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Chest Wall Tumors: Radiologic Findings and Pathologic Correlation

Part 2. Malignant 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; 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 1.  Leiomyosarcoma in a 49-year-old woman. Sagittal T1-weighted (repetition time msec/echo time msec = 600/12) MR image of the spine, obtained after administration of gadolinium-based contrast material, shows a soft-tissue mass with heterogeneous enhancement. Note the enhanced rim or periphery and the central area of low signal intensity. Invasion of the surrounding muscle (arrow) was confirmed at microscopic evaluation of a tissue specimen.

View larger version (123K): [in a new window]   Figure 2.  Rhabdomyosarcoma in a 51-year-old woman. Coronal reformatted image of the apex of the left hemithorax from a contrast-enhanced CT study shows a mass that has invaded muscle, fascia, adipose tissue, nerves, and vascular structures (arrows). A = aorta, C = clavicle.

View larger version (105K): [in a new window]   Figure 3.  Angiosarcoma in a 67-year-old man. Axial gadolinium-enhanced T1-weighted (600/12) MR image of the apex of the left hemithorax shows an invasive mass with heterogeneous enhancement in the left lateral chest wall. Vascular flow-voids are seen near the surface of the tumor (arrows). V = vertebra.

View larger version (106K): [in a new window]   Figure 4a.  Storiform-pleomorphic malignant fibrous histiocytoma in a 68-year-old woman. (a) Nonenhanced CT scan at the level of the ascending aorta (A) shows a destructive mass with origins in the sternum and extension into the surrounding soft tissue (arrowheads). (b) Photograph of the dissected tumor reveals invasion of the subcutaneous tissue (arrowheads). R = rib.

View larger version (71K): [in a new window]   Figure 4b.  Storiform-pleomorphic malignant fibrous histiocytoma in a 68-year-old woman. (a) Nonenhanced CT scan at the level of the ascending aorta (A) shows a destructive mass with origins in the sternum and extension into the surrounding soft tissue (arrowheads). (b) Photograph of the dissected tumor reveals invasion of the subcutaneous tissue (arrowheads). R = rib.

View larger version (107K): [in a new window]   Figure 5a.  Aggressive fibromatosis in a 38-year-old woman. (a) Coronal reformatted image of the right axilla from a contrast-enhanced multidetector CT study shows a mass (M) inferior to the scapula (S) with invasion of the surrounding musculature (arrows). (b) Photograph of the resected specimen shows a mass (M) of dense trabeculated fibrous tissue with invasion of adjacent structures (arrowheads).

View larger version (77K): [in a new window]   Figure 5b.  Aggressive fibromatosis in a 38-year-old woman. (a) Coronal reformatted image of the right axilla from a contrast-enhanced multidetector CT study shows a mass (M) inferior to the scapula (S) with invasion of the surrounding musculature (arrows). (b) Photograph of the resected specimen shows a mass (M) of dense trabeculated fibrous tissue with invasion of adjacent structures (arrowheads).

View larger version (132K): [in a new window]   Figure 6.  Ganglioneuroblastoma in a 6-year-old girl. Axial T2-weighted (6,000/112) MR image at the level of the diaphragm (D) shows a tumor (arrowheads) with heterogeneous high signal intensity extending along the pleural surface.

View larger version (115K): [in a new window]   Figure 7.  Malignant peripheral nerve sheath tumor in a 74-year-old woman. Axial T2-weighted (6,000/112) MR image at the level of the aortic arch (A) shows an ill-defined tumor with invasion of bone, fat, muscle, and fascia (arrowheads).

View larger version (85K): [in a new window]   Figure 8a.  Chondrosarcoma in a 19-year-old woman. (a) Contrast-enhanced CT scan at the level of the left atrium (A) shows a rib mass with chondroid mineralization (black arrowheads) and invasion of the overlying musculature (white arrowhead). (b) Sagittal T2-weighted (6,000/112) MR image of the lateral chest wall shows a mass arising from the rib (R), with a signal intensity higher than that of intercostal muscle. Areas of low signal intensity (arrowheads) indicate dense mineralization in the tumor.

View larger version (151K): [in a new window]   Figure 8b.  Chondrosarcoma in a 19-year-old woman. (a) Contrast-enhanced CT scan at the level of the left atrium (A) shows a rib mass with chondroid mineralization (black arrowheads) and invasion of the overlying musculature (white arrowhead). (b) Sagittal T2-weighted (6,000/112) MR image of the lateral chest wall shows a mass arising from the rib (R), with a signal intensity higher than that of intercostal muscle. Areas of low signal intensity (arrowheads) indicate dense mineralization in the tumor.

View larger version (110K): [in a new window]   Figure 9a.  Dedifferentiated chondrosarcoma in a 66-year-old man. (a) Contrast-enhanced CT scan at the level of the pulmonary artery (P) shows a mass with peripheral calcification (arrow) arising from the costovertebral joint and expanding into the thoracic cavity. Note the small pleural effusion. (b) Axial T2-weighted (4,500/97.7) MR image at the level of the pulmonary artery shows a tumor with heterogeneous high signal intensity extending into the thoracic cavity and invading the vertebral pedicle (curved arrow). The MR image better depicts the tumor extension in the rib (straight arrow) than does the CT scan. The pleural effusion had increased in size by the time of MR imaging.

View larger version (113K): [in a new window]   Figure 9b.  Dedifferentiated chondrosarcoma in a 66-year-old man. (a) Contrast-enhanced CT scan at the level of the pulmonary artery (P) shows a mass with peripheral calcification (arrow) arising from the costovertebral joint and expanding into the thoracic cavity. Note the small pleural effusion. (b) Axial T2-weighted (4,500/97.7) MR image at the level of the pulmonary artery shows a tumor with heterogeneous high signal intensity extending into the thoracic cavity and invading the vertebral pedicle (curved arrow). The MR image better depicts the tumor extension in the rib (straight arrow) than does the CT scan. The pleural effusion had increased in size by the time of MR imaging.

View larger version (124K): [in a new window]   Figure 10.  Osteosarcoma in a 25-year-old woman. Axial gadolinium-enhanced T1-weighted (500/15) MR image shows a large mass (M) with heterogeneous enhancement in the upper left hemithorax. The mass has invaded the posterior chest wall (arrowheads) and filled the thoracic cavity on the left side. V = vertebra.

View larger version (98K): [in a new window]   Figure 11a.  Round cell liposarcoma in a 34-year-old man. (a) Axial T2-weighted (6,000/112) MR image reveals a large mass (M) with heterogeneous but overall high signal intensity that originates from the posterior chest wall, fills the thoracic cavity, and displaces the aortic arch (A). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows atypical round cells in a myxoid background that accounts for the very high signal intensity on the T2-weighted MR image.

View larger version (157K): [in a new window]   Figure 11b.  Round cell liposarcoma in a 34-year-old man. (a) Axial T2-weighted (6,000/112) MR image reveals a large mass (M) with heterogeneous but overall high signal intensity that originates from the posterior chest wall, fills the thoracic cavity, and displaces the aortic arch (A). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows atypical round cells in a myxoid background that accounts for the very high signal intensity on the T2-weighted MR image.

View larger version (140K): [in a new window]   Figure 12.  Dedifferentiated liposarcoma in a 56-year-old man. Axial T1-weighted (600/12) MR image of the apex of the left hemithorax shows a mass that originates from the left superior chest wall and has heterogeneous signal intensity including a fat component (arrow) and a larger soft-tissue component. V = vertebra.

View larger version (145K): [in a new window]   Figure 13.  Malignant lymphoma in a 62-year-old woman. Coronal T1-weighted (605/20) fat-suppressed MR image at the level of the left atrium (A) shows an infiltrating mass in the chest wall (arrows) with homogeneous enhancement after administration of gadolinium-based contrast material.

View larger version (101K): [in a new window]   Figure 14a.  Solitary myeloma in a 69-year-old woman. (a) Nonenhanced CT scan at the level of the pulmonary artery (P) shows a well-defined subpleural mass with reactive bone sclerosis (arrowheads). (b) Photograph of the resected specimen shows a well-demarcated mass (arrows) with minimal bone invasion.

View larger version (67K): [in a new window]   Figure 14b.  Solitary myeloma in a 69-year-old woman. (a) Nonenhanced CT scan at the level of the pulmonary artery (P) shows a well-defined subpleural mass with reactive bone sclerosis (arrowheads). (b) Photograph of the resected specimen shows a well-demarcated mass (arrows) with minimal bone invasion.

View larger version (114K): [in a new window]   Figure 15.  Multiple myeloma in a 59-year-old man. Contrast-enhanced CT scan at the level of the aortic arch (A) shows multiple osteolytic lesions involving the sternum, vertebral body, scapulae, and ribs, and a soft-tissue mass (arrowheads) that originates from a left rib.

View larger version (100K): [in a new window]   Figure 16.  Low-grade dermatofibrosarcoma protuberans in a 56-year-old man. Contrast-enhanced CT scan at the level of the aortic arch (A) shows a well-demarcated subcutaneous mass (arrow) without muscle invasion.

View larger version (121K): [in a new window]   Figure 17.  High-grade dermatofibrosarcoma protuberans in a 68-year-old woman. Contrast-enhanced CT scan at the level of the left atrium (A) shows a large heterogeneous mass (arrow) that originates from the anterior chest wall. Invasion of mediastinal structures (arrowheads) suggests malignancy.

View larger version (106K): [in a new window]   Figure 18a.  Ewing sarcoma in a 15-year-old girl. (a) Axial T1-weighted (600/12) MR image at the level of the diaphragm (D) shows an extraosseous extrapleural mass. A focus of high signal intensity (arrow) indicates intratumoral hemorrhage. (b) Photograph of the resected specimen reveals no bone involvement. A small focus of hemorrhagic degeneration (arrow) corresponds to the area of high signal intensity on the MR image.

View larger version (113K): [in a new window]   Figure 18b.  Ewing sarcoma in a 15-year-old girl. (a) Axial T1-weighted (600/12) MR image at the level of the diaphragm (D) shows an extraosseous extrapleural mass. A focus of high signal intensity (arrow) indicates intratumoral hemorrhage. (b) Photograph of the resected specimen reveals no bone involvement. A small focus of hemorrhagic degeneration (arrow) corresponds to the area of high signal intensity on the MR image.

View larger version (165K): [in a new window]   Figure 19a.  Synovial sarcoma in a 60-year-old woman. (a) Coronal T2-weighted (6,000/112) MR image shows a large paravertebral mass with heterogeneous signal intensity and numerous internal septa. The tumor has displaced the diaphragm (arrowheads). (b) Photograph of the dissected tumor reveals invasion of the paravertebral muscle (arrowheads) and cystic degeneration and hemorrhage (arrow), which account for the heterogeneous signal intensity observed in the tumor on the MR image.

View larger version (95K): [in a new window]   Figure 19b.  Synovial sarcoma in a 60-year-old woman. (a) Coronal T2-weighted (6,000/112) MR image shows a large paravertebral mass with heterogeneous signal intensity and numerous internal septa. The tumor has displaced the diaphragm (arrowheads). (b) Photograph of the dissected tumor reveals invasion of the paravertebral muscle (arrowheads) and cystic degeneration and hemorrhage (arrow), which account for the heterogeneous signal intensity observed in the tumor on the MR image.

View larger version (83K): [in a new window]   Figure 20.  Proximal-type epithelioid sarcoma in a 48-year-old woman. Axial T1-weighted (570/12) MR image obtained after administration of gadolinium-based contrast material shows a large heterogeneously enhancing mass (M) between the subcutaneous tissues and the deep layer of fat and muscle (arrowheads).