What is chest wall tumor A chest wall tumor is a tumor of the deep soft and skeletal tissues of the chest wall. It generally does not include tumors of skin, subcutaneous tissue, superficial muscle or breast. Chest wall tumors can be divided into two categories: primary and secondary; primary chest wall tumors can be divided into benign and malignant. Chest wall tumors account for 5% of chest tumors, 5%-8% of bone and soft tissue tumors, and about 30%-50% of them are malignant. Tumors originating from the skeletal part of chest wall account for about 5%-10% of the primary bone tumors in the whole body, of which 80% occur in the ribs and 20% in the sternum, and are malignant in most cases, which is also true in children. Rib tumors usually occur in the anterior and lateral chest wall, and less often in the posterior chest wall. Most soft tissue tumors of the chest wall are benign and commonly occur in young adults. More than half of the bone tumors of chest wall are malignant, mostly metastases from distant primary foci. Malignant tumors of the chest wall often occur in middle-aged and elderly patients, and are more frequent in men than in women. More than half of the chest wall tumors are secondary, mostly from the metastasis of malignant tumors from other parts or direct invasion of tumors from adjacent organs, which often cause local destruction or pathological fracture of ribs, and the common metastatic tumors of chest wall are mostly from lung cancer, breast cancer, kidney cancer, stomach cancer, esophageal cancer, rectal cancer, etc. There are more pathological types of chest wall tumors. Among the skeletal tumors of chest wall, benign ones include chondrosarcoma, osteochondroma, fibrous dysplasia of bone, etc.; malignant ones include chondrosarcoma, osteosarcoma, malignant giant cell tumor of bone, myeloma, endothelial cell sarcoma of bone, etc. are more common. Cartilage tumors of chest wall account for about 48% of all rib and sternal tumors, among which chondrosarcoma is the most common. Among the soft tissue tumors of chest wall, benign ones such as neurofibroma, fibroma and lipoma are more common; malignant ones such as fibrosarcoma, neurofibrosarcoma and hemangiosarcoma are more common. Classification and characteristics Primary chest wall tumors can be divided into soft tissue tumors of chest wall and skeletal tumors of chest wall according to the site of occurrence. According to the cell type, they can be divided into benign and malignant. Secondary chest wall tumors are all malignant and have the pathological characteristics of primary tumors. Primary soft tissue tumors of the chest wall are mostly benign and commonly include fibromas, neurofibromas, nerve sheath tumors, lipomas and hemangiomas. Malignant soft tissue tumors include fibrosarcoma, neurofibrosarcoma, malignant nerve sheath tumor, liposarcoma, and angiosarcoma. Fibrosarcomas and fibrosarcomas arise from the fibrous connective tissue of the deep fascia and periosteum of the chest wall and are most commonly seen in adolescents. Fibrosarcoma grows slowly and its pathological pattern is benign, but the tumor cells tend to infiltrate into the surrounding tissues, so it has a low malignant tendency and is prone to recurrence and malignancy after surgery; fibrosarcoma grows faster and infiltrates into the local area, and bloodstream metastasis can occur in the late stage, which is more malignant and prone to recurrence. Neurogenic tumors come from intercostal nerves and other nerves in the chest wall. Benign tumors are slow-growing, with intact envelope and distributed along the nerve; malignant lesions are fast-growing and infiltrate into the surrounding tissues, so radical surgery is recommended. Hemangiosarcoma is mostly seen in infants and children, and it expands with age. The tumor border is unclear and often connects with one or several larger blood vessels, so adequate estimation and preparation should be made before surgery to prevent massive blood loss. Angiosarcoma is malignant and prone to early hematogenous metastasis. Primary skeletal tumors of the chest wall are malignant and occur mostly in the ribs, followed by the sternum, clavicle, and scapula. Benign lesions such as chondrosarcoma, osteochondroma, giant cell tumor, bone cyst, and fibrous dysplasia of bone are common, and malignant lesions include chondrosarcoma, osteosarcoma, myeloma, Ewing tumor, and reticulocytic sarcoma. Lesions of cartilaginous origin, which occur at the junction of the rib cartilage and ribs or in the cartilaginous portion of the sternum, are most often seen in young and middle-aged people. Chondrosarcoma grows slowly, is hard, nodular or lobulated, accelerates in malignancy, and can produce severe pain when compressing nerves. Although its pathological pattern is benign, it can recur many times, and some poorly differentiated cells appear; chondrosarcoma grows rapidly, involves pericardium and large blood vessels with intrathoracic infiltration, shows mediastinal compression symptoms, and early hematologic metastasis, which can be cured after radical resection. Osteoma and osteosarcoma are less common, occurring in young and middle-aged people, with obvious pain symptoms. malignant lesions can cause extensive destruction of bone and pathological fractures, early radical surgery and postoperative adjuvant radiotherapy can improve the cure rate. ewing tumor is more malignant, occurring in young men, and can be treated with a combination of radiotherapy and surgery. The front of the thorax is short, consisting of the sternum, rib cartilage and the anterior segment of the rib cage, and the back is long, consisting of the thoracic segment of the spine and the posterior segment of the rib cage, and the sides are round and convex, consisting of the rib cage. The activity of the thorax mainly relies on the movement of the vertebral rib joints and the elasticity of the ribs and rib cartilage. The skin area of the chest wall is large, and the color and texture of the skin of the anterior part of the chest, especially the upper part of the chest, is closer to that of the maxillofacial area, and the chest has its specific flap arteries, which are conducive to the use of the chest wall skin as a flap with vascular tips. The superficial structures of the chest wall include the pectoralis major, pectoralis minor, subclavian, sternoclavicularis fascia, serratus anterior, trapezius and latissimus dorsi muscles. Each of the pectoralis major muscle has its own major vascular nerve, which is conducive to the clinical use of each muscle flap or musculoskeletal flap. Treatment strategies for chest wall tumors are mainly surgical. If for some reasons cytologic or histologic diagnosis cannot be obtained, and if metastases or primary foci cannot be diagnosed, surgery should be performed as soon as the patient’s condition is acceptable for surgery. For different histological types of chest wall malignant tumors, certain preoperative and postoperative radiotherapy is feasible. The specific radiotherapy regimens have been discussed in detail in the chapters of bone, soft tissue and skin tumors. For benign chest wall tumors, including benign chondrosarcoma and neurological tumors, local excision of the tumor is feasible. For malignant and suspected malignant tumors, extensive resection should be performed. The extent of resection is determined by the size of the tumor and the relationship with the surrounding tissues and organs. Generally speaking, the resection margin should be at least 3 cm from the edge of the tumor, and more distant for malignant cases. The surrounding invaded muscles, bone tissue, pleura and some organs should be completely removed as far as possible.