Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma

Thymic carcinoma presenting as atypical chest pain

A 58-year-old woman with a 2-month history of atypical chest pain was referred to the chest pain clinic by the general practitioner. Exercise stress test was positive and subsequent coronary angiogram revealed significant triple vessel disease with left ventricular impairment requiring a coronary artery bypass graft (CABG). The patient had a chest X-ray as part of the preoperative work up. Chest X-ray revealed a large anterior mediastinal mass. Subsequent thorax CT revealed a 7.2 cm anterior mediastinal mass. CT-guided biopsy of the mass revealed the diagnosis of a poorly differentiated thymic basaloid carcinoma. The patient was successfully treated with concomitant surgery involving complete resection of the mass and a CABG procedure.

CASE REPORT Sternal Chondrosarcoma After Sternotomy for Coronary Artery Bypass Grafting

OBJECTIVE

Primary bony tumors of the chest wall are usually benign and most commonly located in the ribs or sternum. Chondrosarcoma is regarded as one of the most frequent primary malignancies of the chest wall and its incidence after a sternotomy for a cardiac procedure is extremely rare. We present a case of sternal chondrosarcoma.

METHODS

The patient presented with a sternal mass 4 years after undergoing coronary artery bypass grafting for ischemic coronary artery disease. The mass originally emanated from the upper portion of the patients' sternum and then rapidly enlarged to include the anterior aspects of his neck. Radiologic imaging studies were undertaken: computed tomographic scan and magnetic resonance imaging, with surgical intervention for excision.

RESULTS

Computed tomographic scan and magnetic resonance imaging established an 8.4 × 6.2 × 8.6 cm(3) complex solid tissue mass within the lower neck arising from the sternal manubrium, with extensive bone destruction. Computed tomography-guided biopsy showed cells of uncertain significance. Surgical excision was performed and the mass was diagnosed as a grade II chondrosarcoma.

DISCUSSION

Primary sarcomas of the sternum though uncommon are potentially curable with wide surgical excision. Success depends on tumor histologic type and grade, which dictate recurrence.

Concomitant aortic valve replacement and gastrectomy for gastric cancer

A 75-year-old male patient developed hematemesis due to gastric cancer 1 week before scheduled aortic valve replacement for severe aortic stenosis. A gastrectomy was urgently required, but the risk of intraoperative cardiac decompensation was judged as too high because of the severity of his cardiac disease. On the other hand, cardiopulmonary bypass posed an exceedingly high risk of bleeding from the stomach cancer. Concomitant aortic valve replacement and gastrectomy were performed successfully.