Giant Cell Tumor Arising from Anterior Arc of the Rib
A 27-year-old man presented with a 9-month history of chest wall pain and a palpable growing mass in the anterior end of the left sixth rib. The mass was hard and fixed to the chest wall. There was mild tenderness. The overlying skin was normal. He had a history of contusion at the left anterior chest wall 9 months earlier. There were no specific pulmonary symptoms.\nA chest X-ray demonstrated an expansile bony mass in the distal end of the left 6th rib. Computed tomography revealed a large irregular contoured and heterogeneously enhancing soft tissue mass in the anterior arc of the left 6th rib. The tumor contained peripheral calcification and bony destruction (). No abnormality was found on laboratory examinations.\nA surgical resection was performed. The tumor was completely resected, including surrounding soft tissue. The tumor was adhered to the parietal pleura. There was no visceral pleural invasion. The distance of the margin from the tumor was 3 cm (medial) and 6 cm (lateral). The medial margin of the resected rib was the lateral border of the sternum. A frozen biopsy of the tumor was performed in the operating room, and the tumor was confirmed to be a giant cell tumor (GCT). Partial resection of the ribs above (5th) and below (7th) the GCT including the intercostal muscle and soft tissue was performed. The lengths of the resected ribs were 10.5 cm, 13.5 cm, and 13 cm (). The chest wall defect was covered with a 2-mmthick Gore-Tex Soft Tissue Patch (W. L. Gore & Associates Inc., Flagstaff, AZ, USA).\nThe tumor was 6×4.5×4.5 cm in size. There were focal hemorrhage and a yellowish mass-like lesion in gross findings. The tumor was composed of round, oval, or spindle-shaped stromal mononuclear cells and uniformly interspersed multinucleated giant cells (). The pathological diagnosis was a primary GCT of the left sixth rib.\nNo adjuvant treatment was performed. The patient has been receiving follow-up care for 3 months since the surgery with out evidence of recurrence.