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Vol. 59. Issue 4.
Pages 251-252 (April 2023)
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Vol. 59. Issue 4.
Pages 251-252 (April 2023)
Case Report
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Chondrosarcoma of Manubrium: Innovative Chest Wall Reconstruction
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Ana Triviñoa,
Corresponding author
atrivi_17@hotmail.com

Corresponding author.
, Rafael López-Canoa, Jesús Machucab
a Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena. Sevilla, Spain
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A 42-year-old male presented a protruding mass in manubrium with progressive growing for 4 months. Physical examination revealed a firm, non-movable, well-defined 5cm mass in sternum. Computed tomography and magnetic resonance showed a manubrial mass (45mm×39mm×34mm) with cortical breach and adjacent soft tissue calcification. Bone scintigraphy revealed an increased focal uptake in an osteoblastic mass in manubrium. These radiological findings suggested a chondrosarcoma. An incisional biopsy established a diagnosis of low grade chondrosarcoma.

Anterior bloc-resection of the chest wall with 2cm surgical margins was performed through a midline T-shaped skin incision. The manubrium, 1–3° costal cartilages of the right and left sides, and sternoclavicular joints bilaterally were removed. The affected area of the right pectoralis major muscle and the biopsy scar were also resected. A sternal titanium plate and pre-curved sternal staples (Trionyx System®) was used to reconstruction the chest wall and 3 wedge anchors (Stryker®) attached both clavicles to a multi-perforated sternal implant (Fig. 1A). The defect resulted was covered with left pectoralis major muscle flap. The histological examination of specimen confirmed the diagnosis of a grade 2 chondrosarcoma with microscopically tumor-free surgical margins (R0) (Fig. 1B). The patient was discharged without complication on postoperative day 5 (Fig. 1C) and the upper extremities mobility was conserved (Fig. 1D). He is running and doing weight training since the first postoperative month. Eight months after surgery, the patient keeps up a stable fixation of the sternoclavicular joint, and there is no evidence of local tumor recurrence.

Fig. 1.

(A) Sternal reconstruction with Trionyx Rib Fixation System® and sternoclavicular joint fixation with wedge anchor (Stryker®) (green cross: clavicles; blue cross: sternocleidomastoid muscle attached to titanium sternal plate). (B) Gross specimen of the manubrium shows tumor growth. (C) The post-operative chest X-ray shows the costal arches fixations (orange arrows) and the 3 wedge anchors in both clavicles (green arrows). (D) Outcomes at the first postoperative month: position with arms in abduction without functional limitation.

(0.38MB).

Primary neoplasms of the sternum are very rare, less than 1% of primary bone tumors.1 Most are malignant neoplasms, and chondrosarcoma is the most common,2 as in our case. The 5-year survival rate of chondrosarcoma is 64–92%.2–4 They are resistant to chemotherapy and radiotherapy. Radical resection with surgical margins R0 is the gold standard for treatment.2 A high-grade tumor, size >10cm and incomplete resection (R1) are negative predictors. In our case, the tumor was a grade 2 of chondrosarcoma, the size was <5cm and complete surgical resection was performed (R0). If manubrium is affected by a neoplasm, sternoclavicular joint will also be involved. These cases represent a challenging procedure to preserve respiratory function and to keep the sternoclavicular articulation function. There are different techniques and materials for chest wall reconstruction: non-rigid materials, rigid materials, autologous tissue or allografts. In our case, the reconstruction of the rigid wall of the chest is performed using a sternal plate plus rib attachments and a wedge anchor for both sternoclavicular joints. The ideal prosthesis by sternoclavicular articulation is no universally accepted. Our device is inserted in clavicle head like a screw and it is affixed at a sternal implant by non-absorbable suture. The advantages of our technique are as follows: reduction operative time, high versatility, easy to model in situ, perfect adaptability (different sizes) and multi-perforated sternal plate for clavicle attachment point or muscle reinsertion. This reconstruction procedure is a safe and cost-effective method with good orthopedic and oncological outcomes. We report our results with this thoracic implant and a new sternoclavicular fixation system.

Conflict of Interests

The authors state that they have no conflict of interests.

References
[1]
E. Jibah, S. Sabaratnam, N. Gautam.
Primary sternal tumours.
Scand J Thor Cardiovasc Surg, 23 (1989), pp. 289-292
[2]
K. McAfee, P.C. Pairolero, E.J. Bergstralh, J.M. Piehler, K.K. Unni, R.A. McLeod, et al.
Chondrosarcoma of the chest wall: factors affecting survival.
Ann Thorac Surg, 40 (1985), pp. 535-540
[3]
H.S. Bawa, D.D. Moore, J.C. Pelayo, N. Cipriani, G. Mak, R.C. Haydon.
Pediatric chondrosarcoma of the sternum resected with thorascopic assistance.
Open Orthop J, 11 (2017), pp. 479-485
[4]
H. Gao, Y. Zhou, Z. Wang, R. Zhao, S. Gian.
Clinical features and prognostic analysis of patients with chest wall chondrosarcoma.
Medicine (Baltimore), 98 (2019), pp. e17025
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