Lin Chung-Wei, Ho Tsung-Yu, Yeh Chen-Wei, Chen Hsien-Te, Chiang I-Ping, Fong Yi-Chin
Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan.
Department of Education, China Medical University Hospital, China Medical University, Taichung City 40447, Taiwan.
World J Clin Cases. 2021 Apr 6;9(10):2302-2311. doi: 10.12998/wjcc.v9.i10.2302.
Chondrosarcoma, a cartilage matrix producing tumor, is the second most commonly observed primary bone tumor after osteosarcoma, accounting for 15% of all chest wall malignancies. We herein report the case of a patient with chondrosarcoma of the sternum and our management of the chest wall defects that presented following radical tumor resection.
A 31-year-old patient presented to our hospital with dull pain and a protruding mass overlying the chest for 3 mo. The presence of nocturnal pain and mass size progression was reported, as were overhead arm elevation-related limitations. Computed tomography showed a focal osteoblastic mass in the sternum with bony exostosis and adjacent soft tissue calcification. Positron emission tomography-computed tomography revealed hypermetabolic activity with a mass located over the upper sternum. Magnetic resonance imaging showed a focal ill-defined bony mass of the sternum with cortical destruction and periosteal reaction. Preoperative biopsy showed a consistent result with chondrosarcoma with immunohistochemical positivity for S100 and focal positivity for IDH-1. The grade II chondrosarcoma diagnosis was confirmed by postoperative pathology. The patient underwent radical tumor resection and chest wall reconstruction with a locking plate and cement spacer. The patient was discharged 1 wk after surgery without any complications. At the 1-year follow-up, there was no local recurrence on imaging. The functional scores, including Constant Score, Nottingham Clavicle Score, and Oxford Shoulder Score, showed the absence of pain in the performance of daily activities or substantial functional disabilities.
The diagnosis of chondrosarcoma must be considered when chest wall tumors are encountered. The surgical reconstructive materials, with a locking plate and cement spacer, used in our study are cost-effective and readily-available for the sternum defect.
软骨肉瘤是一种产生软骨基质的肿瘤，是骨肉瘤之后第二常见的原发性骨肿瘤，占所有胸壁恶性肿瘤的15%。我们在此报告一例胸骨软骨肉瘤患者以及我们对肿瘤根治性切除后出现的胸壁缺损的处理。
一名31岁患者因胸部隐痛和突出肿物3个月就诊于我院。患者报告有夜间疼痛和肿物大小进展情况，以及与上臂上举相关的活动受限。计算机断层扫描显示胸骨有一个局灶性成骨性肿物，伴有骨外生骨疣和相邻软组织钙化。正电子发射断层扫描-计算机断层扫描显示上胸骨处有一个肿物，代谢活跃。磁共振成像显示胸骨有一个边界不清的局灶性骨质肿物，伴有皮质破坏和骨膜反应。术前活检结果与软骨肉瘤一致，免疫组化S100呈阳性，异柠檬酸脱氢酶-1呈局灶性阳性。术后病理证实为II级软骨肉瘤。患者接受了肿瘤根治性切除，并使用锁定钢板和骨水泥间隔物进行胸壁重建。患者术后1周出院，无任何并发症。在1年随访时，影像学检查未发现局部复发。包括Constant评分、诺丁汉锁骨评分和牛津肩评分在内的功能评分显示，患者在日常活动中无疼痛，也无明显功能障碍。
遇到胸壁肿瘤时必须考虑软骨肉瘤的诊断。我们研究中使用的锁定钢板和骨水泥间隔物等手术重建材料性价比高，且易于用于胸骨缺损修复。
