A Case of Sternectomy for Metastasis from Occult Primary Adenocarcinoma

Abstract

A man in his fifties was admitted to our hospital with chest pain of two months duration. A 4-cm-diameter tumor was found at the sternal bone on chest computed tomography (CT). Despite intensive investigations the biopsy revealed primary unknown metastatic adenocarcinoma. He was diagnosed as having solitary sternal bone metastases on 18F-fluorodexyglucose (18F-FDG) positron emission tomography (PET)/CT. To achieve a macroscopic cure and for pain control, the sternal bone with skin, costalcartilage, and thymic fat tissue was radically resected with negative pathology margins. The defect was reconstructed using a Composix Mesh (Bard^®) back of the costal bones and fourfold Marlex Mesh (Bard^®) on the front. The primary site remained unknown even after postoperative histopathology. One and a half months after the operation, he developed multiple bone metastases and then died six months after the resection due to rapid progression despite systemic chemotherapy.