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Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy
BACKGROUND: Sacral chordoma is a locally aggressive malignant tumour originating from ectopic notochordal cells. The natural history of sacral chordoma is a slow growing tumour arising at the midline of the lower sacrum that can invade the sacrum and progressively increase in size expanding craniall...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234700/ https://www.ncbi.nlm.nih.gov/pubmed/30428857 http://dx.doi.org/10.1186/s12885-018-5012-3 |
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author | Phang, Zi Hao Saw, Xue Yi Nor, Noreen Fadzlina Binti Mat Ahmad, Zolqarnain Bin Ibrahim, Sa’adon Bin |
author_facet | Phang, Zi Hao Saw, Xue Yi Nor, Noreen Fadzlina Binti Mat Ahmad, Zolqarnain Bin Ibrahim, Sa’adon Bin |
author_sort | Phang, Zi Hao |
collection | PubMed |
description | BACKGROUND: Sacral chordoma is a locally aggressive malignant tumour originating from ectopic notochordal cells. The natural history of sacral chordoma is a slow growing tumour arising at the midline of the lower sacrum that can invade the sacrum and progressively increase in size expanding cranially and anteriorly. Metastasis is very rare even when the tumour is large. Sacral chordoma affects males more than females and is more commonly found in middle age and elderly patients. CASE PRESENTATION: A 25 years old female had neglected an extremely large midline sacral mass for 2 years. On presentation to hospital, she had been bed bound for the past 2 years. The sacral mass was so large that it prevented her from lying down supine and sitting on the wheelchair comfortably. Clinical examination showed a 40 cm × 30 cm × 20 cm hard mass over the sacrum that involved both buttocks and the gluteal fold. Neurological exam of bilateral lower limb was normal. Computed Tomography Scan of the Pelvis showed a large destructive sacrococcygeal mass measuring 43 cm × 38 cm × 27 cm with extension into the presacral space resulting in anterior displacement of the rectum, urinary bladder and uterus; and posterior extension into the dorsal soft tissue with involvement of the gluteus, piriformis, and left erector spinae muscles. Biopsy taken confirmed Chordoma. This patient was managed by a multidisciplinary team in an Oncology referral centre. The patient had undergone Wide En Bloc Resection and Sacrectomy, a complex surgery that was associated with complications namely bleeding, surgical site infection and neurogenic bowel and bladder. Six months post operatively the patient was able to lie supine and sit on wheelchair comfortably. She required extensive rehabilitation to help her ambulate in future. CONCLUSION: This is a rare case of neglected sacral chordoma in a young female treated with Wide En Bloc Resection and Sacrectomy associated with complications of this complex surgery. Nevertheless, surgery is still worthwhile to improve the quality of life and to prevent complications secondary to prolonged immobilization. A multidisciplinary approach is ideal and team members need to be prepared to address the complications once they arise. |
format | Online Article Text |
id | pubmed-6234700 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62347002018-11-20 Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy Phang, Zi Hao Saw, Xue Yi Nor, Noreen Fadzlina Binti Mat Ahmad, Zolqarnain Bin Ibrahim, Sa’adon Bin BMC Cancer Case Report BACKGROUND: Sacral chordoma is a locally aggressive malignant tumour originating from ectopic notochordal cells. The natural history of sacral chordoma is a slow growing tumour arising at the midline of the lower sacrum that can invade the sacrum and progressively increase in size expanding cranially and anteriorly. Metastasis is very rare even when the tumour is large. Sacral chordoma affects males more than females and is more commonly found in middle age and elderly patients. CASE PRESENTATION: A 25 years old female had neglected an extremely large midline sacral mass for 2 years. On presentation to hospital, she had been bed bound for the past 2 years. The sacral mass was so large that it prevented her from lying down supine and sitting on the wheelchair comfortably. Clinical examination showed a 40 cm × 30 cm × 20 cm hard mass over the sacrum that involved both buttocks and the gluteal fold. Neurological exam of bilateral lower limb was normal. Computed Tomography Scan of the Pelvis showed a large destructive sacrococcygeal mass measuring 43 cm × 38 cm × 27 cm with extension into the presacral space resulting in anterior displacement of the rectum, urinary bladder and uterus; and posterior extension into the dorsal soft tissue with involvement of the gluteus, piriformis, and left erector spinae muscles. Biopsy taken confirmed Chordoma. This patient was managed by a multidisciplinary team in an Oncology referral centre. The patient had undergone Wide En Bloc Resection and Sacrectomy, a complex surgery that was associated with complications namely bleeding, surgical site infection and neurogenic bowel and bladder. Six months post operatively the patient was able to lie supine and sit on wheelchair comfortably. She required extensive rehabilitation to help her ambulate in future. CONCLUSION: This is a rare case of neglected sacral chordoma in a young female treated with Wide En Bloc Resection and Sacrectomy associated with complications of this complex surgery. Nevertheless, surgery is still worthwhile to improve the quality of life and to prevent complications secondary to prolonged immobilization. A multidisciplinary approach is ideal and team members need to be prepared to address the complications once they arise. BioMed Central 2018-11-14 /pmc/articles/PMC6234700/ /pubmed/30428857 http://dx.doi.org/10.1186/s12885-018-5012-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Phang, Zi Hao Saw, Xue Yi Nor, Noreen Fadzlina Binti Mat Ahmad, Zolqarnain Bin Ibrahim, Sa’adon Bin Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title | Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title_full | Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title_fullStr | Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title_full_unstemmed | Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title_short | Rare case of neglected large sacral Chordoma in a young female treated by wide En bloc resection and Sacrectomy |
title_sort | rare case of neglected large sacral chordoma in a young female treated by wide en bloc resection and sacrectomy |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234700/ https://www.ncbi.nlm.nih.gov/pubmed/30428857 http://dx.doi.org/10.1186/s12885-018-5012-3 |
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