대한흉부영상의학회 Weekly Chest Cases

Case No : 141 Date 2000-07-08

Courtesy of Seon Young Yoo, MD. / Korea Veterans Hospital, Seoul, Korea
Age/Sex 67 / M
Chief ComplaintPalpable mass in anterior chest wall (rapidly growing for one year)

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Diagnosis With Brief Discussion

Diagnosis: Chondrosarcoma of Sternum
Radiologic Findings: Chest PA shows large soft tissue mass overlying superior cardiac border.

Chest CT shows 10x8x10 cm-sized, huge protruding anterior chest wall mass with destruction of sternum, flocculent calcifications and large low-density soft tissue portion with central necrosis arising from sternal body.
This mass extended into the right costosternal joint and adjacent anterior chest wall muscles.

Chest MRI demonstrate heterogeneous iso- and low-signal intensity mass with partially poorly defined right lateral border in T1WI and diffuse increased signal intensity in T2WI.
Contrast-enhanced T1WI shows diffuse contrast enhancement of this mass.

RI bone scan reveals hot uptake of the huge mass in the sternal body.
Brief Review: 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 is 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.

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.
References: 1. Douglas YL, Meuzelaar KJ, Leiz B, Pras B, Hoekstra HJ. Osteosarcoma of the sternum. Eur J Surg Oncol 1997; 23:90-91
2. Peabody CN, Mass F. Chondrosarcoma of sternum: Report of a six-year survival. J Thorac Cardiovas Surg 1971; 61:636-640
3. Fraser RS, Muller NL, Colman N, Pare PD. Diagnosis of disease of the chest. 4th ed. Philadelphia: Saunders, 1999: 3031-3032
4. Resnick D, Bone and joint imaging. 2nd ed. Philadelphia: Saunders, 1996: 1021-1026
5. Downey RJ, Huvos AG, Martini N. Primary and secondary malignancies of the sternum. Seminars in Thoracic and Cardiovascular Surgery 1999; 11:293-296
Keywords: Sternum, Malignant tumor,

No. of Applicants : 47

▶ Correct Answer : 37/47, 78.7%

- 媛理
- 嫄곗갹
- 嫄닿뎅
- 寃쎈
- 怨
- 怨
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- 諛깆
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- 留臾멸린
- 蹂대蹂源
- 遺理湲곕났
- 遺二쇱
- 源
- 諛李쎈
- 臾몄밴
- 源
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- 源
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- 沅寃쎌
- 怨쏀⑥
- 以
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- 源
- 沅諛곗＜
- Asan Medical Center Jeong Hyun Lee
- Asan Medical Center Jin Seong Lee
- Baptist Hosp., Pusan, Korea Mi-Jeong Shin
- CHU Nancy-Brabois, Vandoeuvre les Nancy cedex, France Denis REGENT
- Gachon Medical School Gil Medical Center Seo Joon Beom
- Hospital General Universitario de Alicante, Spain Juan Arenas
- Matsuyama Red Cross Hospital,Matsuyama, Japan Shunya Sunami
- Seoul National University Hospital Dr.Z.
- Seoul National University Hospital Seong Ho Park
- Seoul National University Hospital Hyuck Jae Choi

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 141 Date 2000-07-08

Discussion

No. of Applicants : 47