Brief report
Self limiting sternal tumors of childhood: Two case reports
Tumores esternales autolimitados en edad pediátrica: a propósito de dos casos
Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, City of Buenos Aires, Argentina
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A propósito de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2680 "Ancho" => 2833 "Tamanyo" => 410525 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Axial and coronal cervicothoracic computed tomography with IV contrast. (A and B) Voluminous left cervical tumour, heterogeneous, with intense uptake of contrast, which engulfs the carotid arteries (arrows) with thrombosis of the internal jugular vein (asterisk). (C) Multiple millimetric pulmonary nodules, of bilateral and diffuse distribution, compatible with metastasis. 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"apellidos" => "Moreno-Pastor" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833818302078" "doi" => "10.1016/j.rx.2018.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818302078?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300035?idApp=UINPBA00004N" "url" => "/21735107/0000006100000002/v1_201903140618/S2173510719300035/v1_201903140618/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Self limiting sternal tumors of childhood: Two case reports" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "167" "paginaFinal" => "170" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Adri, T. Kreindel" "autores" => array:2 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Adri" "email" => array:1 [ 0 => "danieladri33@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Kreindel" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, City of Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumores esternales autolimitados en edad pediátrica: a propósito de dos casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1506 "Ancho" => 2000 "Tamanyo" => 355135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A and B) Transverse ultrasound scan obtained with a linear transducer showing a lesion at a depth of a few millimetres from the skin (line) that is hypoechoic relative to costal cartilage (arrows). (C) Doppler ultrasound study showing only a motion artefact caused by the patient, but no peripheral or intralesional blood flow. (D) One-month follow-up ultrasound showing shrinkage of the mass (lines).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tumors of the chest wall, particularly in the sternum, are rare. Differential diagnoses include various entities, both benign (bone cysts, fibrous dysplasia) and malignant (Ewing's sarcoma, chondrosarcoma, rhabdomyosarcoma).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">SELSTOCs (self-limiting sternal tumors of childhood) are defined as fast-growing, asymptomatic masses not associated with prior trauma. They are alarming for parents, and are the cause of medical consultations.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–3</span></a> Soft tissue ultrasound and simple chest radiography can help characterise these lesions and define their relationship with adjacent tissues.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 22-month-old female patient with no relevant family or personal history was taken to the clinic for a 20-day history of right-sided, presternal, solid-elastic mass with low mobility.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A soft tissue ultrasound was performed, which showed a hypoechoic lesion in contact with the costal cartilage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), avascular on Doppler examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The lesion had well-defined margins, with no adjacent bone involvement. We reached a presumptive diagnosis of SELSTOC and the patient was scheduled for follow-up at 1 month.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the follow-up ultrasound, the lesion was found to have shrunk (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 12-month-old male patient with no relevant personal or family history presented with a hard tumor in the upper third of the sternum measuring approximately 3<span class="elsevierStyleHsp" style=""></span>cm in diameter.</p><p id="par0035" class="elsevierStylePara elsevierViewall">An X-ray of the thoracic cage showed an area of increased density on the anterior aspect of the sternum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Ultrasound showed an exophytic sternal mass with an echogenicity similar to cartilage that appeared to involve the sternal cartilage (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). In subsequent follow-ups, the lesion was observed to have shrunk, and this improvement confirmed the initial suspicion of SELSTOC.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The varied spectrum of differential diagnoses of lesions of the chest wall includes benign and malignant tumors and inflammatory or infectious processes.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–3,8</span></a> What is more, sternal masses can be caused by systemic diseases with connective tissue involvement.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Primary tumors of the chest wall are rare<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a>; in 2013, they accounted for only 7–8% of all intrinsic bone tumors, and 5% of all thoracic tumors. Approximately 1% arise from the sternum and can derive from various tissues, such as the subcutaneous cellular, cartilage, muscle, bone or serosa.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In an in-depth study of a series of 1700 children treated for sternal tumors between 2001 and 2009, Winkel et al. describe SELSTOCs as self-limited, usually self-involuting, asymptomatic tumors originating from an exacerbated immune response to an aseptic inflammatory process.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a> They are characterised by the absence of prior trauma, laboratory analysis within normal parameters and no radiographic signs of malignancy. Both biopsy and histopathology samples are negative for malignancy. On imaging studies, they appear as well-defined, dumbbell-shaped lesions involving the sternal cartilage but not the surrounding tissues. Radiology shows soft tissue swelling, with no associated bone injury. Diagnosis is confirmed by shrinkage of the mass within a few months and up to 18 months, or until complete resolution.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Unlike benign masses, malignant sternal lesions show aggressive signs of destruction and invasion of neighbouring structures and tend to increase in size.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Follow-up of this self-limiting pathology is performed with soft tissue ultrasound using a high-frequency linear transducer to obtain high quality images that can characterise the type of lesion.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,7,8</span></a> This technique does not use ionising radiation (unlike simple radiology and computed tomography) and is performed without the need for sedation. Magnetic resonance, with its morphological and functional sequences (DWI/ADC), multiplanar reconstruction, and no ionising radiation, can be used to obtain a better evaluation of the characteristics of the tumor tissue and invasion of adjacent tissues. However, this technique requires sedation to avoid movement and respiration artefacts.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">SELSTOC, though rare, must be taken into account in patients with a rapidly growing sternal tumor and no significant history. In the hands of an experienced operator, ultrasound contributes to the diagnosis by showing a well-defined mass involving the sternal cartilage but not the surrounding tissues. Diagnosis is confirmed by shrinkage of the mass within a few months, and complete resolution in up to 18 months.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Conservative management with ultrasound for between 3 and 5 weeks, or even longer, is indicated<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> for the reasons mentioned above.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Authorship</span><p id="par0075" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0080" class="elsevierStylePara elsevierViewall">People responsible for the integrity of the study: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Conception of the study: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Study design: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Data acquisition: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Analysis and interpretation of data: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Statistical processing: N/A</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Literature search: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Writing: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: DA and TK.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Approval of the final version: DA and TK.</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1163687" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1089261" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1163686" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1089260" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case reports" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack397469" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-20" "fechaAceptado" => "2018-07-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1089261" "palabras" => array:3 [ 0 => "Sternum" 1 => "Ultrasound" 2 => "Benign neoplasms" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1089260" "palabras" => array:3 [ 0 => "Esternón" 1 => "Ultrasonido" 2 => "Neoplasias benignas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sternal tumors are rare in children. The differential diagnoses include a wide spectrum of benign (from bone cyst to osteoblastoma, osteochondroma and fibrous displasia) and malignant tumors (Ewing's sarcoma, chondrosarcoma rhabdomyosarcoma), inflammatory lesions and infectious processes.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The SELSTOC (Self Limiting Sternal Tumors of Childhood) are entities of non-specific origin, they are self-limiting and characterised by a rapidly growing tumor that disappears spontaneously with no history of trauma or active infection.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The onset of a rapidly growing mass with no preceding trauma is worrying to parents who then consult the health professionals. Soft tissue ultrasound enables us to characterise these lesions and define their nature in relation to the adjacent tissues. Chest X-ray and MRI can also help to characterise these lesions.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this paper we present two case reports of children referred to our department for characterisation of sternal tumors.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las tumoraciones esternales son poco frecuentes en la infancia. Entre los diagnósticos diferenciales se incluyen un amplio espectro de tumores benignos (desde quistes óseos hasta osteoblastomas, osteocondromas o displasia fibrosa) y malignos (sarcoma de Ewing, condrosarcoma, rabdomiosarcoma), las lesiones inflamatorias y los procesos infecciosos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los SELSTOC (<span class="elsevierStyleItalic">Self Limiting Sternal Tumors of Childhood</span>) son una entidad de origen inespecífico, autolimitada, que se caracteriza por una tumoración de rápido crecimiento que desaparece espontáneamente y sin antecedentes de trauma o infección activa en el paciente.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La aparición de una masa de rápido crecimiento, sin traumatismo precedente, genera preocupación a los padres y consultas a los profesionales de la salud. A través de la ecografía de partes blandas podemos caracterizar dichas lesiones y definir el carácter de estas en relación con los tejidos adyacentes. Otros estudios que pueden contribuir a su caracterización son la radiografía de tórax y la resonancia magnética.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En el siguiente trabajo se describen dos casos de pacientes en edad pediátrica referidos a nuestro servicio para caracterización de tumoraciones esternales.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Adri D, Kreindel T. Tumores esternales autolimitados en edad pediátrica: a propósito de dos casos. Radiología. 2019;61:167–170.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1506 "Ancho" => 2000 "Tamanyo" => 355135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A and B) Transverse ultrasound scan obtained with a linear transducer showing a lesion at a depth of a few millimetres from the skin (line) that is hypoechoic relative to costal cartilage (arrows). (C) Doppler ultrasound study showing only a motion artefact caused by the patient, but no peripheral or intralesional blood flow. (D) One-month follow-up ultrasound showing shrinkage of the mass (lines).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2115 "Ancho" => 2000 "Tamanyo" => 385583 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(A) X-ray of the lateral thoracic cage (enlargement) showing a convex opacity on the anterior face of the sternum (circle). (B) Transverse ultrasound obtained with linear transducer confirming an exophytic sternal lesion (circle) involving the cartilage (arrow). 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