Daliakopoulos et al. Journal of Medical Case Reports 2010, 4:75 http://www.jmedicalcasereports.com/content/4/1/75 performed and described total sternectomy due to chon- drosarcoma involving the entire sternum. The surgical treatment of chest wall tumors challenges the aggressiveness and ingenuity of the operating sur- geon who closes the defect. Partial or total sternectomy, together with rib resection, are common thoracic surgi- cal procedures. These are undertaken for primary and secondary tumors arising from any of the structures forming the chest wall, as well as recurrent breast can- cer or lung tumors invading the chest wall. Myocuta- neous flaps and prosthetic materials greatly facilitate reconstruction after massive chest wall resection. Case presentation We report the case of a 70-year old Caucasian woman who was referred to the thoracic oncology unit of our hospital for the management of a retrosternal mediast- inal mass. She had been well 8 weeks before admission when she experienced the sudden onset of sharp left anterior chest pain. The pain was worse in the area adjacent to the sternum and also worsens when she takes a deep breath. In 1999, she underwent radical left side mastectomy followed by CEF (cyclophosphamide, epirubin and fluorouracil) chemotherapy and radiother- apy. The clinical and histological characteristics of the primary breast cancer revealed a Stage IIIa adenocarci- noma with positive axillary lymph node metastasis. Her estrogen receptor assay, as well as the amplification of the human epidermal growth factor receptor type 2 Page 2 of 8 (HER 2/neu) was negative. Expression of her progester- one receptors was defined as low (Reiner score for stain- ing of tumour-cell nuclei). On admission our patient’s vital signs were normal. She had neither jugular venous distension nor cervical or supraclavicular lymphadeno- pathy. Her chest was clear on auscultation. There was no tenderness on palpation of her ribs or sternum. The remainder of her examination results was normal. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) of our patient’s chest revealed a 74.2 × 37.7 × 133.6-mm mass in her anterior mediasti- num adjacent to the main pulmonary artery, the right ventricle, and ascendens aorta contiguous to the pericar- dium (Figures 1 and 2). There was no specific direct evi- dence of vascular invasion but we raised the question of pericardial invasion. Our patient was vigorously scruti- nized for metastatic disease, which included routine blood chemistries and the determination of lipid asso- ciated sialic acid, carcinoembryonic antigen (CEA) and CA 15-3 serum markers. CT scan of her neck and abdo- men for restaging revealed no other foci of metastatic disease. A bone scan showed uptake only in her sternum. Our patient was anaesthetized and ventilated with a double-lumen endotracheal tube. An epidural catheter was also inserted for pain control during the peri-opera- tive period. Our patient was placed at first in a right thoracotomy position with soft rotation of the coxa towards the surgeon. Standard thoracotomy incision was Figure 1 Magnetic resonance imaging of axial plan with intravenous contrast gadolinium-BOPTA demonstrating a mass adherent to the right ventricular wall.