Discussion And Literature Review:

Chondrosarcoma of the rib are rare and most of the patients present with enlarging anterior chest wall tumour. We present an unusual case of chondrosarcoma arising from the posterior ribs.

CT imaging provides the most definitive diagnostic information, revealing characteristic "flocculent" or "punctate" calcifications within the chondroid matrix that create the pathognomonic "ring and arc" or "popcorn-like" appearance.[1]

Multiplanar CT reconstructions clearly delineate the tumor's relationship to adjacent structures, particularly vital mediastinal and pleural anatomy, while precisely mapping areas of matrix mineralization that may be overlooked on plain radiography. The differential diagnosis includes enchondroma, fibrous dysplasia, and metastatic disease.

Treatment involves wide surgical excision, as these tumors demonstrate relative resistance to conventional radiation and chemotherapy. Inadequate surgical margins are associated with local recurrence rates exceeding 30%. Sangma et al. presented a case report of a 29-years old female with a painless tumor on the left anterior chest wall [2]. CT showed a lobulated heterogeneous mass with peripheral calcifications in the anterior aspect of the 8th rib. Biopsy revealed Chondrosarcoma, and radical resection procedure was performed. Their study emphasized CT scanning as the preferred imaging modality and emphasized that surgical resection with wide margins remains the cornerstone of treatment with routine lifelong surveillance. This approach was mirrored in our 36-year-old patient presenting with back pain, where a prompt VATS procedure following CT diagnosis facilitated wide tumor resection.

Milants et al. analyzed a case of chondrosarcoma presenting as a lower abdominal mass and demonstrated that while MRI provides superior delineation of tumor extent and marrow involvement, CT more effectively visualizes matrix mineralization and cortical destruction.[3]

Gao et al. described an incidentally discovered mediastinal mass.[4] CT revealed a lobulated mass containing diffuse stippled calcifications adjacent to the right side of T4/5 vertebra, demonstrating classic features of cortical scalloping of the rib with marginal sclerosis. Surgical resection of portions of the fourth and fifth ribs, with subsequent histopathological examination confirming the diagnosis of periosteal chondroma.

Chondrosarcoma of the rib in our case aligns with the literature findings regarding presentation, diagnostic approach, and management strategies. The prompt identification and wide surgical excision through the VATS procedure follow current best practices for treating this challenging malignancy.

Conclusion

Chondrosarcoma of the ribs is a rare neoplasm and commonly involves the anterior ribs, however posterior rib involvement is less common. The reviewed literature highlights that chondrosarcoma management requires a multidisciplinary approach with careful radiological and histopathological correlation. Surgical resection with adequate margins remains the mainstay of treatment. Imaging plays a critical role in diagnosis, staging, and surgical planning. Future research should focus on identifying molecular markers for better prognostication and developing targeted therapies for patients with unresectable or metastatic disease.