Abstract
Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a) being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b) the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed.
Highlights
A 52 year old male smoker undergoing coronary artery bypass grafting for three vessel coronary artery disease and moderately impaired left ventricular function was felt to have a mass arising from the under surface of right costal margin adjacent to right lower sternal margin while sternopericardial ligament was being broken off by finger dissection prior to sternotomy
Histopathology revealed the overall appearances of grade 1 chondrosarcoma with a tumour composed of lobules of cartilage of varying size separated by fibrous tissue (Figure 6)
Chondrosarcoma accounts for nearly 30% of all malignant bone neoplasms and is the second most common matrix producing malignant tumour of bone
Summary
Chondrosarcoma accounts for nearly 30% of all malignant bone neoplasms and is the second most common matrix producing malignant tumour of bone. If the diagnosis of chondrosarcoma is made before CABG, the management, ideally, consists of excision of the tumour with a wide clearance including the ribs from which it arises, with reconstruction of chest wall with various synthetic meshes available. This could be done before, during or after coronary artery surgery depending on the urgency of revascularisation. The tumour is discovered incidentally during coronary surgery, the frozen section is not unequivocal and the tumour arises from a wide base necessitating an elaborate chest wall reconstruction, a wide resection, without excision of multiple ribs necessarily, and CABG, followed by careful surveillance for local recurrence is not inappropriate. A copy of the written consent is available for review by Editor-in-Chief of this journal
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