A 57-year-old male with a history of COPD, a 15 pack-year smoker and a moderate drinker, who consulted for a rapidly growing, painless, firmly adherent tumor in a deep plane.
Plain radiography and CT with intravenous contrast and three-dimensional reconstruction of the chest revealed a 5-6 cm diameter tumor in the manubrium with cortical destruction.
No signs of mediastinum or clavicles.
(See Figures 1 and 2).
1.
In the general laboratory no significant alterations were observed, being the study of immunoglobulins (IgG, IgA, IgM and beta 2 microglobulin) normal.
A FNAC and a surgical biopsy were performed, as well as a cytology non conclusive diagnosis.
Immunohistochemical tests were positive for the following markers: CD 138; CD 68 (isolated); LAMBDA (some cells); KAPPA (intense positivity in almost all cells).
Simultaneous sinus congestion
Bone scintigraphy showed an increase in uptake only in the region of the tumor as well as in both biliary strictures.
Bone marrow biopsy showed no pathological findings and the absence of Bence-Jones proteins was found in the urine study.
Extensive block excision of the manubrium is performed and partial resection of both clavicles, the first two ribs and the body of the sternum, including the skin adjacent to the tumor.
Mediastinal discomfort was not observed.
Coverage of the resulting defect with a polypropylene mesh and midline pectoral suture.
There were no postoperative complications.
The fixation and stability of the chest wall were satisfactory from the immediate postoperative period.
The hospital stay was 7 days.
The anatomopathological description of the surgical specimen indicated abundant mononucleated plasma cells intermingled with other multinucleated cells with immunohistochemical positivity for antiCD138 antibodies and kappa chains for lambda antibodies.
The resection margins were free of disease.
Radiotherapy (50 Gy in 30 sessions for 4 weeks) was completed.
In the follow-up review six months after surgery, there were no clinical signs or signs of disease progression or late postoperative complications.
