ABSTRACT
INTRODUCTION: Osteoblastomas are uncommon primary benign bone tumors. The sacrum is an uncommon site of involvement. We present a case of a large, technically challenging sacral osteoblastoma in a pediatric patient that was managed with en-bloc resection and lumbo-sacral reconstruction showing long-term remission. CASE REPORT: A 15-year-old Hispanic male presented to our clinic in May 2006 with low back pain. Imaging revealed a large expansile and erosive mass at the S2 vertebral body. Definitive treatment of the lesion with en-bloc surgical resection was planned after a biopsy that confirmed osteoblastoma. The patient underwent pre-operative embolization and a same-day, two-stage resection of the tumor with lumbosacral instrumentation for pelvic reconstruction. The S1 nerve roots were sacrificed during en-bloc resection of the mass. Post-operatively, the patient developed an areflexic bladder without major motor or sensory impairment. Subsequently, insertion of an artificial urinary sphincter and a colostomy were performed. At the five-year follow up, the patient remains symptom free with no detectable recurrence. CONCLUSION: The sacrum is a known, but rare, location for an osteoblastoma. We present a technically challenging case of a pediatric patient with a large sacral osteoblastoma. We highlight the importance of a multidisciplinary approach to ensure a long-term, disease-free outcome.
Subject(s)
Osteoblastoma/rehabilitation , Osteoblastoma/surgery , Spinal Neoplasms/rehabilitation , Spinal Neoplasms/surgery , Adolescent , Biopsy , Colostomy , Diagnosis, Differential , Follow-Up Studies , Humans , Magnetic Resonance Imaging/methods , Male , Osteoblastoma/diagnosis , Plastic Surgery Procedures/methods , Sacrum/surgery , Spinal Neoplasms/diagnosis , Treatment Outcome , Urinary Sphincter, ArtificialABSTRACT
Se presentan retrospectivamente los resultados de 31 pacientes con tumores óseos, con lesiones que variaron de benignas agresivas a malignas de bajo y alto grado, tratadas con cirugía amplia, artrodesis con clavo centromedular macizo femorotibial de tamaño especial fijo al hueso por pernos, e injerto autónomo hemicilíndrico. El diagnóstico histopatológico fue de tumor de células gigantes en 22 casos (70.96 por ciento), de los cuales 16 correspondieron a lesiones benignas agresivas y 6 a malignas de bajo grado, 2 histiocitomas fibrosos malignos (6.45 por ciento), 2 sarcomas radioinducidos (6.45 por ciento), 1 osteosarcoma (3.22 por ciento), 1 osteoblastoma (3.22 por ciento), 1 condrosarcoma (3.22 por ciento), 1 fibrosarcoma (3.22 por ciento) y un fibroma desmoplástico (3.22 por ciento). Los casos de histiocitoma fibroso maligno se manejaron con el esquema de quimioterapia con vincristina 0.5 mg, epirrubicina 75 mg, y ciclofosfamida 600 mg todo por metro cuadrado de superficie corporal. En el sarcoma osteogénico se usaron dosis altas de metotrexato a 5 g/m² de superficie corporal. El periodo de seguimiento fue de 6 a 96 meses (x=52.6 meses), obteniéndose buenos resultados al conseguirse, el control satisfactorio del tumor, buena rehabilitación dentro de las limitaciones de la artrodesis de la rodilla, la marcha a los 5 días del postoperatorio, la ausencia de recidivas y adecuada aceptación psicológica por la conservación de la extremidad
