JPMA. The Journal of the Pakistan Medical Association · 2026
En Bloc Resection of a Giant Sacrococcygeal Chordoma Presenting with Urinary Bladder Distension to the L4 Level: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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John Simon, Khaliq Tehniat, Brohi Ghulam, Khan Jahan, Masood Izhan, Ilyas Maryam
Аннотация
OBJECTIVES: To report a previously undescribed sacrococcygeal chordoma presentation with massive bladder distension to L4 from mechanical outlet obstruction, managed with nerve-sparing en bloc resection.
METHOD: A 54-year-old male presented on 10th June 2025 at JPMC, Karachi, with 5 months of progressive urinary retention and back pain. MRI, ultrasound KUB, and image-guided biopsy with immunohistochemistry were performed. Multidisciplinary planning preceded posterior en bloc sacral resection with S2-S3 osteotomy under continuous neuromonitoring, preserving bilateral S1-S2 nerve roots. Written informed consent was obtained from the patient for publication of his case.
RESULTS: MRI showed a 6.3×8.0×7.1 cm S3-S5 mass with bladder distension to L4. Biopsy confirmed brachyurypositive chordoma. Blood loss was 1,800 mL; operative time 310 minutes. Histopathology confirmed R0 resection. Voiding was restored (residual <50 mL) with preserved bowel and limb function. One-year follow-up showed no recurrence.
CONCLUSIONS: This is the first reported sacrococcygeal chordoma with L4-level bladder distension from mechanical obstruction. Nerve-sparing en bloc R0 resection achieved full functional recovery, highlighting multidisciplinary planning and intraoperative neuromonitoring.
METHOD: A 54-year-old male presented on 10th June 2025 at JPMC, Karachi, with 5 months of progressive urinary retention and back pain. MRI, ultrasound KUB, and image-guided biopsy with immunohistochemistry were performed. Multidisciplinary planning preceded posterior en bloc sacral resection with S2-S3 osteotomy under continuous neuromonitoring, preserving bilateral S1-S2 nerve roots. Written informed consent was obtained from the patient for publication of his case.
RESULTS: MRI showed a 6.3×8.0×7.1 cm S3-S5 mass with bladder distension to L4. Biopsy confirmed brachyurypositive chordoma. Blood loss was 1,800 mL; operative time 310 minutes. Histopathology confirmed R0 resection. Voiding was restored (residual <50 mL) with preserved bowel and limb function. One-year follow-up showed no recurrence.
CONCLUSIONS: This is the first reported sacrococcygeal chordoma with L4-level bladder distension from mechanical obstruction. Nerve-sparing en bloc R0 resection achieved full functional recovery, highlighting multidisciplinary planning and intraoperative neuromonitoring.