Malignant invasion of sternotomy incision after cardiac operation

Neoplastic involvement of the sternotomy incision has rarely been described after cardiac operations. We present 3 patients with sternotomy incisions that were initially suspected to be infected but were subsequently found to involve metastatic spread of a distant primary tumor. These patients presented with renal cell carcinoma, multiple myeloma, and endometrial cancer, malignancies known to invade bone, within 12 months of their cardiac operation. The immediacy of presentation after the operation suggests that these patients may have had subclinical cancer at the time of the procedure. Seeding of the surrounding tissue may therefore have occurred with the sternotomy. Neoplastic involvement should, therefore, remain part of the differential diagnosis for incisional drainage or induration, especially beyond the initial postoperative period.