대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Giant cell tumor of the rib

Radiologic Findings

PA chest radiograph shows a large mass in the left middle lung, with normal hilar structures visualized through the mass (hilar overlay sign). The aortic arch and descending thoracic aorta are clearly defined, indicating the anterior location of the mass. CT shows a large well-enhancing soft tissue mediastinal mass arising from the 3rd left anterior rib. Both peripheral, rim-like calcifications and internal, septa-like calcifications are seen in the mass.

Brief Review

Giant cell tumor (GCT) of bone is an uncommon neoplasm accounting for about 4–5% of all primary bone tumors. GCT are generally considered benign but malignant cells can arise either de novo or via malign transformation. GCT's are more common in females [1-4]. Only few cases of GCT involving the ribs have been reported in the literature with most of them involving the posterior aspect. Due to its rarity, GCT arising from the chest wall is difficult to diagnose, particularly when the tumor is located in the anterior rib [1]. Cytologic differential diagnosis includes aneurysmal bone cyst (ABC), brown tumor, chondroblastoma, chondromyxoid fibroma (CMF), non-ossifying fibroma (NOF), giant cell rich osteosarcoma and malignant fibrous histiocytoma [1].
On radiographs, GCT of the rib manifests as a lytic lesion that may be eccentric and has well-defined, non-sclerotic margins. The lesion may cause cortical thinning, or, as in the current case, breakthrough and bone expansion [5,6]. CT may show osseous lysis caused by the tumor. Although matrix calcification is rare, peripheral calcifications, internal septa (which can also be calcified), and cystic components have been described [7-10]. Disruption of the cortex and extension in the soft tissue can also be appreciated on CT. Although MR is helpful for the surgical planning, the MR features of GCTs are nonspecific, with low or intermediate T1 signal intensity and high T2 signal intensity. Inhomogeneous appearance is common on MR, with signal voids and signal intensities suggestive of hemorrhage [5].

References

1. Manjunatha H, Ramaswamy A, Kumar BS. Aggressive giant cell tumor of the anterior arc of the rib. J Cytol 2012 Jan;29(1):51-53
2. Shin JS, Lee IS, Kim A, Kim BH. Giant cell tumour originating from the anterior arc of the rib. J Korean Med Sci 2002;17:849–851
3. Kilpatrick SE, Renner JB, Creager A, editors. Diagnostic musculoskeletal surgical pathology: Clinicoradiologic and cytologic correlations. Pennsylvania: Saunders; 2004. pp. 163–79
4. Vigorita VJ, Ghehman B, Mintz D, editors. Orthopaedic pathology. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2008. pp. 280–9
5. Moschouris H, Marinis A, Bouma E, Karagiannis E, Kiltenis M, Papadaki M. Nonepiphyseal giant cell tumor of the rib: a case report. Case Rep Oncol Med 2012. http://dx.doi.org/10.1155/2012/745292
6. Tateishi U, Gladish GW, Kusumoto M, Hasegawa T, Yokoyama R, Tsuchiya R, Moriyama N. Chest wall tumors: radiologic findings and pathologic correlation: part 1. Benign tumors. Radiographics 2003;23(6):1477–1490
7. Briccoli A, Malaguti C, Iannetti C, Rocca M, Bertoni F. Giant cell tumor of the rib. Skeletal Radiology 2003 Feb;32(2):107-10
8. Kumar A, Varshney MK, Trikha V, Rastogi S. An unusual presentation of a rare chest wall tumour: giant cell tumour of bone. Joint Bone Spine 2007 Jan;74(1):100-2
9. Gupta V, Mittal R. Giant cell tumor of rib—rare location on the anterior aspect. Archives of Orthopaedic and Trauma Surgery 2000;120(3-4):231-2
10. Reddy RH1, Queen S, Jilaihawi AN, Prakash D. Giant-cell tumour of the rib. European Journal of Cardio-thoracic Surgery 2003 Sep;24(3):450

Keywords

Rib, Benign tumor,