Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2302-2311
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2302
Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report
Chung-Wei Lin, Tsung-Yu Ho, Chen-Wei Yeh, Hsien-Te Chen, I-Ping Chiang, Yi-Chin Fong
Chung-Wei Lin, Tsung-Yu Ho, Hsien-Te Chen, Yi-Chin Fong, Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
Chen-Wei Yeh, Department of Education, China Medical University Hospital, China Medical University, Taichung City 40447, Taiwan
Hsien-Te Chen, Yi-Chin Fong, Department of Sports Medicine, College of Health Care, China Medical University, Taichung City 40402, Taiwan
Hsien-Te Chen, Spine Center, China Medical University Hospital, China Medical University, Taichung City 40454, Taiwan
I-Ping Chiang, Department of Pathology, China Medical University Hospital, China Medical University, Taichung 40454, Taiwan
Yi-Chin Fong, Department of Orthopedic Surgery, China Medical University Beigang Hospital, Yunlin County 65152, Taiwan
Author contributions: Chen HT designed the concept; Fong YC was the attending doctor and treated the patient; Lin CW and Ho TY contributed to literature review and manuscript drafting; Lin CW and Yeh CW revised the manuscript; Chiang IP performed histopathological analysis.
Informed consent statement: The patient provided consent for the treatment and the use of his medical documentation and information for the present article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Chin Fong, MD, Chief Doctor, Professor, Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, No. 2 Xueshi Road, North District, Taichung City 40454, Taiwan. d1762@mail.cmuh.org.tw
Received: October 1, 2020
Peer-review started: October 1, 2020
First decision: December 28, 2020
Revised: January 10, 2021
Accepted: January 25, 2021
Article in press: January 25, 2021
Published online: April 6, 2021
Processing time: 180 Days and 3.9 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Chondrosarcoma; Sternum; Chest wall; Cement; Reconstruction; Case report

Core Tip: Chondrosarcoma is the second most commonly observed primary bone tumor after osteosarcoma, accounting for 15% of all chest wall malignancies. Radical tumor excision is deemed the gold standard treatment. However, reconstruction of chest wall defect following tumor resection remains challenging. Our clinical case presents an innovative surgical procedure in managing chest wall defect. The surgical reconstructive materials including a locking plate and cement spacer are cost-effective and readily-available. We believe this technique, which yielded promising results, may serve as an alternative in cases such as ours.