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1/9. Metastatic meningioma in the sacrum: a case report.

    STUDY DESIGN: This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma. OBJECTIVES: To describe an unusual presentation of a metastatic meningioma in the sacrum. SUMMARY OF BACKGROUND DATA: Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma. methods: A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space. RESULTS: Surgical removal of the sacral tumor via an anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention. CONCLUSIONS: In this case of metastatic meningioma in the sacrum, which is the first such report to the authors' best knowledge, total excision of the tumor was successful.
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2/9. Local recurrence after S2-3 sacrectomy in sacral chordoma. Report of four cases.

    Excision is the treatment of choice in cases of sacral chordoma. Local recurrences, however, have often been observed even after total en bloc resection. The authors assessed outcomes in four cases of tumor recurrence in patients who underwent total en bloc S2-3 resection for sacral chordomas that were located below S-3. The primary recurrences were located at either side of the lateral portion of the remaining sacrum in all patients. In two patients in whom preoperative magnetic resonance imaging indicated no invasion of the tumor into surrounding soft tissues, recurrence in the resected end of the gluteus maximus or piriformis muscle was also observed. The authors therefore recommend that the S2-3 sacrectomy should be performed over an adequate margin, including a part of sacroiliac joints at the bilateral portions of the sacrum and soft tissues such as the gluteus maximus or piriformis muscle.
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keywords = sacrum
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3/9. Total sacrectomy and reconstruction for sacral tumors.

    STUDY DESIGN: Report of three patients in whom the lumbosacral junctions were successfully restored by spinal instrumentations after total sacrectomies. OBJECTIVES: To describe the surgical technique of the reconstruction of the continuity between the pelvic ring and spinal column by using a transpedicular and iliac screw system. SUMMARY OF BACKGROUND DATA: Although there have been case reports about reconstruction methods after total sacrectomy, biomechanical, and technical problems still remain unresolved. methods: Total sacrectomy was carried out in three cases: two with chordomas and one with a recurrent giant cell tumor. In the first case, reconstruction was achieved with Zielke transpedicular screw and rod system and a sacral rod. The other two patients were reconstructed using a transpedicular and iliac screw system and a sacral rod for bilateral fixation of the iliac wings. In the third patient, the vertical rods were connected to transverse rod with rod connectors. RESULTS: No instrumentation failure was observed, and the continuity between the pelvic wing and spinal column was established with the instrumentation and bone grafting. Although one patient died of metastatic chordoma, the lumbosacral junction was successfully reconstructed with the instrumentation. The other two patients could stand with double crutches 13 and 2 years after surgery, respectively. CONCLUSIONS: Total sacrectomy is a feasible operation for primary malignant tumors involving the entire sacrum. Reconstruction of the union between the lumbar spine and the ilia with spinal instrumentation achieves stabilization suitable for ambulation.
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ranking = 0.125
keywords = sacrum
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4/9. Low-grade endometrial stromal sarcoma recurring with multiple bone and lung metastases: report of a case.

    BACKGROUND: Approximately 50% of patients with low-grade endometrial stromal sarcoma (ESS) develop recurrent disease, mainly in lung or pelvis. Bone metastasis of low-grade ESS is an extremely rare phenomenon. CASE: A 63-year-old Japanese female developed multiple bone and lung metastases 18 years after initial treatment for low-grade ESS. Bone scintigram showed a high uptake area at thoracic spine (Th6, Th8-9 and Th12), right 9th rib, iliac bone, and sacrum. radiation therapy with Liniac of 4500cGy to the Th6 vertebra and Liniac of 4200cGy to sacrum was performed for the palliation of the pain. radiotherapy was effective for the pain relief, although the size of recurrent tumor was unchanged. CONCLUSION: This is the first detailed reported case of multiple bone recurrence in a patient with low-grade ESS. The long-term follow-up after treatment is recommended.
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5/9. Extraspinal ependymomas. Report of three cases.

    Spinal ependymomas may rarely arise from heterotopic ependymal cell clusters and thus occur in an extraspinal location. Presentation of three cases and a review of the literature reveal that these tumors have characteristic radiographic and clinical features. They occur mainly in patients in the third decade of life, and present either in the soft tissue posterior to the sacrum or in the pelvis. In the case of posterior tumors, the patient exhibits a mass which is usually mistaken for a pilonidal cyst. patients whose tumor is pelvic in location present with sphincter disturbances or dysfunction of the sacral nerve roots. Conventional and computerized tomographic studies will reveal erosion of the sacrum. myelography will demonstrate an extradural mass indenting the thecal sac from below. The protein in the cerebrospinal fluid will be normal. A combined posterior and anterior approach with the goal of complete tumor removal is the procedure of choice. If this is not feasible, then radiation therapy should be employed. Because of the increased incidence of systemic metastases, the average postoperative survival is approximately 10 years.
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ranking = 0.25
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6/9. Computed tomography in recurrent or metastatic colon cancer: relation to rising serum carcinoembryonic antigen.

    Twenty patients with Stage Duke B or C adenocarcinoma of the colon or rectum who have undergone radical surgical resection and demonstrated rising serum carcinoembryonic antigen (CEA) during follow-up are the subject of this study. In all cases, while there was a continuous and progressive elevation of serum CEA, CT examination of the abdomen and pelvis was performed. Abnormal CT findings were demonstrated in 19 patients and included pelvic mass, liver metastases, and periaortic or mesenteric lymphadenopathy. There was one normal CT scan in a patient who subsequently developed metastases in the sacrum. Based on the observations in these patients, it is concluded that in routine follow-up after colorectal surgery, rising serum CEA should be considered a warning sign and warrants additional investigation by CT.
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ranking = 0.125
keywords = sacrum
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7/9. Giant condyloma acuminatum (buschke-lowenstein tumor) involving a pilonidal sinus: a case report and review of the literature.

    Giant condyloma acuminatum or buschke-lowenstein tumor has been reported to involve many areas about the perineum. The majority of previous documentations have implicated the coronal sulcus, prepuce, and fossa navicularis of the penis as the most likely foci to support growth. Authors have contributed multiple cases of perianal and rectal involvement as well as rare reports of inguinal, bladder, and endocervix-low uterine segment tumors. A case of giant condyloma acuminatum involving a chronic pilonidal sinus overlying the sacrum is described. Wide surgical extirpation was found to be a curative means of management.
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ranking = 0.125
keywords = sacrum
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8/9. Giant-cell tumor of the sacrum.

    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.
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9/9. Early local recurrence of rectal cancer showing extremely rapid growth after curative surgery: report of a case.

    We report herein the case of a 59-year-old woman who developed a local recurrence of rectal cancer which showed extremely rapid growth. The patient had undergone a curative low anterior resection with total mesoexcision, and was discharged on postoperative day 25 after an uneventful recovery. However, 2 months after the operation, she developed bleeding from the rectum during defecation, the quantity of which gradually increased. A colonoscopy performed during the fifth postoperative month revealed a circular tumor at the suture line. The tumor was unresectable because it had firmly invaded not only the sacrum, but also the right ureter. Despite the administration of 5-fluorouracil and leucovorin, the patient died of cancer 18 months after her initial surgery. Considering that local recurrence of rectal cancer does not usually occur within 1 year after surgery, this case is unusual because the local recurrence developed very early and showed extremely rapid growth, occupying the entire lumen of the rectum by the time it was detected by colonoscopy during the fifth postoperative month.
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ranking = 0.125
keywords = sacrum
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