Clear Cell Chondrosarcoma of the Sacrum

The authors report on a rare case of clear cell chondrosarcoma arising from the sacrum in a 26-year-old man. The patient was treated with en block excision of the tumor and reconstruction with instrumentation and bone grafting. There was no local recurrence or metastasis of the tumor at a follow-up examination 30 months postoperatively. To our knowledge, this is the first reported case of clear cell chondrosarcoma occurring in the sacrum. SICOT Online Report E040 Accepted July 18th, 2003 2 Introduction Clear cell chondrosarcoma is a rare malignant bone tumor of a cartilaginous origin. It is characterized by large tumor cells with clear cytoplasm arranged in sheets [1,6-8,10,11]. It is more common in men than in women with a ratio of 2:1 [1]. The age range is wide; however, most patients are in the third or fourth decades of life [1]. Clear cell chondrosarcoma usually involves the epiphyseal ends of the long bones, particularly the proximal femur and humerus [1-3,6-11]. Lesions arising from flat bones are rare [1,5,8]. Case Report A 26-year-old man presented with a one-month history of increasing pain in his left buttock and calf. The patient could not stand or walk without assistance due to severe pain, and complained of urinary incontinence. He had no previous medical history of systemic illness. Physical examination revealed soft tissue swelling and tenderness over the left side in the posterior aspect of his sacrum, but no mass was palpated. Neurological examination showed a decreased sensation to touch in the left S1 to S5 dermatomes. The patient had three fifths of his normal strength in the left hamstrings muscles, and the extensors and flexors of his left ankle and great toe. The patellar tendon reflex was normal, but the Achilles tendon reflex was absent in the left leg. Rectal examination revealed extremely weak sphincter tone. Radiographs of the lumbar spine were normal, but radiographs of the pelvis revealed a large osteolytic lesion in the left sacrum (Fig. 1). SICOT Online Report E040 Accepted July 18th, 2003 3 Fig. 1 An anteroposterior radiograph of the pelvis shows a large osteolytic lesion in the left sacrum