Background Primary sternal chondrosarcoma, although rare, is the most common malignant tumor of the sternum. The gold standard treatment is complete surgical excision, which frequently causes the instability of the thorax necessitating future reconstruction. Local recurrence is common increasing the risk of distant metastasis. Case presentation A 60-year-old male patient was diagnosed with primary sternum chondrosarcoma and underwent surgical excision with negative resection margins. Later, he was found to have two local recurrences at 11 months and 37 months post initial excision. The two recurrences were surgically removed followed by local adjuvant radiation. Conclusion The seeding theories have been reported more frequently with relation to diagnostic biopsy procedures, tumor manipulation and self-seeding tumors. The patient developed two local recurrences despite total resection with negative margins, without concerns regarding seeding in distant metastasis.

Background: Pulmonary carcinoid is rare with surgery remaining the gold standard treatment which may include radical lung resection as well as minimally invasive procedures and parenchymal sparing bronchial resection. However, resection may impact patients' daily activities due to decreased lung volume reserve and postoperative pain. Our study aims to compare the impact of different types of surgical resection on the post-operative quality of life with the application of a strict peri-operative pulmonary care program. Methods: Patients who underwent surgery for bronchopulmonary carcinoid tumors in a tertiary cancer center between August, 2017 and March, 2020 were included. For the qualitative and quantitative assessment of pain and quality of life, we utilized the Arabic version of Short-form McGill Pain Questionnaire and Activity of Daily Living (ADL) instrument respectively. Lung reserve was assessed before and after surgery. Statistical analysis conducted on SPSS version 24. Results: A total of 16 patients underwent different type of resection. The majority were males (n=10; 63%) with a mean age of 44 years (19-81). Most common clinical stage was stage I (n=12, 75%) with typical carcinoid features recorded in more than half of the cases (n=11, 69%). Almost all patients underwent surgical excision (n=15, 94%) with negative resection margin and no major post-operative complications. Bilobectomy was the most frequent procedure (n=6, 40%) and video-assisted thoracoscopic surgery (VATS) was utilized in 8 patients (50%). Expected changes were recorded in pre- and postoperative pulmonary function test. The majority of patients (n=15, 94%) were totally independent. Mild intermittent pain was found in 7 patients (44%) who scored an average intensity of 1.6 out of 10. Conclusions: Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoid tumors with little to no effect on patients' lung function and quality of life in regard to performance status and post-operative pain when a good peri-operative pulmonary, physical rehabilitation, and pain management programs are adopted and strictly implemented.

Background: Thymomas, although rare, remain the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality conventionally. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy may be utilized to increase the chance of R0 resection. Therefore, questions of efficacy and safety of the NACT arise.Methods: Data from 25 patients (10 NACT vs 15 primary surgery) who had undergone tumor resection (January 2015-October 2021) was collected from electronic medical records at the King Hussein Cancer Center. Both radiological and pathological tools used to assess the effect of neoadjuvant chemotherapy on tumor. CT scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of neoadjuvant chemotherapy (NACT) on tumor burden as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). The pathological response was determined by measuring the percentage of necrotic tissue.Results: The majority of patients were male. Mean age 46.28 +-15.31 at diagnosis. Distribution among stages was as followed; stage I (4; 16%), stage II (7; 28%), stage III (7; 28%), stage IV (7; 28%). Patients who received NACT were evenly distributed among stages III and IV accounting for 71.4% each. Eleven patients underwent VATS tumor resection; one of them is in the NACT group (10%). Negative resection margins in 96%; 24 patients. Patients received 3–6 cycles of platinum-based NACT. A single patient who received definitive radiation and 12 cycles of chemotherapy outside our center developed chemotherapy induced heart failure and died immediately postoperatively. No other patients reported severe toxicity. The mean change in tumor volume and maximum diameter was 165 cm3 (p = 0.079) and 1.53 +- 1.49 cm (p < 0.01) respectively. Tumor diameter stratified according to stage showed a variation of 2.0+- 1.6 cm in stage IVa (p = 0.02) and 1+-1.35 cm in stage III (p = 0.08), respectively. The effect of NACT on tumor burden based on RECIST criteria was minimal as 80% (n = 8) of patients had SD and the remaining 2 patients had PR and PD. Based on pathological findings, the average necrotic portion of the tumor was 39.5%.; 23% in stage III and 56% in stage IVa (p = 0.152). The overall survival rate is 91.2%, mean survival was 115 months (4-125). Recurrence occurred in 28% (n = 7). The NACT group had a higher risk for recurrence (5; 50%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy.Conclusions: The exact role of induction chemotherapy in locally advanced thymoma patients theoretically to increase the chance of R0 resection remains controversial. Though our study group number is small but we combined both radiological and pathological tools for better assessment of neoadjuvant chemotherapy effect on tumor burden, we found that the radiographic and histopathological effect of NACT on thymic tumors is minimal especially on stage III with the greatest variation in tumor burden is in Stage IVa. However, NACT was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.

Background: Primary sternal chondrosarcoma, although rare, is the most common malignant tumor of the sternum. Adequate surgical excision is the mainstay of treatment, which may compromise the chest wall stability and obligate for reconstruction. Local recurrence is common and increases the risk of distant metastasis. Case presentation: We report a rare case of a 60-year-old male patient diagnosed with primary sternum chondrosarcoma successfully resected as primary treatment with negative margins accompanied by two local recurrences at 11 months and 37 months from the original surgery which were managed with local resection and adjuvant radiation Conclusion: seeding theories has been increasingly reported recently including tumor biopsy seeding, self-seeding tumors and tumor manipulation seeding, our patient developed two local recurrences despite resection with free margins and no distant metastasis raises the concern for seeding.