A review of clinical experiences with 30 cases.

Tumors of the chest wall, although not uncommonly encountered, have received relatively little attention in the literature. In view of this, we are prompted to present a review of our clinical experiences with 30 such tumors particularly to emphasize their insidious nature and the consequent necessity for early and adequate surgical extirpation. The clinical features of benign and malignant chest wall tumors will be reviewed and the principles of their surgical management discussed. The sequence of inadequate primary excision of an ostensibly benign tumor followed by repeated local recurrences and ultimately by widespread metastases is tragically documented in several of our cases. Also, two cases are included in which a metastatic chest wall tumor provided the sole clue to the location and nature of a silent primary neoplasm. In 1933, Hedblom1 reviewed the world literature and collected 291 cases of tumors of the osseous structures of the chest wall to which he added 22 cases of his own. Thereafter, Sommer and Major,’ in 1942, summarized an additional 66 cases recorded in the world literature from 1933 to 1940 and added 15 cases from the thoracic surgical service of the University of Michigan. No further review of the subject appeared until Blades and Paul3 summarized their experiences with 53 chest wall tumors in 1950. From 1950 to the present, there have been isolated case reports of chest wall tumors, generally dealing with the complexities and technics of repair of large chest wall defects following surgical excision. To our knowledge, however, there have been no further reviews of clinical experiences with chest wall tumors as a group. In view of the inconsistency of the clinical behavior of certain of these lesions with their pathological appearance, we feel that it is appropriate to employ a clinical classification, as suggested by Blades and Paul, of (1) benign; (2) malignant; and (3) metastatic chest wall tumors. All of the tumors included in this report were encountered in a practice restricted to thoracic surgery so that the many varieties of neoplasms of the skin and subcutaneous tissues which are not clinically fixed to the deeper structures of the chest wall are automatically excluded. In addition, we have excluded all metastatic tumors of the chest wall except those which were solitary and originated from a silent primary neoplasm. Accordingly, these metastatic lesions clinically appeared to be primary chest wall neoplasms.