Daliakopoulos et al. Journal of Medical Case Reports 2010, 4:75 http://www.jmedicalcasereports.com/content/4/1/75 Page 6 of 8 Figure 6 The mass. scans of her chest, abdomen, and brain. She remains asymptomatic and the stability of her chest wall is well- preserved. Discussion The operative management of massive chest wall malig- nancies presents as an infrequent but formidable surgi- cal challenge mainly because of the difficulty in making full thickness resections without compromising the sta- bility and the reconstruction of the chest wall. A review of the literature showed that a complete chest wall resection is only performed in very rare cases, with the largest reported study in the last 20 years coming from Mora et al. and including 69 patients [1]. In patients with breast cancer, the presence of either sternal invol- vement or an isolated sternal metastasis is relatively uncommon, with reported incidences of 5.2% and 1.9% to 2.4%, respectively [2]. Sternal involvement may occur either from direct invasion by enlarged internal mam- mary lymph nodes or from hematogenous spread. How- ever, in contrast with vertebra lesions, which tend to result in multicentric bony disease from spread through the paravertebral plexus [3], some sternal lesions have been observed to remain solitary over time and may be amenable to surgical resection with curative intent [4]. Although local recurrence after breast surgery does not consistently represent systemic metastasis [5], the role of surgery is controversial in breast cancer metastasis involving the thoracic wall and the sternum [6], as well as in sternectomy for isolated breast cancer. This can be gleaned from the fact that the literature consists predo- minantly of retrospective case series. Meanwhile, local recurrence following the primary treatment of breast cancer ranges from less than 5% for stage I to greater than 25% for stages II and III with an extremely variable disease-free interval [7]. Since chest wall recurrence is associated with disseminated metasta- sis in 60% to 100% of cases, simple excision, radiation therapy and chemotherapy are utilized to treat local and systemic diseases. Noguti et al. [8] performed sternal resections with parasternal and mediastinal lymph node dissection on nine patients before chemo-endocrine therapy was undertaken. The eventual relapse of the cancer in 8 patients revealed that lymph node dissection had no effect on locoregional control. Nevertheless, dis- section provided prognostic information because all patients with involved parasternal and mediastinal lymph nodes relapsed and died within 30 months, while 3 patients without lymph node involvement survived for more than 6 years. Lequaglie et al. performed radical, curative-intent ster- nectomies in a subgroup of 28 patients with isolated breast cancer recurrence and noted that the 10-year overall survival in the group was 41.8% [9]. Meanwhile, McCormack et al. noted in a series of 35 patients that 20 (57.14%) were alive from 5 to 120 months with a median of 50 months [10]. These authors stated that surgical resection of recurrent mammary carcinoma