A Case Report of Huge Sacrum Undifferentiated Pleomorphic Sarcoma Treated with Two Separate Surgeries of Decompression a
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SURGERY
A Case Report of Huge Sacrum Undifferentiated Pleomorphic Sarcoma Treated with Two Separate Surgeries of Decompression and Stabilization Takeru Tsujimoto 1,2
&
Akira Iwata 3 & Tomomichi Kajino 1 & Yuichiro Hisada 1 & Norimasa Iwasaki 2
Accepted: 16 April 2020 / Published online: 5 May 2020 # Springer Nature Switzerland AG 2020
Abstract Primary sacrum undifferentiated pleomorphic sarcoma (UPS) is an extremely rare malignant lesion. Furthermore, sacral tumor is often an uncontrollable condition, because the first diagnosis is usually made at advanced stage in the patients of sacral tumors. In this article, we report a patient with sacrum UPS, who showed aggressive local recurrence and early progression of multiple metastases in major organs after palliative surgery, resulting in the occurrence of a U-shaped sacrum pathological fracture requiring stabilization from the fourth lumbar to the ilium. An 87-year-old male patient showed progressively worsening gait difficulty following bladder and bowel dysfunction because of the presence of a sacrum tumor. Palliative surgery (laminectomy) from the first to the third sacrum (S) and tumor excision were performed. His neurological dysfunction tended to recover after surgery. However, a U-shaped sacrum pathological fracture occurred. Percutaneous stabilization from the fourth lumbar to the ilium was performed during the second postoperative week. The findings were consistent with those of a UPS. The patient was able to transfer from the bed to a wheel chair. However, his general condition deteriorated, with multiple organ metastases, and he expired because of respiratory insufficiency caused by the UPS 2 months after stabilization. Sacral stabilization should be considered for patients with an invaded S1–2 pedicle because of the potential occurrence of S1 pedicle and sacrum fractures. Palliative treatment with only radiation and analgesic agents after needle biopsy might have been another option, considering the age and the biological nature of sacral UPS. Keywords Sacrum surgery . Undifferentiated pleomorphic sarcoma . Malignant fibrous histiocytoma . Spinal fracture
Introduction Undifferentiated pleomorphic sarcoma (UPS)—also referred to as malignant fibrous histiocytoma (MFH) according to the 2002 World Health Organization classification—is a rare and This article is part of the Topical Collection on Surgery * Takeru Tsujimoto [email protected] 1
Department of Orthopedic Surgery, Tonan Hospital, Sapporo, Hokkaido, Japan
2
Department of Orthopedic Surgery, Faculty of Medicine and Graduate of Medicine, Hokkaido University, N15W7, Sapporo, Hokkaido 060-8638, Japan
3
Department of Preventive and Therapeutic Research for Metastatic Bone Tumor, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
aggressive type of mesenchymal malignancy without a definitive origin of cells or specific recurrent genetic hallmarks [1, 2]. Primary sacrum UPS is extremely rare. Since its initial description in 1977, a specific
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