RESUMO
Sacral chordoma is a rare tumor arising from notochord remnants. Sacral pain is the most common sign. The authors report the case of a sacral chordoma diagnosed in a urology department. It was a rare cause of erectile dysfunction and it was unusually revealed by lower urinary tract symptoms (LUTSs). Case Presentation: A 67-year-old man had severe dysuria associated with erectile dysfunction. On digital rectal examination, we palpated a mass protruding through the posterior wall of the rectum. The gluteal region is infiltrated by a firm mass. MRI revealed an osteolytic sacral tumor. A percutaneous biopsy of the tumor was performed. A pathological examination confirmed the diagnosis of sacral chordoma. The patient had palliative radiotherapy. One year after radiotherapy, he had rectal stenosis associated with severe constipation. Clinical Discussion: Sacral chordoma is a rare malignant tumor. Sacralgia is the most common sign. LUTS and erectile dysfunction were rarely reported in patients affected by this bone tumor. MRI is very suggestive of this pathology. Diagnostic confirmation requires pathological examination. The curative management consists of a large resection of the tumor. For inextricable tumors, palliative radiotherapy can be carried out. The prognosis of sacral chordoma is defined by a high recurrence potential and a low metastatic risk. Conclusions: Sacral chordoma is a rare bone tumor. It is an unusual cause for LUTS and erectile dysfunction. Complete tumor excision is the only curative treatment. Recurrence after treatment is the main challenge for surgeons.
RESUMO
Introduction and importance: Lung, bone, lymph nodes and liver are the most common metastatic sites. This observation presents a metastatic renal cell carcinoma (RCC) with atypical secondary sites and a rare mode of revelation corresponding to diabetes mellitus. Case presentation: We report the case of a 64-year-old woman recently diagnosed with diabetes mellitus. A thoracic parietal nodule was palpated. An uro-CT scan had shown a renal tumor with unusual metastatic sites: pleura, pancreas, and contralateral kidney. The patient underwent a biopsy of the pleural nodule. The pathology report concluded to the diagnosis of clear cell RCC. She had a targeted therapy. Three months after admission, the patient had altered general condition and total hematuria. Clinical discussion: RCC commonly metastasizes haematogenously via renal veins. Atypically, secondary lesions may involve pleura. Such a metastatic site may be of particular interest for percutaneous biopsy, as in our case. The rare metastatic invasion of the pancreas is most likely the cause of the inaugural diabetes in our patient. The controlateral kidney was involved in 1.4% of secondary lesions. For patients with poor prognosis, according to International Metastatic RCC Database Consortium classification, anti-angiogenic treatment is recommended. The median overall survival of patients with poor prognosis is 8 months. Conclusions: Pancreas and contralateral kidney are rare secondary sites of RCC. The clinical expression of pancreas metastatic invasion can rarely fit with diabetes. Metastatic dissemination to these organs is most often associated with an unfavorable prognosis.
