Claviculaosteotomy for operative access to a chondrosarcoma arising in the first rib

Introduction:

Chondrosarcoma, a rare mesenchymal cartilaginous tumor, accounts for 10 – 20% of all malignant bone tumors [1]. About 9% of all chondrosarcomas occur in the ribs [2]. Regardless of tumor etiology, surgery in the cervicothoracic region is challenging due to the close anatomical relationship to the thoracic wall and neurovascular axis [3].

Case:

A 53-year-old patient applied with a painful, solid swelling of the right supra- and infraclavicular region with local hypoesthesia. The tumor was not relocatable and has grown for one year.

Computed Tomography revealed a polycystic tumor in the anterior and lateral cervical triangle, 9 cm in diameter, with infiltration of the thoracic wall and an elevated right diaphragm.

In cooperation with the Department of Thoracic Surgery, the tumor was resected by including the subclavian vein and the 1st and 2nd rib. For access an osteotomy of the clavicle and the manubrium sterni was chosen, which were subsequently refixed osteosynthetically by clavicle plating and wire sternal closure.

One week post-operatively, a thoracic hematoma on the right had to be removed by VATS. Histologic examination revealed a grade 1 chondrosarcoma of the 1st rib. Three months after surgery numbness on the right thoracic wall, reduced strength of the right hand, abduction of the arm up to 90 °, subtle swelling of the forearm and hand and increased vascular drawing of the right chest caused by resection of the subclavian vein remained.

Conclusion:

Tumors located in the cervicothoracic region are rare. In order to meet the special requirements of the surgery in this region including the possible complications, an interdisciplinary treatment is necessary.

Publication History

Publication Date:
23 April 2019 (online)