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.
