PMC5337383_01
Preoperative chest X-ray (a) and CT scan (b) showing a large mass with multiple areas of low attenuation that has compressed the heart but without obvious invasion to vital organs.
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A tumor was suspected based on the chest X-ray and therefore a chest CT scan was done that revealed a large mass with differential diagnosis of primary sternal tumor in origin or anterior mediastinal tumor with invasion to sternum (Figures 1(a) and 1(b)).
Preoperative picture of patient with a large bulging in anterior mediastinal area (a). At the time of operation a large hemorrhagic mass without obvious invasion to surrounding tissues was discovered (b) that was completely resected along with sternal manubrium (c). Large anterior defect of chest wall (d) was reconstructed by a cryopreserved sternal allograft (e) that was fixed by titanium plates and screw (f).
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Due to large dimension of tumor, pectoralis major muscles were pushed laterally to nearly mid clavicular lines (Figures 2(a) and 2(b)). Large 20 x 20 cm mass was completely resected and an extensive defect remained in the chest wall (Figures 2(c) and 2(d)). Graft was tailored gradually and fixed to patient's ribs by titanium mesh plates and screws and exactly fixed to bilateral clavicles (Figures 2(e) and 2(f)).
Serial postoperative chest X rays. Early postoperative (a) about two weeks (b) and nearly three months after operation (c).
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Serial chest X rays of patient have been shown in Figure 3.
Histopathology (H&A, 200x) showed that the tumor cells exhibited multiple cystic lesion that was filled with red blood cells without endothelial lining surrounded by osteoclast like giant cells.
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Final pathologic report was compatible with aneurysmal bone cyst (Figure 4).
About 18 months after sternal resection there is no evidence of tumoral lesion with small keloid tissue in incisional line.
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More than eighteen months after surgery, patient had some keloid tissue in primary incision with no evidence of tumor regrowth (Figure 5).