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Weekly Chest CasesArchive of Old Cases

Case No : 568 Date 2008-09-15

  • Courtesy of Ki Nam Kim, MD, Ki-Nam Lee, MD, Sang Yun Lee, MD. / Dong-A university hospital, Busan, Korea.
  • Age/Sex 35 / F
  • Chief ComplaintAbnormal findings on chest radiograph. / She has local tenderness in the left anterior chest wall.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Thoracic desmoid tumor
Radiologic Findings
Simple radiographics
Chest PA shows a mass-like increased opacity with well-defined medial border in the Lt. upper lung field.
No definite evidence of rib erosion is noted.

CT
CT scan shows a homogeneously enhanced mass with chest wall extended. But, no rib destruction.
On saggital view, the mass surrounds the Lt. internal mammary artery without luminal narrowing.

Pathology
A lump of tissue from chest wall that contains three ribs. The mass shows fibrotic cut surface with intervening growth between intercostal spaces. Definitive bony destruction is not identified.
The predominant histologic appearances of the tumor is a hypocelluar arrangement of spindle-shaped cells with a fibromyxoid background.
Vimentin: Positive.
SMA(smooth muscle actin): focal positive.
Brief Review
Desmoid tumors belong to a group of disorders called fibromatosis, which show an infiltrating growth of well-diffentiated fibroblasts of myofibroblast. There are seen more frequently in 4th decade, predominantly in women. Although they can be locally aggressive and tend to recur after resection, these firm, fibroblastic tumors are considered benign and do not metastasize.

Historically, they have been divided into the abdominal, extraabdominal and intra-abdominal. Extraabdominal desmoid tumors chiefly involve the chest wall, shoulder, thigh and neck. Thoracic desmoid tumors occur most frequently in the intercostal muscle, usually after trauma, previous mastectomy, and excision of a neurofibroma.

The imaging appearance of these tumors depends on the relative amounts of fibroblast proliferation, fibrosis, collagen content, and vascularity of the tumor.

At CT, the masses are either ill-defined or well circumscribed. Before contrast material is administered, the tumors show variable attenuation, relative to muscle. After contrast material is administered, they may or may not appear enhanced. Usually, the lesions demonstrate higher attenuation than adjacent muscles.

At MR imaging, the masses are hypointense on T1WI. T2WI show variable signal intensity (low, medium, or high) relative to muscle.
References
1. Imaging of Chest Wall Disorders. Radiographics 1999;19:617-637
2. Imaging of Intra and Extraabdominal Desmoid Tumors. Radiographics 1991;11:959-968
3. Extra-abdominal desmoid tumor presenting as an intrathoracic tumor: Case report and literature review. Pathology International 2001;51:824-828
Keywords
Chest wall, Benign tumor,

No. of Applicants : 88

▶ Correct Answer : 4/88,  4.5%
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - UCLA , United States Fereidoun Abtin
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - All India Institute of Medical Sciences , India puneet kochar
▶ Correct Answer as Differential Diagnosis : 10/88,  11.4%
  • - SMG-SNU Boramae Hospital , Korea (South) Daehee Han
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - CHRU lille , France manuel toledano
  • - BHMRC, NEW DELHI , India nidhi goyal
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
▶ Semi-Correct Answer : 68/88,  77.3%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Osaka University , Japan Osamu Honda
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - jaslok hospital mumbai , India jainendra jain
  • - NONE , India REKHA GUPTA
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - K.J.SOMAIYA HOSPITAL AND RESEARCH CENTRE. , India vipul jethwa
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Cheongshim international medical center , Korea (South) Hae Jum Yang
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - McGill university , Canada Makki Almuntashri
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Seoul national university hospital , Korea (South) Jihoon Park
  • - BATRA HOSPITAL NEW DELH , India MONIKA AGARWAL
  • - Al-Hada Armed Forced Hospital , Saudi Arabia Ahmed FathiEid
  • - Hanmaeum Hospital , Korea (South) Kwon Kim
  • - ARORA NEURO CENTRE, LUDHIANA , India RAKESH SHEORAN
  • - CHU Grenoble , France Fabrice Bing
  • - wonju christial hospital , Korea (South) daekeon Lim
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Apollo Hospital, Ahmedabad. , India Sandip Shah
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - partner, aditya imaging centre , India vivek patel
  • - CHRU Lille , France Benjamin DAMAREY
  • - OSWAL CANCER HOSP. , India VISHAL GARG
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - National Taiwan University Hospital , Taiwan Nin Chieh Hsu
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - arora neuro centre,ludhiana , India devendra kumar
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - JUBILEE MISSION HOSPITAL , India gopinath ANKALA
  • - Central Queensland Medical Imaging , Australia Sandeep Joshi
  • - EKH-Berlin , Germany Michael Weber
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - Saga University , Japan Ryoko Egashira
  • - Seoul National University Hospital , Korea (South) Kwang Nam Jin
  • - chp st martin , France Mariotte benoit
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - chest hospital , Egypt assaad assaad
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - radiology department ANNECY , France gilles GENIN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Kasturba Medical Collage , India NAVEEN KULKARNI
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - NOUR EL-ISLAM RADIOLOGY CENTER , Egypt elsayed mousa
  • - Kwang Myung Sungae Hospital , Korea (South) Jiyong Rhee
  • - jiangsu province hospital , China yuan doctor
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - All India Institute of medical sciences , India Justin Moses
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - kims,narkatpally , India k bhaskar
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