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J Thorac Cardiovasc Surg 1996;112:1402-1403
© 1996 Mosby, Inc.

BRIEF COMMUNICATIONS

STERNAL HEMANGIOMA: A RARE TUMOR

Jerusalem, Israel

Received for publication Jan. 22, 1996 Accepted for publication Feb 8, 1996. Primary tumors of the bony chest wall are uncommon. ¹ Among those tumors, sternal tumors are extremely rare ² and usually malignant. ^2,3 In this case report, we discuss a benign hemangioma of the sternum in a 30-year-old woman who had a 2-year history of chest pain without objective physical findings. She underwent a bone scan, with results regarded as normal. Computed tomography demonstrated a round mass in the body of the sternum (Fig. 1, A). On magnetic resonance imaging (Fig. 1, B), the mass was found to be located in the lower part of the sternal body to invade the sternal cortex. An open biopsy sampling of the mass was performed elsewhere, and a benign hemangioma was diagnosed. During the biopsy procedure, the patient had extensive bleeding, which was finally controlled.

View larger version (196K): [in this window] [in a new window]   Fig. 1. A, Computed tomographic section of chest showing round mass in body of sternum. B, Longitudinal section of magnetic resonance image of chest showing mass located in lower part of sternal body and invading sternal cortex.

The patient had uneventful operative and postoperative courses and went home 8 days after the operation. Histologic examination of the mass revealed an encapsulated 5 x 5 x 9 cm hemangioma that replaced almost the entire resected sternum. At 6-month follow-up the patient had regained a normal lifestyle, with no chest pain and no signs of recurrence.

A search of the literature revealed only one similar case, that of a 38-year-old woman who reported pain in the midanterior area of the chest. ⁴ This patient had a history of similar intermittent pain for 15 years. Physical examination revealed only slight prominence and tenderness of the superior aspect of the sternal body. The patient underwent a surgical excision of the sternal lesion.

Benign sternal tumors are extremely rare, and all sternal tumors should be considered malignant until proved otherwise. ⁴ Hemangiomas of the chest wall are most often encountered in the vertebra, ribs, and skeletal muscles. ⁵ Although hemangiomas are quite common tumors, no hemangiomas of the sternum have been described except for the case published by Boker and coworkers ⁴ and the case described here by us. Irradiation therapy, interferon therapy, and selective embolization of feeding vessels have been suggested as alternatives to surgical treatment, especially for children and patients with hemangiomas of the skin. ^6-8 Because there is no sharp distinction between benign hemangiomas and low-grade malignant hemangioendotheliomas and because of the relatively high recurrence rate of hemangiomas, ⁵ we decided to operate on this patient and to resect the tumor with adjacent sternal tissue.

Footnotes

From the Departments of Thoracic and Cardiovascular Surgery^a and Plastic Surgery,^b Hadassah University Hospital, Jerusalem.

J THORAC CARDIOVASC SURG 1996;112:1402-3

References

1. Sabarantam S, Salama FD, Morgan WE, Harvey JA. Primary chest wall tumors. Ann Thorac Surg 1985;39:4-15.[Abstract/Free Full Text]
   
2. Pascuzzi CA, Dahlin DC, Clagett OT. Primary tumors of the ribs and sternum. Surg Gynecol Obstet 1957;104:390.[Medline]
   
3. Ochsner A Jr, Lucas GL, McFarland GB Jr. Tumors of the thoracic skeleton: review of 134 cases. J THORAC CARDIOVASC SURG 1966;52:311-21.[Medline]
   
4. Boker SM, Cullen GM, Swank M, Just JF. Case report 593: hemangioma of sternum. Skeletal Radiol 1990;19:77-8.[Medline]
   
5. Faber LP, Somers J, Templeton AC. Chest wall tumors. Curr Probl Surg 1995;32:661-756.[Medline]
   
6. Furst CJ, Lundell M, Holm LE. Radiation therapy of hemangiomas, 1990-1959: a cohort based on 50 years of clinical practice at Radiumhemmet, Stockholm. Acta Oncol 1987;26:33-6.[Medline]
   
7. White CW. Treatment of hemangiomatosis with recombinant interferon alfa. Semin Hematol 1990;27:15-22.
   
8. Trout HH. Management of patients with hemangiomas and arteriovenous malformations. Surg Clin North Am 1986;66:333-8.[Medline]
   

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