Presentation
Recurrent persistent low back pain and coccydynia for a long time.
Patient Data
Illdefined erosive lesion of the sacrum.
A large destructive mass is seen infiltrating the lower aspect of the sacrum and adjacent part of the coccyx. It has a large presacral soft tissue component that displaces the rectum anteriorly. Luminal contrast fills the rectum well. The median and two lateral sacral arteries which constitute the main arterial supply of the tumor can be identified.
A large destructive midline soft tissue mass is seen infiltrating the lower aspect of the sacrum and adjacent part of the coccyx. It has a large presacral soft tissue component that displaces the rectum anteriorly.
Electrom microscopy shows giant cells with few stroma.
Case Discussion
The patient was complaining from low back pain and coccydynia long time ago. Initially, he was investigated by plain XR of the lumbosacral spine and coccyx. It suggested an erosive lesion of the sacrum. After that, the patient underwent pre and post contrast study of the lumbosacral spine and coccyx. It showed a definite sacrococcygeal destructive mass with a large soft tissue component that displaces the rectum. Lastly, CT is requested with IV and transrectal contrast to assess the relation of the large associated presacral mass with the pelvic structures especially the rectum. We can also trace the median and two lateral sacral arteries, the main arterial supply of the mass to ensure good hemostasis during surgical intervention. After resection and histopathological examination, it is proved to be a giant cell tumor of the sacrum.
The case is courtesy of Dr/ Nabeeh Bajunaid, Neurosurgeon Consultant, RCMC
Thanks to Dr / Mamdouh Radwan for path. Photo.
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