Bone chondrosarcomas are malignant tumors whose cells produce a cartilage matrix. In terms of the frequency of occurrence, chondrosarcoma takes the second place among primary malignant bone tumors after osteosarcoma, and, according to various authors, accounts for 10 to 25% of all primary bone sarcomas [4,22,23]. It is found in the age group from 5 to 90 years, mainly in middle and old age - most often between 40 and 60 years (about 60% of patients). It has a slightly higher frequency of occurrence in men. Any bone of cartilaginous origin can be affected. The most frequent localization (three quarters of patients) is in the bones of the trunk (pelvis, ribs) and the proximal ends of the femur and humerus [24]. Among the malignant tumors that affect the sternum, chondrosarcomas are diagnosed most frequently [1,2,7]. Among 458 common chondrosarcomas diagnosed during the period from 1987 to 2009 at the pathology department at our institute, only 5 (1%) were localized in the sternum [25]. Among the 2004 primary bone tumors in the registry of the St. James’s University Hospital (Leeds, West Yorkshire, England), 9 (0.45%) were localized in the sternum, of which 6 (0.3%) were chondrosarcomas [6].

The progression of chondrosarcomas varies from slowly growing tumors to aggressive metastatic sarcomas. Morphologically chondrosarcomas are divided into tumors of low (I), medium (II) and high (III) degrees of malignancy [4,22,23,26]. Almost 60–90% of chondrosarcomas belong to the category of low and moderate degree of malignancy [25]. In the case presented in this article, a chondrosarcoma (G2, stage IIB according to Enneking) was diagnosed based on histopathological examination. Numerous approaches to reconstructive surgery of the anterior chest wall after resection of the sternum have been described in literature [7,10,12-15,19].

Titanium is a biocompatible, inert material with physical characteristics that allow to design robust individualized implants that closely replicate the shape of the sternum and chest wall. The implant structure can also be perforated without sacrificing stiffness, which facilitates its fixation. Additionally, titanium does not interfere with computed tomography or magnetic resonance imaging, allowing for safe and informative postoperative evaluation [12].

Gonfiotti and Santini (2009) described a case of surgical treatment of a patient with a chondrosarcoma, in which, after a total resection of the sternum, the defect was reconstructed with 4 metal plates attached to the ribs with titanium clips [13]. А polytetrafluoroethylene sheet, which was fixed to the plates with non-absorbable suture material, was used to separate the chest organs from the metal plate. The postoperative period was uneventful. Six months after surgery, the implant was clinically and radiologically stable, there was no tumor recurrence, and no respiratory dysfunction was noted. In a study by Rocco et al, reconstruction of the anterior chest wall defect was performed using three metal plates and an omental flap. This approach allowed the authors to achieve full stability and to avoid complications [19].

Voronovich and Pashkevich (2011) reported on a case, where a perforated titanium plate was used for chest wall reconstruction after total sternum resection in a patient with a chondrosarcoma [10]. The plate had a thickness of 15 mm and was manufactured in advance based on the patient’s radiographs. The follow-up period was 2 years. The patient had a complicated case of chondrosarcoma recurrence, which required surgical removal of the recurrent tumor nodes twice. No plate instability was observed during the course of treatment. The patient died due to metastatic spread of the tumor.

Demondion et al reported on a case of a 28-year-old patient with intraductal invasive carcinoma of the left breast with metastases to the sternum [12]. After four courses of chemotherapy, the patient underwent radical mastectomy on the left, axillary lymphadenectomy and subtotal resection of the sternum. Reconstruction of the anterior chest wall was performed using an individualized titanium plate, manufactured based on a 3D model and CT data. Six months after surgery, the implant was clinically and radiologically stable, there were no signs of respiratory dysfunction. He and Huang reported on a case of a primary chondrosarcoma of the sternum in a 37-year-old woman [7]. The patient underwent resection of the sternum with defect reconstruction using a titanium mesh and steel wire. At a 12-month follow-up the clinical and radiological results were good.

Aranda reported on the use of an individualized titanium prosthetic costo-sternal complex, also manufactured using additive technology and CT data, in a patient with a primary chondrosarcoma [14]. No complications were observed in the early postoperative period. Mansour reported on 47 patients (24%) who underwent such surgeries and had complications during the hospital stay [16]. The most common complications were pneumonia (27 patients, 14%), acute respiratory distress syndrome (ARDS) - 11 patients (6%) and flap loss - 10 patients (5%).

Weyant et al (2006) noted that severe complications, such as infection, splitting, flap loss and hematomas, were reported to occur in 8%–20% of cases [21].  In our case, utilization of a stereo-lithographic model, 3D modeling, and manufacturing of an individualized titanium plate yielded excellent long-term clinical and cosmetic results, comparable to those of other authors. We believe that the described approach, as well as constantly developing technological advances can significantly improve the results of surgical treatment of patients with tumors of the sternum.