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Sternal cavernous hemangioma and reconstruction of the anterior chest wall: a case report
Liliana Fernández-Trujillo1,2, Saveria Sangiovanni3, Eliana I Morales4,5
1Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Avenida Simón Bolívar, Carrera 98 # 18-49, Tower 6, 4th Floor, Cali, 7600032, Colombia. liliana.fernandez@fvl.org.co.
Insights
Sternal hemangiomas are rare, painful masses that can mimic malignancy. Surgical resection and reconstruction are crucial for managing these sternal tumors and improving patient quality of life.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Diagnostic imaging
Background:
- The sternum is an uncommon site for tumors, accounting for 15% of thoracic wall tumors.
- Primary sternal tumors are rare, with a high incidence of malignancy.
- Sternal hemangiomas present a diagnostic challenge due to their potential for expansive growth and bone destruction.
Observation:
- A 39-year-old male presented with a 2-year history of sternal pain and a palpable mass.
- Imaging revealed an expansive, lytic sternal lesion involving the manubrium and third sternocostal joint.
- No intrathoracic compromise or involvement of mediastinal vascular structures was observed.
Findings:
- Histopathological examination confirmed a cavernous hemangioma with clear surgical margins.
- The lesion demonstrated expansive growth and caused structural defects in the sternum.
- Despite benign histology, the initial presentation mimicked a malignant sternal tumor.
Implications:
- Sternal hemangiomas require a high index of suspicion and should be managed aggressively due to their potential to mimic malignancy.
- Radical surgical resection followed by reconstruction is the recommended treatment approach.
- Successful surgical management can restore bone structure and significantly improve the patient's quality of life.
Background:
The sternum is considered an unusual tumor site, corresponding to 15% of all thoracic wall tumors. Primary sternal tumors are even rarer and most commonly malignant. We present the case of a young man who consulted with a painful sternal mass, which after its resection is confirmed to be a cavernous hemangioma.
Case Presentation:
A 39-year-old man, with unremarkable medical history besides a 2-year-long sternal pain, non-irradiated, which worsens over the last few months and is accompanied by the appearance of a sternal palpable mass. On physical exam, there was a bulging of the sternal manubrium, with no inflammatory changes. Thoracic CT scan shows an expansive and lytic lesion of the sternum, compromising the manubrium and extending to the third sternocostal joint, without intrathoracic compromise nor cleavage plane with mediastinal vascular structures. The patient is taken to resection of the mass and sternal reconstruction using prosthetic material and pectoral and fasciocutaneous muscular flaps. Histopathological findings: cavernous hemangioma with negative borders and no other malignant findings.
Conclusions:
Sternal hemangiomas can cause defects in the bone structure and show an expansive growth, challenging the differentiation between a benign or malignant lesion. Therefore, they should be considered malignant until shown otherwise. Management involves radical surgery with curative purposes and posterior reconstruction to improve quality of life, as shown with our patient.
