Case Report- A 60 year old gentleman came with the history of gradually increasing swelling in the upper midline chest for last 6 months. He had been investigated elsewhere and a fine needle aspiration was done. The diagnosis was chondrosarcoma of the manubrium sterni. The CT scan images were also suggestive of the diagnosis. The tomor appeared to be locallu containe with no involvement of the mediastinal structures.
We advised the patient surgery and did a PET scan to rule out any secondaries. The PET scan was negative for tumor spread.
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| PET Scan negative for any metastasis. |
Surgery- A wide excision with a 5cm margin was planned. This meant removing nearly half of sternum, 1-3 ribs and medial end of clavicles. This would result in a large defect requiring reconstuction.
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| Wide gap in the chest wall after radical excision. |
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| Resected sternum with 1-3 ribsand clavicles (medial ends). |
A median sternotomy incision was used and adequate resection carried out. The defect was repaired with a customised composite prosthesis made in the OR using double polypropylene mesh and acrylic bone cement. The prosthesis was covered with bilateral pec major flaps sutured in the midline.
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| Customised Composite prosthesis for sternal reconstruction using polypropylene mesh and acrylic bone cement |
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| Composite prosthesis being sutured in place to fill defect |
The patient was extubated on table and made an uneventful recovery and discharged on the 3rd postoperative day.
Histopathology Report- Chondrosarcoma Grade II.
Comment-
Primary sternal tomors are rare and account for 1% of bone neoplasms. Chondrosarcoma is the commnest primart sternal tumor. It is resistant to chemotherapy and radiotherapy and curative resection is the only hope. Survival after curative resection is good if the tumor has not metastasised. Surgery involves radical resection with reconstruction of the anterior chest wall with various techniques.
