2013 Volume 27 Issue 6 Pages 742-747
A 57-year-old woman presented with an anterior chest wall tumor. She had undergone left partial mastectomy for breast cancer 13 years previously. Positron emission tomography/computed tomography (PET/CT) and dynamic enhanced magnetic resonance imaging (MRI) revealed a massive sternal tumor, another separated bone metastasis in the manubrium, and right parasternal lymph node metastasis. A recurrent sternal metastasis originating from breast cancer was diagnosed by fine needle aspiration biopsy. We performed subtotal sternectomy and reconstruction of the chest wall defect with a methylmethacrylate sandwich prosthesis. Thoracoscopic drainage for fluid collection under the prosthesis was required on the 19th postoperative day. She was discharged on the 37thpostoperative day.
Pathologically, the upper margin of the specimen was positive for cancer because of an insufficient surgical margin from the bone metastasis in the manubrium. An axillary lymph node metastasis was detected on PET/CT 2 years after the operation. She has been treated with chemotherapy and hormone therapy. Radical sternectomy for solitary sternal metastasis originating from breast cancer is feasible. Resection of the sternal tumor should be radical if including 3-cm margins macroscopically, and appropriate chest tube drainage around a prosthetic material should be performed for reconstruction with a sandwiched methylmethacrylate and Marlex mesh prosthesis.
