RJ’s journey: Overcoming a rare rib tumor extending to his lung, filled with hope for a return to the baseball field

Randy Williams, a 15-year-old high-school sophomore affectionately known as RJ by his family, has faced numerous challenges throughout his life. As a young child, baseball has always been his biggest passion – even though playing ball sometimes slows him down due to a hereditary bone disorder. Last April, RJ had to take a break from sports altogether after experiencing sudden chest pains and shortness of breath that seemed to come out of nowhere.

“While at school, his teacher texted me that my son was slumped over in his desk,” said Ann Luster. “He was complaining of stinging chest pains, and that he was having a difficult time breathing. I was extremely concerned about him. So, I scheduled an appointment with RJ’s pediatrician, Dr. Nicole Kerley-McGuire, who is affiliated with Children’s Hospital New Orleans. After examining him, she put him on Z-Pak for three days because she suspected RJ might have pneumonia after a spot was found on his lung.”

When RJ’s symptoms did not improve, Ann took her son to the emergency room. RJ had a follow-up X-ray that indicated the spot on his lung had not changed. Afterward, a CAT scan was ordered to get a more definitive evaluation of the suspicious spot on his lung. When the results of the CAT scan came back, the nurse practitioner in the ER shared the unexpected diagnosis.

“She said my son had an osteochondroma on his rib that was growing into his lung,” recalled Ann. “Since the bone tumor was close to his lungs, RJ had to stop playing sports. If he inhaled too deeply or fell and landed on his chest, the bone tumor could potentially puncture his lung. The CAT scan showed the tumor had already attached to the pleura (a thin layer of tissue that covers the lung). Dr. Kerley-McGuire referred us to Children’s Hospital of New Orleans where we met Dr. Matthew Cable, a musculoskeletal oncology surgeon, who took over my son’s case.”

An osteochondroma is a bone tumor that develops in the growing bones of children. It is the most common benign bone tumor that forms near the ends of bones near the growth plate, where new bone growth occurs in children and teens. It develops in childhood and usually stops growing when their skeleton stops growing. Most often, osteochondromas affect the long bones in the leg, the pelvis or shoulder blade. In RJ’s case, the bone tumor had grown out of his left rib.

“Osteochondromas of the ribs are rare, and usually arise at or near the anterior end of the rib,” said Dr. Cable, a pediatric surgeon who specializes in musculoskeletal oncology at Children’s Hospital and University Medical Center in New Orleans. “Treatment for osteochondromas varies depending on the size of the tumor and the severity of the patient’s symptoms. RJ’s bone tumor was on his left fourth rib and growing inward towards the lung. Since the growth invaded the pleural space of RJ’s lung and was causing him considerable discomfort, the best treatment option was to remove the mass.”

Ann was concerned about her son’s condition since the osteochondroma was located close to her son’s chest wall, but she was not surprised. Whenever doctors mention a bone disorder, Ann is used to hearing those words because she and her son have a hereditary bone condition. When RJ was just 7 years old, he had his first surgery to remove a bone spur that caused his forearm to bow out a little. Since then, RJ has had several surgeries to treat various bone spurs.

“When we met with Dr. Cable, he explained the rib tumor excision surgery to us in detail,” said Ann. “He told us that he would remove the growth on part of RJ’s rib. Dr. Cable answered our questions and concerns which really helped put our minds at ease. We could tell he was very knowledgeable by the way he explained things to us. Since he was familiar with my son’s bone disorder, we felt more comfortable about everything. While it was difficult to see my son go into surgery, I knew everything would be okay. RJ and I put our trust in Dr. Cable and his team.”

“I wasn’t really that nervous about the surgery,” said RJ. “I was ready to get it over with, so I could play baseball again. When I found out that I had a tumor on my rib, I was worried it was going to be cancer – that was my worst fear at that moment. When I found out later that it was not cancer, that’s when all the stress and worry left me. As for the surgery, I knew this would be a big game changer for me. I just wanted to play baseball and feel like a normal person again.”

On May 9, 2022, RJ underwent surgery to treat the osteochondroma that had been growing on the end of his rib and had penetrated the pleura in his lung. Before Dr. Cable could remove the tumor, which measured 3 centimeters across, Dr. Timothy Pettitt, a pediatric cardiothoracic surgeon performed a chest tube thoracostomy which involved placing a tiny plastic tube into RJ’s chest to drain fluid or air from around his lungs. Since the tumor was part of the chest wall – and since this was an invasive surgery where his heart was visible when they opened up his chest wall – Dr. Pettitt was involved in RJ’s case. After inserting the chest tube, Dr. Cable and his team performed an excision in the chest cavity where they opened the skin over the tumor, located the osteochondroma and removed the tumor at the level of normal bone by using an ultrasonic scalpel to prevent damage to the adjacent lung. Once it was removed, pathologists at Children’s Hospital examined the tumor and confirmed the growth was benign (non-cancerous).

“My surgery went well,” said RJ. “Dr. Cable removed the entire tumor off my rib. I spent one night in the cardiac ICU since I still had a tube in my chest. The doctors wanted to make sure my lungs didn’t fill up with fluid. After the chest tube was removed, I was able to leave the hospital and recover at home.”

Since RJ has a hereditary bone disorder, he has regular check-ups with Dr. Dominic Gargiulo, at Children’s Hospital to monitor his bones and treat his bone spurs. Since the bone tumor on his rib was located close to his lungs, Dr. Cable and his team stepped in to assist in the case.

At one of RJ’s follow-up appointments in 2023, Dr. Gargiulo found a benign bone tumor growing on RJ’s hip. On July 7, RJ underwent surgery where Dr. Gargiulo successfully removed the osteochondroma. Ann says her son has one more surgery scheduled. Dr. Jessica Rivera, an orthopedic surgeon at Children’s Hospital, will perform a procedure on RJ to correct the alignment in his arm due to a bone spur. Despite these setbacks, RJ remains hopeful and determined to return to playing baseball after taking some time to recover from his surgeries.

“RJ is such a strong and courageous person who doesn’t give up easily,” said Ann. “He is a soldier when it comes to managing his bone disorder. We are thankful to all the doctors who have taken great care of him and continue to monitor him closely. Their constant vigilance ensures that any potential issues related to his bone disorder can be identified and treated promptly. I am truly thankful for their ongoing commitment to my son’s overall well-being.”

Learn more about Children’s Hospital New Orleans Orthopedic services and patient care by visiting www.chnola.org.