Chest wall fibrolipoma presenting as a massive dumbbell tumour in a child

Chest wall tumours are uncommon lesions, with an incidence of less than 2% of paediatric solid tumours. Overall, the majority of chest wall tumours are malignant and belong to the family of small round blue cell tumours of the Ewing’s family of primitive neuroectodermal tumours. The literature has few large case series in view of their rarity of occurrence in children. From a management point of view, the bony chest wall provides a challenge to complete excision of the tumour and subsequent reconstruction [1]. Against this background, the interesting presentation and management of a massive chest wall tumour with dumbbell extension in a child is detailed.
A 7-year-old boy presented with a left chest swelling, noted since the age of 2 years. In view of a recent increase in size of swelling over the past year, the parents sought medical attention. The boy was otherwise well, without any local pain or discomfort over the swelling. On local examination (Figure 1), a non-tender firm swelling measuring about 7 × 6 cm was palpable over the antero-lateral left lower chest wall, extending into the axilla. The skin over the swelling appeared normal without any prominent vessels. No distal neurovascular deficit was observed in the left upper limb. The systemic examination was unremarkable. Plain X-ray of the chest revealed a soft tissue density with concave deformity of the underlying 4, 5, 6 ribs without bony erosion on the left side. Further imaging with computed tomography (CT) contrast of the chest identified the swelling to be non-enhancing, uniformly homogeneous with density consistent with adipose tissue. The swelling appeared to be encapsulated, dumbbell shaped with the deeper part extending between the ribs to reach the lung hilum subpleurally (Figures 2, 3). Fine needle aspiration cytology of the swelling was consistent with adipose tissue. A preliminary diagnosis of benign chest wall tumour was made and surgical excision was undertaken after obtaining informed written consent. Intraoperatively, the swelling was posterior to the intercostal muscles and anterior to the pleura with a dumbbell extension into the 4th intercostal space, without adherence to the pleura. The swelling was excised completely. After excision, the swelling measured 8 × 6 cm, yellowish, firm, lobulated with a dumbbell appearance (Figure 4). Histology confirmed the presence of mature adipose tissue interspersed with fibrotic strands, consistent with a fibrolipoma. After...


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