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Right external hemipelvectomy plus total pelvic exenteration to chondrosarcoma treatment
Apresentação do caso
We present the case of a 34yr-old with chronic pelvic pain for 1 year of, bilateral edema, functional impairment, urinary retention and a palpable mass in lower abdomen. Computed tomography(CT) showed a tumor on right pelvis with extension to ipsilateral retroperitoneum, infiltrating rectum, bladder and prostate with signs of destruction and remodulation of ischio, pubis and femur size 19x 14x 10,6cm.
With progressive pain and intestinal obstruction, a colostomy was performed and a ultrasound-guided biopsy and patologic analysis exposed Chondrosarcoma with intermediate differentiation (Ki-67: 20%). CT and MRI imaging without metastatic disease, but was close to external iliac vessels.
Was perfomed right external hemipelvectomy plus total exenteration with wet colostomy and gluteus flap for pelvic reconstrution. On his post-operative period, stayed on intensive care unit for 6 days, was diagnosed with pelvic abscess treated with antibiotics. Was released home, on his 26th post-operative day.
Late complications, includes urinary infection treated with antibiotics. Our pacient remains without new evidence of tumor and completely recovered walking functions with prosthestic limb on oncologic surveillance.
The chondrosarcoma is the second most common primary bone tumor, even with low incidence among sarcomas. It derivates of malignant degeneration of hyaline cartilage. Mostly diagnosed around 5th decade of life. Our report is about male- 34yr-old, but all the others aspects fulfill the most common profile about this kind of tumor and reinforces the importance of multidisciplinary follow up and aggressive surgery as cornerstone on treatment of this sarcoma, since it’s almost absent chemo and radiation sensibility. The complete resection with microscopic free margins is the core of treatment of the chondrosarcoma. We have fewer options of chemotherapy with even lower response, and radiotherapy is mostly used on palliative scenario. We live on limb-sparing surgery era, but sometimes for selected pacients we must adopt an aggressive strategy.
In our report, 34yr-old male with very rare sarcoma was very benefited of a extended surgical resection. Therefore, in selected cases, multivisceral resections should be considered as a surgical proposal for locally advanced chondrosarcomas
Hemipelvectomy, chondrosarcoma, pelvic exenteration
Sarcomas / tumores ósseos*
REBECA REIS DA ROCHA , FELIPE AUGUSTO CRUZ LOPES MIRANDA, LUCIANA MATA SILVA, FERNANDO BESERRA CUSTODIO, AUGUSTO CESAR AMORIM NUNES MAIA , ALISSON SILVA DE CARVALHO