Primary malignant giant cell tumor of the sternum

Primary malignant giant cell tumor (PMGCT) is a diagnosis based on the presence of a high-grade sarcomatous component along with a typical benign giant cell tumor (GCT). We report the first case of PMGCT of the sternum in a 28-year-old male with painless swelling over the manubrium sterni. The differential diagnoses of PMGCT and giant cell-rich osteosarcoma were considered. Surgical resection was performed, and the reconstruction was done with a neosternum using polymethyl methacrylate and prolene mesh. At 30 months follow-up, the patient is disease-free.

Sternal or parasternal involvement from breast cancer: a misleading clinical sign

Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer. To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer [BC] about a Tunisian series. We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez [ISA] of Tunis, with presence during the disease evolution [initial or at relapse] of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data [CT-scan and/or MRI], stage, time of occurrence, treatment and evolution. All patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months, > 12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm [24-75 mm] and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain [IMC] adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy [CT]. Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain [IMC] node involvement from breast cancer

Linfoma primario de hueso con afectación multicéntrica / Primary bone lymphoma with multicentric involvement

El linfoma primario de hueso es una enfermedad infrecuente, que tiene una presentación y evolución diferente a los linfomas de otras localizaciones. Se presenta un caso de linfoma primario de hueso de localización craneana y esternal de rápido crecimiento. En su evolución, realizada la exéresis de la lesión primaria de calota, presentó aparición de nuevas lesiones de rápido crecimiento a nivel craneano y fémur y progresión de lesión preesternal que, con anatomía patológica de linfoma no Hodgkin difuso de células grandes B, inició R-CHOPP (ciclofosfamida, doxorrubicina, vincristina, prednisona y rituximab) con rápida disminución de todas las lesiones sin evidencia de progresión al cabo de los seis ciclos.

Primary bone lymphoma is a rare disease, which usually has a different presentation and evolution than lymphomas of other locations. We are presenting a case of primary bone lymphoma of rapid growth, in cranial and sternal locations. In its evolution, once the excision of the primary lesion of the skull was performed, the patient presented new lesions of rapid growth at the skull and femur level, and progression of pre-sternal lesion. With large B-cell diffuse non-Hodgkin lymphoma pathology, the patient initiated R-CHOPP (cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab) with rapid reduction of all lesions without evidence of progression after the six cycles.

Tumor de células gigantes do esterno / Giant cell tumor of the sternum

Relatamos o caso de uma paciente de 74 anos portadora de tumor de células gigantes em osso esterno. A apresentação clínica e radiológica indicava neoplasia primária de osso esterno. A paciente realizou exames complementares e cirurgia. O exame patológico confirmou o diagnóstico. Comumente observado em ossos longos no esqueleto apendicular, esse tipo de tumor caracteriza-se por sua agressividade local e pelo potencial metastático. Também fazemos uma revisão sobre o tema.

We report the case of a 74-year-old female patient diagnosed with a giant cell tumor of the sternum. The clinical and radiological presentation was indicative of a primary tumor of the sternum. The patient underwent complementary tests and surgery. The pathological examination confirmed the diagnosis. Commonly observed in the long bones of the appendicular skeleton, this type of tumor is characterized by its local aggressiveness and metastatic potential. We also review the literature on the topic.

Plasmocitoma solitário ósseo: relato de caso / Solitary bone plasmocitoma: case report

JUSTIFICATIVA E OBJETIVOS: Plasmocitoma é um tumor maligno, originado da proliferação irreversível e autônoma dos plasmócitos, podendo se apresentar como massa circunscrita ou infiltração difusa. O plasmocitoma ósseo solitário é raro. Embora a idade dos pacientes seja variável, é incomum antes dos 30 anos. Tem predomínio no sexo masculino em proporção 3:1 e sua principal localização é a coluna vertebral. No plasmocitoma solitário, a eletroforese de proteínas séricas, o mielograma e as análises laboratoriais e radiológicas não apresentam evidências de doença sistêmica. O objetivo deste estudo foi relatar o caso de plasmocitoma solitário ósseo, localizado no osso esterno, enfocando aspectos essenciais na sua caracterização.RELATO DO CASO: Paciente do sexo masculino, 45 anos, encaminhado ao Serviço de Cirurgia Torácica devido ao surgimento de massa na região do manúbrio esternal, associado à dor local. Realizou tomografia computadorizada (TC) do tórax que mostrou extensa lesão lítica no osso esterno. A avaliação laboratorial incluindo hemograma, eletrólitos, eletroforese de proteínas séricas, análise quantitativa de imunoglobulinas séricas estavam todos dentro da normalidade. A pesquisa de proteína de Bence Jones foi negativa e a avaliação radiológica do crânio e ossos longos e a cintilografia óssea não mostrava outras lesões líticas. A biópsia de medula óssea foi normal. O paciente foi submetido à biópsia incisional da lesão que confirmou o diagnóstico de plasmocitoma solitário ósseo.CONCLUSÃO: Plasmocitoma solitário apesar de raro deve ser lembrado como diagnóstico diferencial de outras afecções para que o tratamento correto seja instituído, objetivando controle precoce da doença e melhor sobrevida.(AU)

BACKGROUND AND OBJECTIVES: Plasmacytoma is a malignant tumor originated of irreversible and independent proliferation of plasma cells. It's able to present itself as a circumscribed mass or diffuse infiltration. Solitary bone plasmacytoma is a rare tumor. Although the age of the patients is changeable, it is uncommon before the 30 years. It has predominance in men in ratio 3:1 and the main localization is the vertebral column. In solitary plasmacytoma, the serum protein electrophoresis, the bone marrow biopsy, as well as the laboratorial and radiological analyses and bone cintilography do not show evidences of systemic disease. The objective of this study is to report the case of a solitary bone plasmacytoma located in sternum, focusing essential aspects in the characterization of this entity. CASE REPORT: A male patient, 45-year-old, directed to the Thoracic Surgery Service due to the sprouting of a mass in sternum associated to local pain. In the Thoracic Computadorized Tomography (CT) Scan was noticed extensive litic injury in sternum. The laboratorial evaluation including hemogram, electrolytes, serum protein electrophoresis, serum quantitative immunoglobulin's analysis were normal. The Bence Jones protein was negative and the radiological evaluation of the skull and long bones did not show other litic injuries. The bone marrow biopsy was normal. The patient was submitted to a biopsy that ensuring the diagnosis of solitary bone plasmacytoma. CONCLUSION: Although solitary is a rare disease it should be remembered for differential diagnosis, objectifying a correct treatment and a better control of the disease.(AU)

Chest wall defects and their reconstruction

Chest wall reconstruction remains one of the most challenging areas of Plastic and Reconstructive Surgery. The purpose of this study is to report our 4 year experience with chest wall reconstruction. A review of 62 patients who had chest wall reconstruction from 2001 to 2004, is included in the paper. Indications include, defects secondary to congenital deformity correction, post neoplastic reconstructions, post burn defects and sternotomy wounds. Procedures performed included direct closure after debridement, vacuum assisted closure with and without skin grafting, pectoralis major flap, rectus abdominis flap, omental flap and free flaps including latissmus dorsi flap. The average hospital stay was 13 days. The uneventful recovery was seen in 50 patients. Minor complications were seen in 12 patients whereas major complications were not seen in any patient. Chest wall reconstruction can be performed with satisfactory outcome provided that reconstruction ladder is followed

Chest wall metastases from unknown primary hepatocellular carcinoma.

Metastases of hepatocellular carcinoma (HCC) to the bones are common but bone metastases of hepatocellular carcinoma in the presence of a normal liver are an uncommon entity. A 50-year-old male patient presented with a rapidly growing tumour on the sternum. Biopsy of the lesion showed metastatic sternal tumour from a primary hepatocellular carcinoma. Radiological evaluation however, failed to detect a primary lesion in the liver. Bone metastases of hepatocellular carcinoma localized to the chest wall in the presence of a normal liver are scarcely reported as anecdotal case reports in the literature.

[Sternal osteomyelitis: an exceptional osteo-articular lesion in inflammatory bowel disease: a case study]

Primary sternal osteomyelitis is a rare condition. It's association with ulcerative colitis is exceptional. We report a case of a 34 years old woman with multiple extra-intestinal manifestations presenting sternal osteomyelitis successfully treated with combined surgical intervention and intravenous antibiotics

Osteomyelitis of the thoracic cage in patients with sickle cell disorder

Thoracic cage osteomyelitis is an extremely rare manifestation in its pure form in sickle cell disease [SCD]. However rib infarction may be a common occurrence in SCD leading to a vicious cycle of chest pain, hypoventilation atelactasis, hypoxia and acute chest syndrome. Two cases of osteomyelitis, one of ribs and the second of sternum in sickle cell disease patients are reported here. The clinical presentation laboratory and radiological abnormalities as well as the response to therapy and outcome is presented

Erosäo esternal por aneurisma da aorta. Qual o melhor acesso? / Sternum erosion provoked by aortic aneurysm. Which is the better approach?

É descrito o caso de um paciente que apresentava erosäo esternal ocasionada por aneurisma da aorta ascendente e hemi-arco aórtico proximal. A via de acesso foi toracotomia bilateral uma vez que a erosäo era na parte alta do esterno, empregando-se hipotermia profunda e parada circulatória total. Foi interposto enxerto de pericárdio bovino para correçäo da aorta ascendente e hemi-arco aórtico proximal e outro enxerto entre o tronco braquicefálico e a parede lateral do enxerto de pericárdio bovino. A artéria descendente anterior foi revascularizada por haver oclusäo do óstio da artéria coronária esquerda. Após 3 anos da operaçäo o paciente está assintomático

Tuberculose da parede torácica: relato de caso / Tuberculosis of thoracic wall: case report

Relatamos um caso de tuberculose da parede torácica em um paciente do sexo feminino, de três anos de idade, apresentando ao exame clínico massa na parede anterior do tórax, em projeção do terço superior do esterno. A radiografia do tórax não demonstrou anormalidades. Ao ultra-som o aspecto era predominantemente sólido, e na tomografia computadorizada apresentava-se como massa heterogênea associada a destruição óssea e cartilagínea, com realce após a injeção do contraste endovenoso, sem sinais de acometimento do parênquima pulmonar. A biópsia da lesão evidenciou processo inflamatório crônico granulomatoso do tipo tuberculóide, com extensas áreas de necrose caseosa. A pesquisa de bacilo álcool-ácido resistente (BAAR) no material foi positiva.

Tuberculous mediastinitis: a rare presentation.

Granulomatous mediastinitis is a rare condition, and tuberculosis and fungal infections are the most important causes of this potentially lethal condition. Tuberculous mediastinitis usually presents with fever, cough, dyspnoea and rarely, florid features of obstruction to intra-thoracic structures are seen. A case of tuberculous mediastinitis presenting as a suprasternal lump, a rare presentation, is described here.

Tuberculosis sistémica con compromiso esternal / Systemic tuberculosis with involvement of the sternum

En los últimos 10 años se ha visto un aumento en el número de casos de Tuberculosis en pacientes HIV positivos en los cuales se ven presentaciones atípicas y resistencia antibióticas. Se describe un caso de Tuberculosis Sistémica con compromiso esternal en una paciente añosa HIV negativa con afectación ganglionar cervical, concomitante aún en ausencia de compromiso pulmonar típico

Resecciones esternales. Técnica utilizada / Sternal resections. Applied technique

Se presentan dos casos de tumores primitivos de esternón que fueron tratados con amplias resecciones. Los defectos parietales ubicados uno en el tercio superior y otro en el tercio inferior, fueron reparados con un "sandwich" de Marlex y metil metacrilato, con una cobertura de epiplón, permitiendo con esta combinación obtener un buen resultado anatómico, cosmético y funcional brindando también una razonable protección contra infecciones

Osteomielitis esternal primaria / Primary sternal osteomyelitis

La Osteomielitis Esternal Primaria (OEP) es una afección muy poco frecuente.En la biografía consultada se recogen solamente 57 casos desde 1918 que fue la primer serie publicada en Alemania hasta 1989.En la bibliografía nacional no encontramos ningún caso publicado hasta el momento.La OEP se puede presentar bajo la forma aguda o crónica, que no son más que dos etapas evolutivas de un mismo proceso, como está comprobado por estudios anatomopatológicos donde coexisten elementos inflamatorios agudos y crónicos.El diagnóstico exige el aislamiento del germen patógeno y la demostración de la lesión esternal.El Tratamiento de la OEP no se aparta de las directivas para las otras localizaciones de osteomielitis

Lesiones esternales únicas en el cancer de mama / Injuries of sternun in the breast neoplasm

Se realizó un estudio retrospectivo de las gammagrafías óseas de 1740 pacientes con cáncer de mama, que acudieron al Centro de Medicina Nuclear de enero de 1988 a abril de 1993. Se encontró 20 pacientes con lesiones esternales únicas. Esta lesión fue correlacionada con los hallazgos anatomopatológicos, radiológicos y/o la evolución, para conocer su etiología. Diecinueve casos correspondieron a enfermedad metastásica y uno a osteomielitis. Estos resultados sugieren que las lesiones esternales únicas en cáncer de mama son infrecuentes y están mayormente (95 por ciento) asociadas a etiología metastásica.

Quiste broncogénico de piel : a propósito de un caso / Bronchogenic skin cyst : apropos of a case

Se presenta un caso de quiste broncogénico localizado en la piel preesternal, se describe su embriopatogenia, una breve reseña de su casuística hasta la fecha, los posibles diagnósticos diferenciales y su tratamiento.