Abstract
IntroductionPrimary rib osteosarcoma is a rare chest wall tumor with variable presentation. Large tumors greater than 10 cm are even rarer and present a challenge for surgical management. Presentation of caseA 61-year-old male with a giant osteosarcoma of the left 2nd rib underwent multidisciplinary management including induction therapy with doxorubicin and cisplatin, followed by en bloc resection with left ribs 1–5, spinous processes of ribs 2–5, small volume lung resection, and chest wall reconstruction with polypropylene mesh and poly methyl methacrylate (PMMA or bone cement). There were no perioperative complications. At 6 months follow-up, the patient remains disease-free. Functional and cosmetic outcome are excellent. DiscussionThis 20 cm mass and resection of ribs 1–5 with resulting 25 cm chest wall defect is the largest primary rib osteosarcoma reported in literature. An R0 resection and chest wall reconstruction using polypropylene mesh and bone cement was feasible and safe. ConclusionGiant chest wall defects involving multi-rib resection can be effectively reconstructed with commonly available and inexpensive polypropylene mesh and PMMA to achieve good cosmetic and functional outcomes.
Highlights
Primary rib osteosarcoma is a rare chest wall tumor with variable presentation
In line with the SCARE criteria for case reports [6], we describe one of the largest resections to date for Primary osteosarcoma of the rib (POSR) requiring skeletal reconstruction with poly methyl methacrylate (PMMA, “cement”), along with a discussion of various techniques used for chest wall reconstruction
The majority of primary osteosarcomas arise in the long bones of children and young adults; primary osteosarcoma of the rib in a middle-aged adult with no prior history of chemotherapy, radiation, or intrinsic bone disease is a rare scenario
Summary
Primary rib osteosarcoma is a rare chest wall tumor with variable presentation. PRESENTATION OF CASE: A 61-year-old male with a giant osteosarcoma of the left 2nd rib underwent multidisciplinary management including induction therapy with doxorubicin and cisplatin, followed by en bloc resection with left ribs 1–5, spinous processes of ribs 2–5, small volume lung resection, and chest wall reconstruction with polypropylene mesh and poly methyl methacrylate (PMMA or bone cement). DISCUSSION: This 20 cm mass and resection of ribs 1–5 with resulting 25 cm chest wall defect is the largest primary rib osteosarcoma reported in literature. An R0 resection and chest wall reconstruction using polypropylene mesh and bone cement was feasible and safe. CONCLUSION: Giant chest wall defects involving multi-rib resection can be effectively reconstructed with commonly available and inexpensive polypropylene mesh and PMMA to achieve good cosmetic and functional outcomes
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