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      Cordoma Sacrococcígeo gigante: relato de caso Translated title: Giant Sacrococcygeal chordoma: case report

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          Abstract

          Cordoma sacrococcígeo é uma neoplasia maligna rara que se origina de remanescentes da notocorda. A localização crítica, comportamento localmente agressivo, reconhecida resistência à radioterapia, significativa morbimortalidade cirúrgica e elevada taxa de recidiva tornam seu tratamento um desafio. Descrevemos um caso de cordoma sacrococcígeo gigante.

          Translated abstract

          Sacrococcygeal chordoma is a rare malignant neoplasm arised from the remmants of the notochord. The critical localization, locally aggressive behavior, well-known resistance to radiation therapy, meaningful surgical morbimortality and increased recurrence rate become its treatment a challenge. We describe a case of a giant unresectable sacrococcygeal chordoma.

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          Most cited references20

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          Cephalad sacral resection with a combined extended ilioinguinal and posterior approach.

          A combined anterior and posterior approach was used for the resection of a large tumor (a chordoma, a giant-cell tumor, an osteosarcoma, or a chondrosarcoma) of the cephalad part of the sacrum in twelve patients. The anterior aspect of the sacrum was exposed through an extended ilioinguinal approach, and the posterior aspect, through a midline approach. This widely extensile procedure permitted simultaneous visualization of the anterior, posterior, and circumferential aspects of the sacrum at the time of the osteotomy and facilitated the resection of these difficult lesions. At the time of follow-up (average duration for the eleven surviving patients, thirty-seven months; median, thirty months; range, twenty to sixty-nine months), ten patients were able to walk independently (four with the use of a cane) and one was confined to a wheelchair. One patient had died immediately postoperatively. The results of the present study indicate that a combined extended ilioinguinal and posterior approach can be used effectively for the wide resection of a tumor arising in the cephalad part of the sacrum.
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            Intradural chordoma without bone involvement. Case report and review of the literature.

            Chordomas are most commonly of extradural origin and associated with bone destruction. The authors describe a rare case of an intradural chordoma. To the best of their knowledge, this is the first case in which multiple lesions were found intradurally without bone involvement; the lesions were disseminated through the thoracolumbosacral spinal cord and extended into the paraspinal muscles, and metastatic lesions in the cervical cord were also present.
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              Abdominosacral resection for malignant tumors of the sacrum.

              Malignant sacral tumors present unique problems because of their location deep in the pelvis, their juxtaposition to the ureters, rectum, and iliac vessels, and the need to preserve spinal stability and sacral nerve function after resection. The simultaneous abdominosacral resection circumvents many of these problems since it provides good exposure of the intraabdominal structures, allows precise selection of the level of sacral resection, and avoids damage to the sacral nerve roots. Tolerable control of bladder and bowel functions is possible by preservation of the S1 nerve roots, and spinal stability can be maintained with preservation of the body of the S1 vertebra. Because malignant tumors of the sacrum have a high propensity for local recurrence, we believe that the exposure afforded by the sacroabdominal approach provides an opportunity to obtain a wide margin of resection during initial resection of these tumors.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbc
                Revista Brasileira de Coloproctologia
                Rev bras. colo-proctol.
                Cidade Editora Científica Ltda (Rio de Janeiro )
                0101-9880
                June 2009
                : 29
                : 2
                : 233-236
                Article
                S0101-98802009000200011
                10.1590/S0101-98802009000200011
                cd8c85cd-688d-49d8-87b5-015d147d9ceb

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0101-9880&lng=en
                Categories
                GASTROENTEROLOGY & HEPATOLOGY
                SURGERY

                Gastroenterology & Hepatology,Surgery
                Chordoma,Sacrococcygeal region,Radiotherapy,Neoplasms,Diagnosis,Cordoma,Região sacrococcígea,Radioterapia,Neoplasias,Diagnóstico

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