Sternal Resection and Reconstruction for Malignant ... · breast neoplasm constituting less than 1...
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IMAGES IN SURGERY Sternal Resection and Reconstruction for Malignant Phylloides Tumor Veda Padma Priya Selvakumar 1 & Dharmaram Poonia 1 & Juhi Agrawal 2 & Ashish Goel 1 & Sandeep Mehta 2 & Kapil Kumar 1 Received: 13 January 2015 /Accepted: 18 May 2015 /Published online: 1 July 2015 # Association of Surgeons of India 2015 Abstract Malignant phylloides tumor is a locally aggressive breast neoplasm constituting less than 1 % of all breast can- cers. It has a tendency for local recurrence and management is multidisciplinary. We hereby report a case of total sternal re- section and reconstruction using Biopore HDPE prosthesis for Malignant Phylloides tumor. Keywords Total sternal resection . Malignant phylloides tumor . Major chest wall reconstruction Total sternal resection for malignant phylloides tumors is rare but feasible and safe. We hereby report a case of total sternal resection and reconstruction using Biopore HDPE prosthesis for malignant phylloides tumor. A 49-year-old premenopausal lady with no comorbidities underwent wide local excision of phylloides tumor in the left breast in 2009. She developed recurrence for which she underwent a re-resection and later mastectomy in May 2012 followed by adjuvant radiation in June 2012. She presented with recurrent swelling in the left chest wall of 5-month duration in March 2013 (Fig. 1). PET CT revealed a heterogenous mass lesion 12.7×9.7×16.5 cm involving the sternum and left second to fifth ribs abutting the mediastinal vessels, pericardium, and diaphragm. She was optimized and underwent chest wall excision of the pectoralis major/minor/all intercostal muscles, left second to sixth rib, sternum, left rectus origin from the seventh rib part of the external and internal, oblique, and transverse muscles. For reconstruction, the first layer was constituted with prolene mesh sutured onto the edges with prolene. The second layer was to substitute bony skeleton using Biopore HDPE Fig. 1 Recurrent malignant phylloides tumor in the left chest wall Indian J Surg (July–August 2015) 77(4):336–337 DOI 10.1007/s12262-015-1287-7 * Veda Padma Priya Selvakumar [email protected] 1 Department of Surgical Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Sector V, Rohini, Delhi 110085, India 2 Department of plastic and Reconstructive Surgery, Rajiv Gandhi Cancer Institute & Research Centre, Sector V, Rohini, Delhi 110085, India
Transcript of Sternal Resection and Reconstruction for Malignant ... · breast neoplasm constituting less than 1...
IMAGES IN SURGERY
Sternal Resection and Reconstruction for MalignantPhylloides Tumor
Veda Padma Priya Selvakumar1 & Dharmaram Poonia1 &
Juhi Agrawal2 & Ashish Goel1 & Sandeep Mehta2 &
Kapil Kumar1
Received: 13 January 2015 /Accepted: 18 May 2015 /Published online: 1 July 2015# Association of Surgeons of India 2015
Abstract Malignant phylloides tumor is a locally aggressivebreast neoplasm constituting less than 1 % of all breast can-cers. It has a tendency for local recurrence and management ismultidisciplinary. We hereby report a case of total sternal re-section and reconstruction using Biopore HDPE prosthesisfor Malignant Phylloides tumor.
Keywords Total sternal resection .Malignant phylloidestumor .Major chest wall reconstruction
Total sternal resection for malignant phylloides tumors is rarebut feasible and safe. We hereby report a case of total sternalresection and reconstruction using Biopore HDPE prosthesisfor malignant phylloides tumor. A 49-year-old premenopausallady with no comorbidities underwent wide local excision ofphylloides tumor in the left breast in 2009. She developedrecurrence for which she underwent a re-resection and latermastectomy in May 2012 followed by adjuvant radiation inJune 2012. She presented with recurrent swelling in the leftchest wall of 5-month duration in March 2013 (Fig. 1). PET
CT revealed a heterogenous mass lesion 12.7×9.7×16.5 cminvolving the sternum and left second to fifth ribs abutting themediastinal vessels, pericardium, and diaphragm. She wasoptimized and underwent chest wall excision of the pectoralismajor/minor/all intercostal muscles, left second to sixth rib,sternum, left rectus origin from the seventh rib part of theexternal and internal, oblique, and transverse muscles. Forreconstruction, the first layer was constituted with prolenemesh sutured onto the edges with prolene. The second layerwas to substitute bony skeleton using Biopore HDPE
Fig. 1 Recurrent malignant phylloides tumor in the left chest wall
Indian J Surg (July–August 2015) 77(4):336–337DOI 10.1007/s12262-015-1287-7
* Veda Padma Priya [email protected]
1 Department of Surgical Oncology, Rajiv Gandhi Cancer Institute &Research Centre, Sector V, Rohini, Delhi 110085, India
2 Department of plastic and Reconstructive Surgery, Rajiv GandhiCancer Institute & Research Centre, Sector V, Rohini, Delhi 110085,India
prosthesis (blocks of 4 and 6 mm) to replace the sternum andribs on the left side fixed with plates and screws, and theframework was anchored with ethibond 1–0 suture (Fig. 2).The third layer of soft tissue defect closed with latissimusdorsi myocutaneous defect taken from the ipsilateral back.The patient is on adjuvant chemotherapy.
Conflict of Interest The authors declare that they have no competinginterest.
Fig. 2 Total sternal reconstruction with Biopore HDPE prostheticframework
Indian J Surg (July–August 2015) 77(4):336–337 337
