular channels (arrows) that correspond to areas of low signal intensity on MR images.

View larger version (83K): [in a new window]   Figure 11b.  Giant cell tumor in a 54-year-old woman. (a) Sagittal T2-weighted (6,000/112) MR image of the ribs (R) shows a mass (M) with overall signal intensity higher than that of muscle but with small foci of low signal intensity in the periphery. (b) Photograph of a resected specimen shows extensive vascular channels (arrows) that correspond to areas of low signal intensity on MR images.

View larger version (124K): [in a new window]   Figure 12a.  Chondromyxoid fibroma in a 56-year-old woman. (a) Axial T2-weighted (6,000/112) MR image at the level of the liver (L) shows a mass in the lateral part of the chest wall. The mass has an overall signal intensity higher than that of fat, but multiple septa (arrow) with lower signal intensity also are visible in the tumor. (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) reveals fibroblasts intermingled with interstitial myxoid material that accounts for the high signal intensity on T2-weighted MR images.

View larger version (176K): [in a new window]   Figure 12b.  Chondromyxoid fibroma in a 56-year-old woman. (a) Axial T2-weighted (6,000/112) MR image at the level of the liver (L) shows a mass in the lateral part of the chest wall. The mass has an overall signal intensity higher than that of fat, but multiple septa (arrow) with lower signal intensity also are visible in the tumor. (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) reveals fibroblasts intermingled with interstitial myxoid material that accounts for the high signal intensity on T2-weighted MR images.

View larger version (137K): [in a new window]   Figure 13.  Lipoma in a 42-year-old woman. Axial contrast-enhanced CT scan at the level of the pulmonary artery (P) shows a well-defined mass with the same attenuation as fat in the left part of the chest wall. Soft-tissue septa (arrows) are clearly visible at the periphery of the mass. Septa not only occur in benign lipomas but also are common in atypical lipomatous tumors and liposarcomas.

View larger version (183K): [in a new window]   Figure 14.  Spindle cell lipoma in a 72-year-old man. Axial gadolinium-enhanced T1-weighted (500/15) MR image at the level of the spleen (SP) and stomach (ST) reveals a nodule (arrow) with heterogeneous enhancement in the subcutaneous tissues of the back. The fat component in this tumor is hard to identify on MR images.