International Journal of Immunotherapy and Cancer Research ISSN: 2455-8591 DOI CC By 041 Citation: Krdzalic G, Mujagic H, Musanovic N, Krdzalic A (2017) Titanium mesh reconstruction after solitary sternal plasmacytoma surgery-A case report. Int J Immunother Cancer Res 3(2): 041-043. DOI: http://doi.org/10.17352/2455-8591.000018 Clinical Group Abstract We present chest wall reconstruction with titanium mesh in a patient who underwent sternal resection due to solitary plasmacytoma (SP). A 35 year old female was admitted to The Thoracic Surgery Department of University Clinical Center Tuzla with pain and tender upper-sternal swelling. Thoracic magnetic resonance imaging (MRI) revealed hypo dense wll-shaped rounded mass involving manubrium streni which was 40mmx40mm in size measured by two right angle perpendicular diameters. Affected part was resected together with removal of sternoclavicular and costochondral junctions and reconstruction with titanium mesh was performed. Case report Titanium Mesh Reconstruction after Solitary Sternal Plasmacytoma Surgery-A Case report Krdzalic G 1 *, Mujagic H 2 , Musanovic N 1 and Krdzalic A 3 1 Department of Thoracic Surgery, Surgery Clinic, University Clinical Centre Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina 2 Former Scholar and Professor, Massachusetts General Hospital Cancer Center, 55 Fruit St.02114 Boston, USA 3 Clinic for Cardiovascular Diseases, University Clinical Centre Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina Dates: Received: 23 November, 2017; Accepted: 28 December, 2017; Published: 29 December, 2017 *Corresponding author: Krdzalic G, Department of Thoracic Surgery, Surgery Clinic, University Clinical Centre Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina, Tel: 003876164555; E-mail: https://www.peertechz.com Introduction Primary sternal tumors are very rare and account for only ~ 1% of primary bone neoplasms [1]. The most common lesion is chondrosarcoma (33%) followed by mayeloma and plasmacytoma (30%), than (21%) lymphoma and occasional lesions like osteosarcoma, fobrosarcoma and Ewing sarcoma [2]. Surgical treatment requires adequate, wide margin resections and reconstruction of the anterior chest wall [3]. Resonstruction is essential for maintenance of respiratory function and for protection of mediastinal organs [4]. Here we report reconstruction of anterior chest wall with titanium mesh inserted between two polypropylene mesh sheets. Case report A 35-year-old female, with no significant past medical history, was admitted to our department with progressive anterior chest wall pain for the past 3 months. Physical examination revealed a palpable fixed mass involving sternal manubrium. Laboratory tests were unremarkable. MRI showed a solitary, well-shaped, hypo dense and round mass which involved manubrium sterni (40mm x 40mm in diameter) with no signs of subcutaneous invasion. A whole body computed tomography detected no metastatic deposits. The case was presented before thoracic team and it was decided to do radical resection. We performed wide manubrial resection including right and left sternocalvicular joints and upper sternal part. Complete specimen was sent to surgical pathology for rapid frozen section diagnosis and pathologist recommended to wait until final analysis. However, considering that all primary sternal tumors are malignant [5] we didn ´ t wait for final diagnosis but proceeded with resection of both clavicle sternal end and the first and the second rib cartilages. To reconstruct and stabilize anterior chest wall a titanium micro mesh (KLS Martin Germany - Ti100mm x 100mm/0.2mm thickness) was used. It was placed over polypropylene mesh to protect major vessels and pericard from direct contact with rigid titanium and fixed to the remaining edges of sternum, clavicles and ribs. Another polypropylene mesh was placed over titanium to avoid contact with subcutaneous tissue and to secure stability of thoracic wall. It was then covered with subcutaneous tissue without use of any myocutaneous flaps [Figures 1-3]. Two hours before surgery patient received Cefazolin 1g and 500mg every 8hours for 24 hours postopratively in five days. Intravenous tramadol and metamizol provided satisfactory analgesia after surgery. On 4th postoperative day, pleural drainage tube was removed, the patient recovered well and was discharged on postoperative day 7. The pathological examination revealed neoplastic plasma cell proliferation with excentric nuclei and eosinophilic cytoplasm. Immunohistochemical analysis was positive for CD138 and kappa-light chains and negative for lambda-light chains, S 100 protein, CKAE1 AE3, CK7 and EMA. The final pathological diagnosis was plasmacytoma. One year after surgery patient is doing well under hematological and surgical follow up.