Primary tumours of the sternum

A diagnostic pitfall of a sternal mass

Primary sternal lymphoma represents a rare entity which must be evoked in front of a sternal mass especially as its treatment is different from that of sarcomas, the principal etiology of sternal masses.

Primary Squamous Cell Carcinoma of the Sternum

Primary squamous cell carcinoma of the sternum is very rare. Imaging features are not specific, and a biopsy specimen may help identify the pathology. Positron emission tomography scan helps rule out a primary focus elsewhere. The treatment will be surgical management, if operable. We encountered a patient with primary squamous cell carcinoma of the sternum with an unusual presentation. After the diagnostic workup, we managed the patient surgically with resection, followed by titanium mesh reconstruction and pectoralis major flap cover. We present the case in view of its rarity and to emphasize the key surgical points.

Bone heterograft for chest wall reconstruction after sternal resection

BACKGROUND

Experimental and clinical results of chest-wall reconstruction with bone heterograft after sternectomy are reported.

METHODS

Seven dogs underwent subtotal or total sternectomy and reconstruction by implantation of a cortico-spongy bone heterograft sandwiched between two layers of a reabsorbable mesh.

RESULTS

No major postoperative complications were observed. The implant has shown favorable mechanical and biological properties. Six and 9 months after operation all animals were sacrificed and pathologic examination showed good incorporation of the implanted bone with only partial resorption of its spongiosa. Subsequently, 2 patients underwent sternal resection with different indications and reconstruction was achieved by the technique developed experimentally. No complications were observed. Excellent immediate chest-wall stabilization was obtained, persisting for a follow-up period longer than 6 months.

CONCLUSIONS

In comparison with autologous bone, sterile bone heterograft seems to offer the same mechanical properties with a significantly reduced surgical trauma.

Predictors of survival in malignant tumors of the sternum

From 1930 to 1994, 54 patients with primary malignant tumors of the sternum were seen. Fifty patients were first seen with a mass, and one half of them also had pain in the sternal region. Two patients had no symptoms at presentation. Among 39 solid tumors were 26 chondrosarcomas, 10 osteosarcomas, 1 fibrosarcoma, 1 angiosarcoma, and 1 malignant fibrous histiocytoma. Of these, 25 were low-grade and 14 were high-grade tumors. Among 15 small cell tumors were 8 plasmacytomas, 6 malignant lymphomas, and 1 Ewing's sarcoma. Partial or subtotal sternectomy was done in 37 patients and total sternectomy in 3. Of the remaining 14 patients, 3 had local excision; 10 had external radiation or chemotherapy without operation, or both; and 1 had no treatment. All but one patient treated by wide resection (N = 40) had some form of skeletal reconstruction of the chest wall defect. Thirty-one (78%) underwent repair with Marlex mesh, and in 25 this was combined with methyl methacrylate. The skin edges were closed per primum in 32 patients; 8 required muscle, omentum, or skin flaps. Resection in chondrosarcomas yielded a 5-year survival (Kaplan-Meier) of 80% (median follow-up, 17 years). The 5-year survival in osteosarcomas was 14%. Resection was curative in 64% of low-grade sarcomas but in only 7% of high-grade sarcomas. In small cell tumors, resection and radiation were helpful for local control; all failures were a result of distant metastases. We conclude that primary sarcomas of the sternum though uncommon are potentially curable by wide surgical excision. With rigid prostheses to repair the skeletal defects, the surgical complication rates are low. Overall survival after complete surgical resection is related to tumor histologic type and grade.