Presentation
Pain and lump right side chest wall
Patient Data
A well-defined lobulated expansile lesion is seen involving and destructing the right anterior third rib and costochondral junction. It measures about 6 x 6 x 6 cm in maximum dimensions. It is of intermediate density and enhancing heterogeneously on post-contrast images. The lesion is displacing adjacent right lung parenchyma posteriorly and displacing intercostal muscles anteriorly with partially obliterated fat plane.
The lesion is heterogeneously hyperintense on T2 / STIR images with multiple rounded areas of hyperintensity mixed with hypointense areas. It is predominantly hypointense on T1-weighted images and shows strong heterogeneous postcontrast enhancement. Multiple rounded non-enhancing areas are seen within the lesion, suggestive of cystic/necrotic component. It displaces the pectoralis muscle anteriorly without any obvious infiltration. No other similar lesions were seen in the rest of the visualized bony cage. No obvious intrapulmonary or mediastinal extension was seen.
Ultrasound-guided FNAC was done – Osteoclastic giant cell-rich neoplasm suggestive of Giant cell tumor of bone.
Case Discussion
Giant cell tumor (GCT) is a relatively common, benign, locally aggressive tumor that typically presents in the 3rd and 4th decades of life, more commonly affecting women. GCT usually affects the ends of the long bones and only rarely the ribs (<1%)
The posterior parts of the rib (head and tubercle) are most commonly affected, while the involvement of the non-epiphyseal portions is very rare.
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