Cost-Effective Reconstruction of the Anterior Chest Wall Following Resection of High-Grade Pleomorphic Sarcoma of the Sternum in an Adolescent: A Case Report.

Abstract

A 15-year-old girl presented with a progressive, painless presternal swelling over two months. Contrast-enhanced CT revealed a heterogeneously enhancing solid mass arising from the mid-sternum with features suspicious for cortical destruction of the sternum. A core needle (Tru-Cut) biopsy confirmed high-grade pleomorphic sarcoma (Ki-67 ~70%, Vimentin and smooth muscle actin positive, S100 negative). The tumor was staged as Stage IIB (T2bN0M0, high grade, >5 cm, deep location) according to the American Joint Committee on Cancer soft tissue sarcoma staging system. Following neoadjuvant chemotherapy, the patient underwent wide local excision, including the body of the sternum and bilateral third and fourth costal cartilages/ribs. Chest wall reconstruction was performed using a polymethylmethacrylate cement block wrapped in polypropylene mesh and secured with the SternaLock system. Postoperative recovery was uneventful. This case highlights a cost-effective and structurally sound approach to sternal reconstruction using commonly available materials in resource-limited settings, with good oncologic and functional outcomes.