A 77-year-old male patient was admitted with "persistent chest wall pain for more than two months, anterior chest wall mass found for one month and progressive enlargement for ten days."
Physical examination: The sternal stalk showed a locally raised mass, stony and well-defined, with a size of 8.4cm× 10.6cm, mild to moderate tenderness in the center and surrounding of the pack, and no superficial skin veins on the surface of the mass (Fig. 1, a).History: A history of tuberculosis, no family history of hereditary cancer or other diseases.Supplementary examination: tumor markers, blood routine, erythrocytic sedimentation rate, alkaline phosphatase, hypersensitive C-reactive protein, urinary during qualitative tests were negative.Color Doppler ultrasound (superficial lymph node examination) bilateral neck region IV lymph node enlargement, the maximum diameter of 1.5cm. Chest plain scan and enhanced CT showed an 8.5cm-shaped round mass in the manubrium sternum, with expansive bone destruction and marginal sclerosis (Fig. 1, b, c).Bone scan: Abnormal concentration of round nuclides in the sternal stalk was observed (Fig. 1, d).
During the operation, the tumor protruding on the surface of the sternal stalk, the size was about 7cms × 8cms, the periosteum was complete and soft, the cancer was not beyond the bilateral sternal edge, and the upper sternal edge, the bilateral clavicle head and the bilateral 1–3 ribs were not invaded (Fig. 2, a). In addition, the tissue inside the tumor was changed like fish, with a crisp texture and apparent oozing blood.
During the operation, the tumor was frozen :(mass of sternal stalk) malignant tumor, so the enlarged radical resection of sternal stalk tumor was performed. The cutting edge was 6cm from the edge of the tumor.No tumor invasion was observed in the aortic arch and superior vena cava. The manubrium sternum, part of the body of the sternum, part of the costal cartilage on both sides, and part of the thymus tissue below the tumor were removed entirely (Fig. 2,b). After the enlarged resection of cancer, the size of the chest wall defect was about 20cm ×20cm. The bilateral pleural cavity and mediastinal part of the defect could be seen under direct vision (Fig. 2,c). Two polyester patches were used to repair the defect.
The broken ends of both clavicles were bridged and fixed with curved reconstruction steel, and the functions of bilateral sternocleidomastoid muscles were rebuilt. The preformed rib plates were reconstructed for thoracic reconstruction (Fig. 2,d).
Postoperative pathological diagnosis was plasma cell tumor (sternal stalk tumor), and isolated bone plasma cell tumor was considered clinically.No tumor was found at the broken rib ends.Immunohistochemistry: Vimentin (+), CD38 (+), Kappa (+), CD138 (partially +), IgG (partially weak +), CD79α (locally +), Ki-67 (+, about 10%) (Fig. 3,a b).Supraclavicular lymph nodes and paratha cava lymph nodes were negative. The incision healed well after surgery, and he was discharged from the hospital smoothly (Fig. 3,c).
Postoperative pathology showed no tumor involvement at the broken ends of the ribs, and no radiotherapy or chemotherapy was performed. Postoperative follow-up for half a year showed no depressions or protrusions in chest wall appearance, good recovery in respiratory and motor function, neck and shoulder activities, and no effect on daily life. In addition, DR chest reexamination showed an excellent rib plate and clavicle plate position, and no loosening was observed (Fig. 3,d).