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Muramatsu K, Tani Y, Seto T, Roces G, Yamamoto M, Ichihara Y, Sakai T. Two cases with giant cell tumor arising from the sternum: Diagnosis and options for treatment. J Orthop Sci 2022; 27:1143-1148. [PMID: 32001081 DOI: 10.1016/j.jos.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/12/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan; Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan.
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Tetsuya Seto
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Gaston Roces
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Manabu Yamamoto
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Yusuke Ichihara
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan
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Osteosarcoma of the sternum after radiotherapy for breast cancer in a patient with suspected hereditary cancer syndrome: a case report. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Radiation-induced malignancies are a rare phenomenon. Post-radiation sarcoma accounts for 0·5–5·5% of all sarcomas. Adjuvant radiotherapy (RT) after surgery plays a significant role in the treatment of breast cancer. Sarcomas of the breast, chest wall, sternum, axilla or supraclavicular region have been reported as a rare complication of RT for breast cancer. Osteosarcoma (OS) of the sternal bone is a rarely reported entity. OS of the sternum secondary to therapeutic ionising radiation is an even rarer diagnosis, and no such cases have been reported in India as per our literature search. Here we report such a case of post-radiation sarcoma after breast cancer treatment—OS presenting in the sternum and both the second ribs in a young lady.Findings:Our patient developed a sarcoma within a previously irradiated field. The latent period was 7·5 years. She initially suffered from a breast carcinoma for which she underwent radical surgery in the form of modified radical mastectomy. She also received 50 Gy RT dose to the chest wall and axilla. She subsequently developed an OS of chest wall in the high-dose region of RT. Another key factor is the high possibility of familial/hereditary cancer inheritance syndrome like Li-Fraumeni in our patient. Though she was never tested for p53 mutations, her young age at first diagnosis (26 years), extremely strong positive family history and spectra of cancers affecting her first-degree blood relatives (brain tumours, leukaemia) strongly hint at the possibility of such a cancer syndrome. Retrospectively, the question certainly arises, given her young age and family history, whether this patient was a right candidate for RT even once as compared to the fact that she received radiation twice.
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Li NP, Wingfield MA, Mills MK, Beckett BR, Hansford BG. Percutaneous image-guided sternal biopsy: a cross-institutional retrospective review of diagnostic yield and safety in 50 cases. Skeletal Radiol 2021; 50:495-504. [PMID: 32815039 DOI: 10.1007/s00256-020-03587-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Image-guided sternal biopsy may be technically daunting given the immediately subjacent critical structures. There is a paucity of literature describing technique, safety, and efficacy. This study aims to quantify the diagnostic yield and safety of image-guided sternal biopsies. Secondary aims include (1) describing the preferred approach/technique and (2) identifying imaging features and disease entities associated with higher and lower diagnostic yields. MATERIALS AND METHODS A retrospective review of 50 image-guided sternal biopsies performed at two quaternary care centers from 2000 to 2019 was performed. Recorded lesion-related variables included as follows: location, density, extraosseous extension, and size. Recorded variables from electronic medical records included as follows: patient demographics, histologic or microbiological diagnosis, and complications. Recorded technique-related variables included as follows: needle obliquity, type, and gauge; biopsy core number and length; and modality. RESULTS Of the 50 biopsies, 88.0% resulted in a definitive histologic diagnosis. Six biopsies were non-diagnostic. The majority of biopsies were performed under computed tomography (88.0%), followed by ultrasound (12.0%). Tumor was the most common biopsy indication (90.0%), followed by infection (10.0%). Of the diagnostic biopsies indicated for tumor, 88.9% were malignant. Seventy-four percent of the lesions were predominantly lytic. Fifty percent of lesions had extraosseous extension. Lesion locations were as follows: manubrium (48.0%), sternal body (48.0%), and sternomanubrial joint (4.0%). No minor or major, acute, or delayed procedure-related complications were encountered. CONCLUSION Image-guided sternal biopsy is an efficacious and safe method of obtaining a definitive histologic diagnosis regardless of lesion-specific features or location.
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Affiliation(s)
- Ningcheng Peter Li
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Molly A Wingfield
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Brooke R Beckett
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Barry G Hansford
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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Singh A, Chandrashekhara SH, Triveni GS, Kumar P. Imaging in Sternal Tumours: A Pictorial Review. Pol J Radiol 2017; 82:448-456. [PMID: 29662571 PMCID: PMC5894046 DOI: 10.12659/pjr.901226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/31/2016] [Indexed: 11/09/2022] Open
Abstract
The sternum is an uncommon site for neoplastic involvement and metastases are far commoner than primary neoplasms. Of the primary tumours, malignant lesions are more frequent than the benign lesions. Early diagnosis and treatment is prudent in such neoplasms not only to halt disease progression but also to prevent circulatory compromise resulting from the mass effect on the mediastinum. Sound knowledge of neoplasms affecting the sternum and their imaging appearance is essential to arrive at an early diagnosis and also to obviate biopsy in cases with classical imaging findings. Neoplastic involvement of the sternum is extremely unusual and should be considered malignant unless proven otherwise. Imaging may help in arriving at the diagnosis of these lesions, together with other factors such as patient's age, type of lesion (lytic/sclerotic or mixed), matrix mineralization, multiplicity and involvement of other sites.
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Affiliation(s)
- Anuradha Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences New Delhi, India
| | | | | | - Pawan Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences New Delhi, India
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Limback JM, Letter HP, Scherer KF, Wasyliw CW, Bancroft LW. Recurrent radiation-induced osteosarcoma of the sternum in a patient with remote radiation therapy for breast cancer. Radiol Case Rep 2016; 11:375-379. [PMID: 27920865 PMCID: PMC5128365 DOI: 10.1016/j.radcr.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/07/2016] [Indexed: 12/05/2022] Open
Abstract
Background Recurrent radiation-induced osteosarcoma of the sternum following remote radiation therapy for breast cancer and sternal reconstruction. Case A 51-year-old woman presents with recurrent, radiation-induced sternal osteosarcoma 11 years after receiving both radiation therapy for breast cancer and sternal reconstruction. The case details both her work-up and subsequent course, including reconstructive and curative efforts. Discussion An uncommon side effect of radiation therapy for breast cancer is development of osteosarcoma of the chest wall. Even rarer is recurrence of the osteosarcoma following sternal reconstruction.
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Affiliation(s)
- Joseph M Limback
- Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803, USA
| | - Haley P Letter
- Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803, USA
| | - Kurt F Scherer
- Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803, USA
| | | | - Laura W Bancroft
- Department of Radiology, Florida Hospital, 601 E Rollins St, Orlando, FL 32803, USA
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Affiliation(s)
- Rakesh K Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, Rohini, Delhi, India
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Abstract
OBJECTIVE To evaluate the use of titanium mesh reconstruction after sternal tumor resection. METHODS From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. RESULTS Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. CONCLUSIONS Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.
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Engel EE, Nogueira-Barbosa MH, Yamashita MEDAS, Cipriano FEG, Valera ET, Brassesco MS. Clinical and cytogenetic aspects of giant cell tumor of the sternum. Clinics (Sao Paulo) 2011; 66:1501-4. [PMID: 21915509 PMCID: PMC3161237 DOI: 10.1590/s1807-59322011000800034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Edgard Eduard Engel
- Department of Orthopedics and Traumatology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Restrepo CS, Martinez S, Lemos DF, Washington L, McAdams HP, Vargas D, Lemos JA, Carrillo JA, Diethelm L. Imaging appearances of the sternum and sternoclavicular joints. Radiographics 2009; 29:839-59. [PMID: 19448119 DOI: 10.1148/rg.293055136] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The sternum and sternoclavicular joints--critical structures of the anterior chest wall--may be affected by various anatomic anomalies and pathologic processes, some of which require treatment. Pectus excavatum and pectus carinatum are common congenital anomalies that are usually benign but may warrant surgical treatment if they cause compression of vital internal structures. By contrast, developmental variants such as the sternal foramen are asymptomatic and do not require further evaluation or treatment. Arthritides of the sternoclavicular joint (osteoarthritis, septic arthritis, and seronegative arthropathies) are common and must be differentiated before an appropriate management method can be selected. The recognition of complications of sternotomy (eg, sternal dehiscence, secondary osteomyelitis) is critical to avoid life-threatening sequelae such as acute mediastinitis. Likewise, the detection of sternal fractures and sternoclavicular dislocations is important, especially where they impinge on vital structures. In addition, sternal malignancies (most commonly, metastases and chondrosarcoma) must be distinguished from benign neoplasms. To achieve accurate and timely diagnoses that facilitate appropriate treatment, radiologists must be familiar with the appearances of these normal anatomic variants and diseases of the sternum.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex., USA
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Haraguchi S, Hioki M, Hisayoshi T, Yamashita K, Koizumi K, Shimizu K. Resection of sternal metastasis from endometrial carcinoma followed by reconstruction with sandwiched marlex and stainless steel mesh: report of a case. Surg Today 2006; 36:184-6. [PMID: 16440169 DOI: 10.1007/s00595-005-3106-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 05/24/2005] [Indexed: 11/29/2022]
Abstract
We report the successful resection of sternal metastasis from endometrial carcinoma, followed by reconstruction of the chest defect, in an 87-year-old woman. We performed subtotal sternectomy and concurrent resection of the ribs and overlying soft tissue. The skeletal defect was then reconstructed with sandwiched Marlex and stainless steel mesh, and soft tissue coverage was accomplished by using a pectoralis major advancement flap. The patient had an uneventful postoperative course with no sign of recurrence during 5 years of follow-up. Thus, reconstruction with Marlex and stainless steel mesh could be an effective technique for preventing paradoxical movement of the thorax and protecting the intrathoracic organs.
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Affiliation(s)
- Shuji Haraguchi
- Department of Surgery, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
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Haraguchi S, Hioki M, Hisayoshi T, Yamashita K, Yamashita Y, Kawamura J, Hirata T, Yamagishi S, Koizumi K, Shimizu K. Resection of sternal tumors and reconstruction of the thorax: a review of 15 patients. Surg Today 2006; 36:225-9. [PMID: 16493530 DOI: 10.1007/s00595-005-3134-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 07/12/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. METHODS Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. RESULTS All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. CONCLUSIONS Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.
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Affiliation(s)
- Shuji Haraguchi
- Department of Surgery, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
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Ferri M, Finlay K, Popowich T, Jurriaans E, Friedman L. Sonographic examination of the acromioclavicular and sternoclavicular joints. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:345-55. [PMID: 16196011 DOI: 10.1002/jcu.20153] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Melanie Ferri
- McMaster University and Hamilton Health Sciences, Henderson General Hospital, 711 Concession Street, Hamilton, Ontario, Canada L8V 1C3
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