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The patient came to the
clinic 08-March-2008 complaining right sciatica
for two months with numbness right S1 territory.
The pain increases during night. |
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MRI
cervical spine done 26-February-2008 showing
huge sacral mass in the right side with
destruction of bone at the level of S2-3-4 right
side. |
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On examination: the patient
is dragging his right leg and has scoliotic stance.
There is weak dorsi and planterflexion right
foot. SLRS was 70 degrees in the right with
pain. |
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Bone scan was confirming the
absence of MTS. |
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Midline incision over the
sacrum and the using drilling the right S2 and
S3 were identified. The mass was pushing them
medially and it was grayish violet in color and
friable in consistency and highly vascular. It
was possible to remove it radically and the
periosteum of the sacrum was not involved. The
bone cavity was filled with healthy bone
harvested from the surround and muscles were
used to fulfill the cavity. An external drain
was inserted with ready-vac drain and negative
pressure. |
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Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of the right foot. |
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The final histologic studies
confirmed the presence of pasmacytoma of
extramedullary type and Bence-Jones proteins
were negative in daily urine collection with ESR
60 mm/h. |
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The patient was advised to
undergo hematologic workup and to undergo
radiotherapy locally with 40-45 Kg over 6 weeks. |
