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Case Reports
. 2024 Nov 30;19(1):639.
doi: 10.1186/s13019-024-03145-4.

Complete resection of a giant costal chondrosarcoma with reconstruction of the thoraco-abdominal wall: a case report

Caiyang Liu #  1 , Qinyan Yang #  2 , Deyuan Zhong #  2 , Hongtao Yan  2 , Hang Gu  3 , Xiaozun Yang  3 , Xiaojun Yang  3 , Qiang Li  3 , Xiaolun Huang  2 , Wei Dai  4
Affiliations
Case Reports

Complete resection of a giant costal chondrosarcoma with reconstruction of the thoraco-abdominal wall: a case report

Caiyang Liu et al. J Cardiothorac Surg. .

Abstract

Background: Chondrosarcoma primarily occurs in the pelvis and femur, with occasional cases in the ribs. Surgical resection remains the main treatment method for costal chondrosarcoma. However, complete resection often leads to a large range of chest wall defects and a challenging reconstruction.

Case presentation: A 49-year-old female patient presented with progressive swelling of the right chest and abdominal wall over 15 years. Chest CT revealed a 20.1 × 15.6 × 13.7 cm multilocular cystic-solid mass with internal calcification, encircling the 8th to 12th ribs and causing elevation of the right diaphragm. Compression of the liver resulting in a significant reduction in volume. Based on an ultrasound-guided biopsy, chondrosarcoma Grade I was diagnosed. After a multi-disciplinary discussion, we performed a complete resection of the tumor, including the 8th to 12th anterolateral ribs and part of the diaphragm. The diaphragm was then reconstructed by suturing it to the ribs and intercostal muscles at the resection margin. The thoraco-abdominal wall defects were reconstructed with a polypropylene mesh. Finally, we excised the excess skin and then closed the incision. Histopathologic diagnosis was chondrosarcoma Grade II. The postoperative course was uneventful. At the 3-month postoperative follow-up, no signs of recurrence were observed.

Conclusions: Wide en-bloc resection followed by reconstruction using polypropylene mesh is feasible and cost-effective for costal chondrosarcoma with limited invasion. This case illustrates the importance of meticulous preoperative planning and multi-disciplinary discussion.

Keywords: Case report; Chondrosarcoma; Reconstruction; Thoraco-abdominal wall.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Our study was approved by the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital (No. SCCHEC-02-2024-138). Consent for publication: Informed consent for publication was obtained. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A: A giant mass located at the junction of the right chest and abdominal wall, between the anterior axillary line and the posterior axillary line. B: CT showed a 20.1 × 15.6 × 13.7 cm multilocular cystic-solid mass with internal calcification compressed the liver, resulting in a significant reduction in volume. C: CT Showed the relationship between the tumor and the liver and right kidney in the sagittal plane. D:Three-dimensional reconstruction visually illustrated the relationship between the tumor and its surrounding tissues
Fig. 2
Fig. 2
A: A 25 cm fusiform incision was made on the surface of the tumor. B: Display of the completely excised tumor. C: Costal chondrosarcoma was removed and thoraco-abdominal wall defects were reconstructed with a polypropylene mesh. D: The excess skin was excised, and the incision was closed. Drainage tubes were placed in both the abdominal cavity and subcutaneous cavity
Fig. 3
Fig. 3
A: A few mitotic figures were visible, with extensive myxoid degeneration in the cartilaginous matrix, suggesting a chondrosarcoma Grade II (HE × 200). B: The chest CT image from the follow-up three months after surgery. C: The abdominal CT image from the follow-up three months after surgery
See this image and copyright information in PMC

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