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Hemipelvectomy for Pelvic Chondrosarcoma
Apresentação do caso
JCJ, male, 68 years old. Admitted in the Orthopedic Surgical Oncology Department on august, 2013 with hip pain for 1 year. CT scans and scintigraphy scan showed osteolytic lesion in the greater trochanter of the right femur. An biopsy was performed with hystological diagnosis of chondromyxoid tumor. Patient undergone surgical resection and the morphological and immunohistochemistry diagnostics was Enchondroma. A tumor growth in the gluteal region was observed during an follow-up routine medical consultation on may 2015. A Nuclear Magnetic Resonance demonstrated an lesion of the right coxofemoral joint and muscle extension and preservation of the vascular-nervous bundle. The biopsied was compatible with Chondrosarcoma. Patient underwent external hemipelvectomy, reconstruction with an anterior myocutaneous flap. The histopathologycal diagnosis of well-differentiated chondrosarcoma of the femoral with soft tissue invasion measuring 17 cm, with no bone invasion of the pelvis, with free surgical margins , compatible with pT2NxMx, EC IIB. In 2019, patient presented an local chondrosarcoma tumor-relapse, with surgical re-approach and tumor resection with partial preservation of the myocutaneous flap, with free-margins been achieved. Adjuvant radiotherapy was performed and patient presented to an 12-month follow-up without tumor relapse according to medical examination and imaging including CT scans and scintigraphy scan.
Chondrosarcoma is a rare bone cancer, it can appear as a primary lesion or secondary to a benign lesion such as enchondroma, affects adults after the 4 th decade. It has high survival rates, overall survival greater than 80%. Lesions are usually well-differentiated and low-grade. Tumor grade is still the best prognostic and survival factor[1, 2]. The standard treatment is surgery. Hemipelvectomy with complete resections (R0) with curative intent are associated with satisfactory clinical outcome with good local control and increased survival. Systemic Chemotherapy has no clear role in the clinical management. Adjuvant treatment with radiotherapy may be useful for some areas such as the spine or pelvis, in which clear surgical tumor free margins are often difficult to be achieved [3, 4].
Surgical resection by hemipelvectomy results in good long-term survival for most patients. There is a very important correlation between tumor grade, complete resections and overall or disease-free survival
Chondrosarcoma, bone tumor, hemipelvectom
Sarcomas / tumores ósseos
VITOR AUGUSTO MELÃO MARTINHO, RENATO MORATO ZANATTO, GUSTAVO GARCIA DE ARRUDA FALCÃO, PEDRO LUIZ BUDIN, BEATRIZ MARTINHÃO HIGA, MAURICIO PEREIRA DA SILVA FILHO, ANA THEREZA BISSOLI, JUNIOR RODRIGUES SOARES, FLAVIA FERREIRA MAGALINI, JUNEA CARIS DE OLIVEIRA