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RESECTION OF A RARE LARGE PELVIC BONE TUMOR THROUGH INTERNAL HEMIPELVECTOMY WITH LOWER LIMB PRESERVATION: A CASE REPORT
Apresentação do caso
Male, 35 years old, admitted to the oncology service complaining of an abdominal tumor in the right lower quadrant. Physical examination evidenced a palpable mass in the right iliac fossa region, measuring 10 cm, painless, hardened, and growing for ten years. Magnetic resonance imaging showed an expansive, well-delimited, heterogeneous, and lobulated bone lesion measuring 11x10x7cm, an internal and chondral bone matrix in the periphery and center, with a large base of 3.2cm in the internal region of the right iliac crest and anterosuperior growth predominantly between the fibers of the transverse abdominal muscle and the internal oblique muscle, without invasion of the abdominal muscle wall and showing a cleavage plane with the regional musculature. Then, performed a type I internal hemipelvectomy en bloc resection with abdominal wall musculature and reconstruction with a myocutaneous flap and polypropylene mesh. Histopathological examination revealed osteochondroma. Currently, the patient is under follow-up with no complaints.
Osteochondroma (OC) is a tumor composed of bone marrow and cortical tissue, mainly affecting the metaphysis and diaphysis of long bones. The pelvic location of the OC is rare. Despite being considered benign, OC can suffer malignant degeneration in chondrosarcoma. In the present case, the heterogeneity of the lesion did not allow us to exclude malignant degeneration. Definitive diagnosis is histopathological, and en bloc resection of the lesion is the treatment of choice when associated malignancy is suspected. However, in pelvic tumors, resection en bloc with free margins is of great technical difficulty due to the anatomical complexity of the region. Despite this, preference should be to limb-sparing surgical modalities, as long as possible free margins. Thus, a type I internal hemipelvectomy (HI) was performed, resecting the iliac bone without the need for bone reconstruction. IH provides limb-sparing with good oncological safety margins, reaching similar curative results to external hemipelvectomy but avoiding mutilation and functional losses.
The pelvic location of the OC can delay and make diagnosis difficult, enabling malignant degeneration. In pelvic bone tumors, IH with preservation of the lower limb, despite being a challenging procedure for the oncologic surgeon, plays a significant role in the patient's quality of life, allowing for the cure of the pathology and the functionality of locomotion.
Osteochondroma, Pelvic neoplasms, Hemipelvectomy
Sarcomas / tumores ósseos*
ANDRÉ LUIZ COSTA E SILVA, JOSÉ AMÉRICO SANTOS COSTA NETO, ANA LUISA SILVA MAIA, LAURA CRISTINA COSTA E SILVA, MARINA ALVARES PRUDENCIO, ROSANE NAYARA MEDEIROS ALVES FERNANDES, INGRID PINHEIRO MOLINA, EDUARDA MORGANA ANDRADE ALMEIDA, GUSTAVO TORRES LOPES SANTOS, THIAGO COSTA PIRES