J Breast Cancer.  2012 Dec;15(4):462-467. 10.4048/jbc.2012.15.4.462.

Simultaneous Chest Wall Reconstruction after Sternectomy and Modified Radical Mastectomy in Locally Advanced Breast Cancer with Solitary Sternal Metastasis

• Kang HJ
• Lee SA
• Park KS
• Yang JH
• Yoo YB

• KMID: 2286445
• DOI: http://doi.org/10.4048/jbc.2012.15.4.462

Abstract

Bone is the most common metastatic organ in patients with breast cancer. The most significant clinical symptom of bone metastasis is pain which reduces quality of life in cancer patients. We report a case of chest wall reconstruction after partial sternal resection for solitary sternal metastasis and modified radical mastectomy in a patient with locally advanced breast cancer. The sternal defect was reconstructed with a 2 mm thick Gore-Tex patch. Postoperative pain was acceptable and the patient was discharged without any complications. The patient received the endocrine and bisphosphonate therapy combined with chemotherapy and radiotherapy. No recurrence or complications were observed during a follow-up period of 36 months. We describe our good surgical management results of sternal metastatic lesion in a patient with locally advanced breast cancer. We suggest that simultaneous sternectomy is a safe and curative surgical method for a solitary sternal metastasis when no evidence of systemic spread is noted.

Keyword

Breast carcinoma; Metastasectomy; Neoplasm metastasis; Sternum

MeSH Terms

Breast
Breast Neoplasms
Follow-Up Studies
Humans
Mastectomy, Modified Radical
Metastasectomy
Neoplasm Metastasis
Pain, Postoperative
Polytetrafluoroethylene
Quality of Life
Recurrence
Sternum
Thoracic Wall
Thorax
Polytetrafluoroethylene

Figure

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  Figure 1 Initial breast imagings. (A) Breast magnetic resonance imaging shows diffuse enhanced left breast cancer involving whole breast with extensive axillary lymph nodes metastases and enhancing nodule in sternum body. (B) 18F-fluoro-2-D-glucose positron emission tomography with computed tomography shows multiple hypermetabolic lesions in left breast and lymph nodes in left axilla, left highest mediastinal area and left supraclavicular area and negative finding in sternum. (C) Bone scintigraphy shows no evidence of bone metastasis.

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  Figure 2 Breast magnetic resonance imaging followed after 4 cycle of palliative chemotherapy. It shows interval decrease of clumped heterogeneous non-mass-like enhancement involving left whole breast and in size of multiple metastatic lymph nodes at left axilla and metastatic nodule at sternum body.

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  Figure 3 The illustration of subtotal sternectomy for metastatic lesion locating on the left side of sternal body at the level of 3rd chondrosternal junction area.

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  Figure 4 Microscopic findings. (A) Breast specimen revealed clusters of infiltrating ductal carcinoma (H&E stain, ×200). (B) Bone marrow specimen of sternum revealed clusters of infiltrating ductal carcinoma (H&E stain, ×200).

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  Figure 5 Postoperative imaging study of 18F-fluoro-2-D-glucose positron emission tomography with computed tomography. (A) Before radiotherapy, 2 months after surgery, it showed mild hypermetabolic activity at sternectomy site, which is caused by postoperative change. (B) After radiotherapy, 12 months after surgery, it showed decreased hypermetabolic activity at sternectomy site.

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  Figure 6 Postoperative imaging study of bone scintigraphy. (A) Before radiotherapy, 2 months after surgery, it showed increased uptake at sternectomy site, which is caused by postoperative change. (B) After radiotherapy, 12 months after surgery, there was no uptake change at sternectomy site.

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  Figure 7 Recent breast imagings, 36 months after surgery. (A) 18F-fluoro-2-D-glucose positron emission tomography with computed tomography showed mild focal hypermetabolic lesion at sternum, which is probably postoperative change in sternum rather than recurrence. (B) Bone scintigraphy showed mild focal uptakes at sternum, which is probably postoperative change in sternum rather than recurrence. (C) Breast magnetic resonance imaging showed regional mild enhancement of operative site at sternum, which is probably postoperative change in sternum rather than recurrence.

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