Sternal metastasis from breast cancerBy mahyarHistory: 66-year-old female with complaints of painfull growth on midline anterior chest wall Findings:
:: CT 1 ::Non contrast-enhanced computerized tomographic scan of thorax showed irregularity and lytic lesion of upper part of sternum with presternal and retrosternal soft tissue mass
:: CT 2 ::Non contrast-enhanced computerized tomographic scan of thorax
:: CT 3 ::Non contrast-enhanced computerized tomographic scan of thorax
:: CT 4 ::Non contrast-enhanced computerized tomographic scan of thorax Discussion: Most sternal tumors are secondary tumors caused by metastases from malignant tumors of the breast, lung, kidney or thyroid. Primary sternal tumors are rare. Most common primary malignant sternal tumors are the chondrosarcoma, whereas osterosarcoma is less frequent. Chondrosarcoma affected sternum about 2% of all of cases. Early diagnosis is important but difficult since the tumor tends to grow inward more than outward. Chondrosarcoma in the ribs or sternum typically arise near the costochondral junction. Radiologic assessment may be useful in suggesting the diagnosis, however, definitive diagnosis requires correlation between the histologic and radiologic appearance of the neoplasm. CT and MRI are helpful in characterizing the tumor and in assessing its extent. CT is superior to MR imaging in the demonstration of foci of calcification in chondrosarcoma and osteosarcomas. However, because of its great ability to distinguish tumor from normal soft tissue, MR imaging is the modality of choice in the assessment of the extent of chest wall tumors and their relationship to adjacent structures.Careful radiologic investigation is necessary to assess the extent of the tumor. The mass evident on examination is often part of a much larger tumor invading the sternum. Planar tomography and skeletal surveys, previously considered part of the standard evaluation, have been replaced by CT scans to evaluate the extent of the tumor and search for pulmonary metastases. High-resolution scans may help assess the extent of the primary tumor, particularly with respect to mediastinal invasion. MRI scans may be useful for large tumors in which mediastinal invasion of the pericardium, heart, or great vessels may be present. MRI sagittal views may be a useful addition to conventional axial scanning. Nuclear bone scanning serves to identify osseous metastases at other sites. Pulmonary function testing is important in patients with chronic obstructive pulmonary disease, in the elderly, and in those with large tumors necessitating a wide resection Wide resection with 2-5 cm margin for skin and 4-5 cm margin for bony structures is acceptable. Although primary closure is often preferred, and in particular after total sternectomy, skeletal and soft tissue reconstruction is necessary. Differential diagnosis: 1) metastases from malignant tumors of the breast, lung, kidney or thyroid. 2) chondrosarcoma 3) osterosarcoma Diagnosis confirmation: Dissection / Histo Category: Musculoskeletal Region / Organ: Thorax-Bones Etiology: neoplastic References: 1. Pairolero PC. Chest wall tumours. In : General thoracic surgery 5th ed, Shields TW, editor. Lippincott Williams and Wilkins: Phildelphia, USA; 2000. p. 589-98. Back to cited text no. 1 2. Nael M, Andrew GH, Michael EB, Heelam RT, Bains MS, McCormack PM, et al . Predictors of survival in malignant tumours of the sternum. J Thorac Cardiovas Surg 1996;111:96-106. Back to cited text no. 2 3. Incarbone M, Nava M, Lequaglie C, Ravasi G, Pastorino U. Sternal resection for primary or secondary tumors. J Thorac Cardiovas Surg 1997;114:93-9. 4. (Nael Martini, Andrew G. Huvos, Michael E. Burt, , Robert T. Heelan, , Manjit S. Bains, , Patricia M. McCormack, , Valerie W. Rusch, Michael Weber, , Robert J. Downey, Robert J. Ginsberg, PREDICTORS OF SURVIVAL IN MALIGNANT TUMORS OF THE STERNUM, J Thorac Cardiovasc Surg 1996;111:96-106). 5. M.L. te Winkel, M.H. Lequin, et al, Self-limiting sternal tumors of childhood (SELSTOC), Pediatric Blood & Cancer, Volume 9999 Issue 9999, Page n/a. Get more for Sternal metastasis from breast cancer Peer-reviewed resources Literature  More publications about Sternal metastasis from breast cancer Challenge yourself with the case quiz! |