Aims We assessed the results of surgical treatment of malignant sacral tumours and aimed to supply information on incidence and distribution of these lesions Methods Forty-six malignant cases out of 65 tumours of the sacrum were assessed retrospectively Three of the patients did not accept treatment Surgical treatment was applied to 23 (652%) of the remaining 43 patients Surgical techniques used were resection and PMMA (polymethylmethacrylate) application through a posterior approach, sacral reconstruction, and resection through a combined posterior and anterior approach Results Twelve of the lesions were primary while 34 were secondary Among the primary sacrum tumours, the most common was chordoma (six cases, forming 92% of all the sacral lesions) Of a secondary sacral lesions, nine cases of breast carcinoma were found, forming the most common group The recurrence rate was 233% Conclusions Chordoma was the most common primary sacral tumour, but found no incidence of giant cell tumour which has been previously reported as the second most common primary sacral tumour We believe the posterior approach for resection of the tumour is sufficient in most instances and lumbopelvic instability must be prevented by reconstructive procedures

Surgical treatment of malignant tumours of the sacrum

Craniospinal giant cell tumors: clinicoradiological analysis in a series of 11 cases

STUDY DESIGN Descriptive. OBJECTIVE To outline a novel multimodality approach for a difficult surgical resection of a giant cell tumor in the cephalad portion of the sacrum. SUMMARY OF BACKGROUND DATA Giant cell tumors of the sacrum are rare primary bone tumors. Recent reports have demonstrated diminished giant cell tumor recurrence with cryosurgery by using a "direct pour" technique with liquid nitrogen. Although successful in decreasing tumor recurrence, this technique is accompanied by a 4%-8% rate of skin necrosis and high rates of pathologic fracture. The authors describe resection and a novel, controlled method of argon-based cryotherapy (followed by a unique pelvic reconstruction) for a large, difficult giant cell tumor of the sacrum. METHODS A 29-year-old woman presented with complaints of right foot drop and decreased sensation of the right buttock, posterior thigh, posterior calf, and lateral aspect of the right foot. Radiographic evaluation revealed a mass in the right sacrum; histologic examination of CT-guided biopsy revealed a giant cell tumor. A combined anterior abdominal and posterior sacral approach was performed, the tumor was resected, and the margin of the cavity was treated with controlled argon-based cryotherapy. The combination of thermocouples, electromyographic monitoring, and rapid freeze-thaw cycles allowed a controlled ablation of the tumor margin while ensuring that surrounding structures, such as the rectal wall, sacral nerves, and gluteal muscles, were not damaged. Posterior spinal fusion L4 to sacrum, posterior spinal instrumentation L4 to pelvis, and allograft reconstruction of the right sacrum were performed. RESULTS The patient recovered well without skin necrosis or pathologic fracture. Urinary and fecal continence were preserved. At the 20-month follow-up the patient has no evidence of local tumor recurrence and is fully ambulatory without a brace or narcotic medication. CONCLUSION A novel multimodality approach, consisting of resection, controlled cryosurgery, and a unique lumbopelvic reconstruction, was safe and successful in managing a challenging proximal sacral giant cell tumor. Twenty months after surgery the patient has excellent bowel and bladder control, no tumor recurrence, and functional ambulation without a brace or pain.

Multimodality management of a giant cell tumor arising in the proximal sacrum: case report.

A giant-cell tumor of the sacrum is rare, and poses significant therapeutic and surgical difficulties largely because of its location. Patients usually present with pain in the lower back radiating to one or both lower limbs, with or without neurological deficit. The index case presented with difficulty in defecation, in addition to pain in both lower limbs for 6 mo. The patient was seen to have a rectal mass, and a per-rectal fine-needle-aspiration was performed. The smears showed a cellular aspirate composed of a large number of osteoclastic giant cells, admixed intimately with clusters and a scattered population of mononuclear cells. Mitotic figures were not observed. Although the differential diagnosis of osteoclastic giant cell-containing lesions is broad, the presence of strong cohesiveness between the mononucleated cells and giant cells in cohesive clusters is a very helpful diagnostic feature, and was a prominent finding in the present case.

Fine-needle aspiration cytologic diagnosis of giant-cell tumor of the sacrum presenting as a rectal mass: A case report.

The diagnosis of sacral lesions

We have presented a case of a patient with sacral giant-cell tumor and reviewed the literature. This is a rare disease originating from the mesenchyme of bone marrow which grows out through the cortex. It is essentially benign but behaves like a malignant tumor in view of frequent recurrences and a high incidence of malignant transformation. Cure can be achieved only by complete extirpation of tumor along with surrounding soft tissue.

Giant-cell tumor of the sacrum

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Giant-cell tumor of the sacrum