Operative management of chondrosarcoma in pelvic region: case series

Abstract

Chondrosarcoma is the second most frequent malignant bone tumour after osteosarcoma. It most often occurs in the pelvis. Treatment of pelvic chondrosarcoma is a difficult problem for the musculoskeletal oncologist. We report 3 patient with chondrosarcoma in pelvic region that undergoing internal hemipelvectomy. First patient, male 28 y.o. with chondrosarcoma in left iliac wing 11.2cm x 10.8cm x 9.2cm. Second, woman, 47 y.o with chondrosarcoma in right superior and inferior pubic rami 13.7cm x 11.5cm x 14.2cm with soft tissue mass around extended to medial part of proximal thigh. Already done A wide excision of the tumor was performed and we use non-vascularized fibular graft (NVFG) to fill the defect. Last patient, pregnant woman 22 y.o. (16weeks gestational age) with chondrosarcoma in right pubic rami 9.8cm x 11.4cm x 13cm. We already done internal hemipelvectomy without terminating the fetus. The second and third patient confirmed with the histopathology result with chondrosarcoma grade II, and the first patient with chondrosarcoma grade I. After 3month post operatively, all of the patients have no pain, no urinary tract complain. The first patient can ambulatory full weight bearing with no crutches or walker. Second patient ambulatory partial weight bearing with crutches. The last patient ambulatory with wheel chair during the pregnancy. Since chondrosarcomas are unresponsive to chemotherapy or radiotherapy, surgical resection was the only therapeutic solution for these patients. It also reinforce the need of a correct diagnose and collaboration between specialities in the treatment of oncological patients.

Internal Hemipelvectomy and Pelvic Reconstruction With Non-Vascularized Fibular Graft for Chondrosarcoma Ilium

“…Further several reports of this procedure described it as an innovative technique with the reconstruction of the pelvic ring [ 1 ]. Enneking and Dunham proposed eight subtypes of hemipelvectomy based on four zones (I - ilium, II - periacetabular area, III - pubis and ischium, IV - sacrum), each requiring a different reconstruction method [ 4 ]. Reconstruction provides stability of the pelvis and spinal column by maintaining continuity of sacrum, ilium and pubis [ 6 ].…”

“…The most common occurrence is the pelvis with iliac bone involving more frequently followed by pubic bone and ischium. Other common sites are the proximal femur, proximal humerus, distal femur and ribs [ 4 ]. As pelvic chondrosarcoma is deeply seated, patients present with large extra skeletal mass without any specific symptoms other than pain.…”

“…But this required considerable time and microsurgical expertise. Studies have shown no conclusive evidence that they perform better over nonvascularized fibular graft [ 4 ]. Reconstruction with nonvascularized fibular graft is simpler, less time-consuming than with vascularised grafts and works well [ 5 , 7 ].…”

Chondrosarcoma pelvis, beyond the boundaries.

“…It shows good results. 16 Netherland cancer registry analyzed 2186 patients with chondrosarcoma, showing 3, 5 and 10 year survival of 96%, 93% and 88% in grade I, 74% & 62% for grade II and 38%, 31% and 26% grade III chondrosarcoma. They suggest incidence of chondrosarcoma is increasing.…”

Grade III chondrosarcoma of the left iliopubic branch: A case report

“…The male gender exhibits a predilection, with a reported sex ratio of 2:1 [ 3 , 4 ]. Chondrosarcoma predominantly afflicts the adult and elderly population, with a typical onset occurring between the ages of 40 and 70 years [ 5 , 6 ].…”