病例報告：巨大骨盆軟骨肉瘤以泌尿道症狀表現，類似攝護腺腫瘤
鄭偉權1、林柏君2、張殷綸1
1高雄長庚紀念醫院泌尿科, 2高雄長庚紀念醫院骨科
Case report: Huge pelvic chondrosarcoma mimicking prostate tumor with lower urinary tract symptoms
Wei Quen Tee1, Po-Chun Lin2, Yin-Lun Chang1
1Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
2Department of Orthopedics, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Case Report
We presented a case report about a huge pelvic mass with lower urinary tract symptoms initially being a suspicious prostate tumor. This 50-year-old man denied any systemic underlying disease. He suffered from difficult voiding with incomplete emptying for months. Associated symptoms included lower abdomen discomfort and constipation. Initially, he asked for help at a nearby clinic, where ultrasound report showed bilateral hydronephrosis was induced by a huge pelvic mass and suspected of prostate origin. Therefore, he was transferred to our hospital for further evaluation and management. Laboratory data showed mild anemia (11.7g/dL) and mild elevated Creatinine (Cr: 1.27 mg/dL). The abdominal CT showed a large soft tissue mass (15cm) with calcification and bilateral hydronephrosis, favoring enlarged prostate or prostate tumor. But the PSA (prostate-specific antigen) was within the normal limit. (2.65ng/mL) Due to the deteriorated renal function and a huge pelvic mass, we arranged bilateral percutaneous nephrostomy for obstructive uropathy and transrectal ultrasound-guided transperineal prostate biopsy. However, the prostate pathologic report showed negative for malignancy. Then, we arranged CT-guided biopsy of the pelvic mass and the pathologic report revealed chondrosarcoma, grade 1.
The surgery was combined with Orthopedics and Urology physician for the excision of the retroperitoneal tumor and bone tumor, including total pubic symphysis excision and partial left side medial acetabular. During the operation, the urethra, bladder, and bilateral ureter were all intact without ruptured or tumor invasion. The patient recovered smoothly and he could also walk by self without an assistive device. Besides, the patient’s bilateral hydronephrosis were all resolved and bilateral PCN were all removed. Then he was discharged after post-operation 2 weeks and followed up at Rehabilitation, Orthopedics, and Urology outpatient departments.
Discussion
Chondrosarcoma is a malignant skeletal tumor with cartilaginous differentiation. The pelvis is one of the most common locations of chondrosarcoma. Chondrosarcoma of the pelvic girdle remains asymptomatic in the long term and may thus be large at the time of diagnosis. Surgical resection remains the mainstay of treatment for chondrosarcomas, particularly of the pelvis, due to their relative resistance to radiation and chemotherapy. According to the literature, aggressive surgical resection of pelvic chondrosarcoma results in the long-term survival of the majority of patients.
Back to our case, this patient had lower urinary tract symptoms due to a huge pelvis mass lesion with extravesical compression that caused bilateral hydronephrosis. Although the location of the tumor below the bladder favor prostate origin, it is crucial to different diagnoses of prostate tumors and pelvic mass tumors.