A 41-year-old female presented with extreme shortness of breath and fatigue for the past half year. The patient reports that a lump was discovered in her chest about 7 years ago, but she did not seek care at the time. Initially, it was the size of a coin but increased to the size of a grapefruit. She reports that the shortness of breath has been present for a long time, but that over the past few months, she has experienced dyspnea even on light exertion, which severely hinders her daily life. On exam, she was afebrile, normotensive with tachycardia (108 beats per minute). Her respiratory rate was 18 breaths per minute and oxygen saturation was 93%. Cardiac exam revealed tachycardia without rubs or murmurs. Lung exam revealed normal chest excursion with clear lung sounds bilaterally without rhonchi, rales or wheezes. Chest exam revealed a hard, non-mobile non-tender nodule located at the lower aspect of her right rib.
Upon admission to the hospital, a contrast-enhanced computed tomography (CT) scan revealed a mass occupying the 5th rib, with destruction of the normal bone structure of the rib (Fig. 1) and visible compression on the right heart border and deviation of the mediastinal structures. The mass was non-enhancing. Based on these findings, a primary bone tumor with low likelihood of metastasis was suspected.
The tumor was removed by osteotomy of nearly the entire 5th rib, and the anterior parts of the 4th and 6th ribs. The diaphragm was also partially resected, and parts of the upper and lower lobes of the right lung were removed. The resected specimen measured 16 cm x 12 cm x 12 cm (Fig. 2). Biopsy revealed a background of stromal cells with round and ovoid shapes, cells with foamy cytoplasm, areas of necrosis, as well as the presence of multinucleated giant cells. A diagnosis of GCTB was made.
Chest wall reconstruction was performed, and in a follow up visit three months later, there was no evidence of recurrence. The patient's chest CT appeared normal at that time.