Chen Chin-Li, Chang Hung
Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No,325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan.
J Med Case Rep. 2014 Jun 19;8:210. doi: 10.1186/1752-1947-8-210.
Myofibromas are benign mesenchymal neoplasms that can present as solitary and multicentric lesions. They can occur in several locations and can occur at any age from neonates to elderly patients. However, most of the lesions are found in neonates and babies. It rarely occurs in adults.
A 29-year-old Taiwanese man presented with persistent dull chest pain in his right lateral chest wall for 2 weeks. A chest X-ray showed a faint patchy opacity over the periphery of his right upper lung zone. Computed tomography and magnetic resonance imaging showed a lobulated mass at the intercostal space between his right fifth and sixth ribs with contrast enhancement and bone invasion. Malignancy could not be excluded. A percutaneous needle aspiration biopsy failed due to technique issues, so he underwent a thoracotomy and the tumor was excised with Marlex mesh repairs for the thoracic defect. Pathology confirmed a myofibroma without malignancy. He recovered uneventfully and no local recurrence was detected at the 1-year follow-up examination.
Chest wall myofibroma presenting with chest pain has never been reported in adults. It is a challenge to differentiate myofibroma from malignancy in chest wall preoperatively, such as seen in our patient. To the best of our knowledge, this has not been previously reported in the scientific literature. Although myofibroma rarely occurs in the chest wall and adults, it must be suspected in any chest wall tumor presenting with chest pain.
肌纤维瘤是一种良性间叶性肿瘤，可表现为孤立性和多中心性病变。它可发生于多个部位，在从新生儿到老年患者的任何年龄段均可出现。然而，大多数病变见于新生儿和婴儿。在成人中很少发生。
一名29岁的台湾男性因右侧胸壁持续钝痛2周前来就诊。胸部X线显示右上肺野周边有淡薄片状模糊影。计算机断层扫描和磁共振成像显示右侧第五和第六肋骨间隙有分叶状肿块，有对比增强及骨质侵犯。不能排除恶性病变。由于技术问题，经皮针吸活检失败，因此他接受了开胸手术，切除肿瘤并使用Marlex网片修复胸壁缺损。病理证实为无恶性的肌纤维瘤。他恢复顺利，1年随访检查未发现局部复发。
成人中从未有过因胸痛就诊的胸壁肌纤维瘤的报道。术前在胸壁鉴别肌纤维瘤与恶性肿瘤具有挑战性，如我们的患者所示。据我们所知，这在科学文献中以前未曾报道过。虽然肌纤维瘤很少发生于胸壁和成人，但任何因胸痛就诊的胸壁肿瘤都必须怀疑有肌纤维瘤。
