Sternal osteosarcoma

Case contributed by Avni K P Skandhan

Presentation

Painful sternal swelling

Patient Data

Age: 65 years
Gender: Male
ct

On axial post-contrast-enhanced images there is evidence of a large, well defined, irregular, moderately enhancing soft tissue lesion noted almost completely eroding and replacing the sternum. Few non-enhancing necrotic areas are noted within. Few small calcified foci are noted inside. The lesion extends superiorly from manubrium sternum to the xiphisternum. Bilateral costochondral cartilages are also involved. The lesion abuts left brachiocephalic vein, arch of the aorta, ascending aorta and right ventricle. However, intervening fat planes are preserved. The lesion anterior invades subcutaneous fat and reaches up to the skin. The lesion measures 14.02cm (superoinferior) x 8.38 cm (transverse) x 5.8cm (anteroposterior). 

Case Discussion

Sternal osteosarcoma is a relatively rare entity. It is seen most often in elderly patients. It is seen to occur as secondary lesions in patients with previous radiation therapy ; however that was not the case in ours. Patient usually presents as a painful mass. The survival rate is about 15%.

Radiographically, sternal osteosarcoma appears as a masslike lesion that consists of bone and soft tissue and contains areas of osteolytic change, calcification, and osteoid matrix .

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