SURGICAL MANAGEMENT OF SOFT TISSUE SARCOMAS OF HOSPITAL SANTA RITA

Case Report: Male, 57 years old, complaining of productive cough and perception of chest injury. Was referred to a specialist with a diagnosis of sternal injury, with computed tomography (CT) showing an expansive formation affecting the entire body of the sternum, with irregular focus of calcification inside. Subtotal sternectomy was performed with thoracic wall reconstruction through two layers of polypropylene mesh with inner layer of metamethylcyanoacrylate, using a sandwich technique. The anatomopathological study of intraoperative freezing of the surgical margins guaranteed their negativity and revealed to be a Class 1 Central Chondrosarcoma (pT1). The patient remained with a portovac drain in the surgical site and bilateral chest drain, which were removed in the 3rd postoperative period. The imaging study after subtotal sternectomy showed hyperattenuating material in the sternum, related to the reconstructive surgical material. The sternum manubrium presented preserved morphology and attenuation coefficients. A recent CT scan showed surgical absence of the sternal body, with the presence of a local graft, normal morphology and attenuation, unchanged from the previous exam. The patient presented a good evolution in one-year follow-up, with no signs of local recurrence. Discussion: Chondrosarcoma accounts for 30% of all primary malignant bone tumors. This tumor is characterized by neoplastic cells, being more frequent in the third and fourth decades of life, more common in males. A palpable mass, with or without pain, is often the first symptom. Tumor growth is slow and usually has a benign behavior. Radiologically, the tumor appears as a lobulated mass that increases in the medullary portion of the bone with destruction of the cortex and mineralization of the tumor matrix, which produces an aspect of calcification. The diagnosis is made through a histopathological and radiographic correlation. Chondrosarcoma is resistant to radiotherapy and chemotherapy, which can be explained by its growth based on matrix production. Therefore, surgical treatment with resection of the compromised area is recommended. Final considerations:The patient in question does not show signs of return of tumor activity and, although there is no consensus on the required follow-up after surgery, most authors advocate a minimum follow-up of two to five years.

 

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Artikel online veröffentlicht:
23. Oktober 2019