case_images: PMC6968258_01
case_images: Axial T2-weighted MR-image (A) shows an area of abnormal signal intensity (bone involvement) in the sternum with associated right parasternal soft tissue component. The soft tissue mass has a lobulated morphology, is well defined and has a high signal intensity. Axial T1-weighted images after intravenous gadolinium contrast administration (B) show a heterogeneous lesion with peripheral enhancement and central areas of low signal intensity, corresponding to areas of necrosis. Axial CT-images at the time of diagnosis (C) show an abnormal density in the sternum with large soft tissue component. Follow-up CT after neoadjuvant chemotherapy (D) shows prominent shrinkage of the mass. Follow-up CT after surgery (E) shows normal postoperative findings after partial sternal resection and reconstruction.
case_images: ICRP_A_1598867_F0001_B.jpg
case_images: PMC6968258_01_ICRP_A_1598867_F0001_B.jpg
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case_images: After initial assessment with ultrasound (not shown), CT and Magnetic Resonance Imaging (MRI) showed a parasternal mass with both an intraosseous and a large soft tissue component (Figure 1(A-C)). The patient was treated with three series cycles of neo-adjuvant VIDE (Vincristine, Ifosfamide, Doxorubicin and Etoposide) chemotherapy with very good response on CT (Figure 1(D)).
case_images: Sternal biopsy. HE stain (4x magnification) shows tumour cell infiltration between muscle fibres (A). HE stain (40x magnification) shows a high-grade population of 'small blue round cells', compatible with Ewing's sarcoma (B).
case_images: ICRP_A_1598867_F0002_C.jpg
case_images: PMC6968258_01_ICRP_A_1598867_F0002_C.jpg
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case_images: Sternal biopsy revealed a high-grade population of 'small blue round cells', compatible with Ewing's sarcoma (Figure 2).
case_images: Cross section scheme of the sternal reconstruction with coronal plane (A), and axial plane (B). A layer of methyl methacrylate was sandwiched between two layers of a polypropylene mesh and sutured to the remaining ribs and muscles with polypropylene 3-0.
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case_images: PMC6968258_01_ICRP_A_1598867_F0003_C.jpg
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case_images: Cross section schemas of the reconstruction are shown in Figure 3.
case_images: Intraoperative images of the resected sternal body incorporating the major pectoral muscles (A), the large defect of the anterior chest wall after resection (B), sternal reconstruction by a methyl methacrylate sandwich graft (C).
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case_images: PMC6968258_01_ICRP_A_1598867_F0004_C.jpg
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case_images: Intraoperative images are shown in Figure 4.
case_images: Comparison of the preoperative situation, which shows a small scar from the sternal biopsy at the presternal area (A), to the result four months after sternum resection and reconstruction by a polypropylene - methyl methacrylate sandwich graft and a pedicled myocutaneous latissimus dorsi flap (B).
case_images: ICRP_A_1598867_F0005_C.jpg
case_images: PMC6968258_01_ICRP_A_1598867_F0005_C.jpg
case_images: F0005
case_images: Figure 5 shows a comparison of the preoperative situation of the patient (Figure 5(A)) and the result four months postoperatively (Figure 5(B)).