Primary malignant clavicular tumours: a clinicopathological analysis of six cases and evaluation of surgical management

Abstract

Primary malignant tumours of the clavicle are extremely rare and little is known regarding their clinicopathological characteristics and outcomes of surgical management. The aim of the study is to analyse the clinical, imaging, and histological features of six patients with malignant tumours of the clavicle and present the outcome of cleidectomy in four of them. A review of the literature is also provided. Six cases were included in this series: two plasmocytomas; three PNETs, one non-Hodgkin lymphoma, one high-grade chondrosarcoma and one post-irradiation fibrosarcoma. Apart from one patient with plasmocytoma and another one with non-Hodgkin lymphoma, the remaining four patients underwent partial or complete cleidectomy according to tumour location. At the time of latest follow-up all patients were alive. Neither local recurrence nor metastases were observed in patients that underwent cleidectomy. In this group, the average score was 86.6% of the expected normal function according to the Musculoskeletal Tumour Society (MSTS) evaluation form. The mean Constant-Murley score of the affected side was 80. Patients after cleidectomy were pain free, they had almost full shoulder range of motion and no significant functional deficit was reported. Primary malignant clavicular tumours may be easily undiagnosed due to their insidious clinical onset. Partial or total cleidectomy is associated with adequate shoulder mobility and mild functional deficit. Therefore, the extent of clavicle excision during tumour removal does not seem to determine the functional outcome of the affected shoulder.