Giant Cell Tumour Of Sternum: Resection And Reconstruction
See unique, uncommon and challenging cases performed by Dr.Praveen and his team.
Mr ABC is a 30 year old farmer who worked aggressively in his farms. He started developing pain in his midline chest bone since 2-3 months. When local remedies did not work he consulted a doctor who referred the patient to us. The CT scan showed tumour arising in the sternum – the bone that forms the middle portion of rib cage. (Fig 01) Biopsy of the tumour showed that it was Giant Cell Tumor.
Fig 01. Shows tumour destroying the entire sternum
Best possible treatment, if any no-surgical options available, if surgical treatment how the defect will be reconstructed, if I will be able to work in the fields again.
Since the tumour was eroding the bone completely there was a risk of tumour spillage in the chest cavity hence medical treatment was not considered ideal for this patient.
The surgical treatment required complete removal of the sternum so that all the tumour is removed with good margins.
We removed the entire sternum along with the medial ends of the clavicles to remove the entire tumour. (Fig 02) We reconstructed the defect that appeared after the removal of the tumour with titanium mesh which was fixed to the ends of the ribs. The mesh was covered with pectoralis major from both sides. (Fig 03)
Fig 03. Reconsturction of the defect with (a) titanium mesh (b) covered with muscle (c)Final closure
Patient recovered well from the surgery. He was started on rehabilitation program to restore functionality.
Within a years’ time patient was back to his routine work with no limitations. (Fig 04)
Gaint Cell Tumour arising from sternum is very rare. When the complete bone is destroyed, surgical resection is the best option of treatment. In this case a rigid reconstruction was necessary to maintain the integrity of the chest cavity which is very necessary for proper functioning of heart and lung while at the same time functional aspect also had to be kept in mind since he was farmer. Titanium mesh reconstruction provides rigid frame and does not cause significant tissue reaction considering the fact that it is directly in front of the heart, lungs and major blood vessels.