Bone Neoplasms ; diagnosis ; surgery ; Humans ; Pelvic Bones

A chondrolipoma is an extremely rare form of a benign mesenchymal tumor containing mature cartilage and fatty tissue. Chondrolipomas may be found in almost any part of the body, particularly in the connective tissue of the breast, head and neck area, as well as in the skeletal muscle. However, to the best of our knowledge, chondrolipomas located in the pelvic cavity have not been reported. In this case report, we describe a case of a chondrolipoma in the pelvis, and show that it has its own characteristic imaging findings, which included the composition of fatty tissue and calcification in most parts, as well as some focal areas of chondroid tissue based on the CT and MR findings.
Chondroma/*diagnosis ; Humans ; Lipoma/*diagnosis ; Male ; Mesenchymoma/*diagnosis ; Middle Aged ; Pelvic Neoplasms/*diagnosis ; Tomography, X-Ray Computed

Lymphangioleiomyomatosis (LAM) is a rare disease usually occurring in young women of child-bearing age. It is characterized by a distinctive proliferation of lymphatic smooth muscle cells, especially occurring in the pulmonary parenchyme. The majority of primary LAM occurs in the lung, but there are a few reports of extrapulmonary cases. We report a case of a 21-yr-old female who first complained of low abdominal pain and was referred from a local clinic with the impression of an ovarian cyst. Gynecologic ultrasonography revealed a large posterior pelvic mass with an irregular echogenicity measuring 9.7x4.2 cm in size. Pelviscopy showed a large, thin walled, partly cystic, pelvic mass. The mass was partly removed. Microscopically, the mass was characterized by a haphazard proliferation of smooth muscle cells arranged in fascicular, trabecular, and papillary patterns around a ramifying network of endothelium-lined spaces. The cells were plump or epithelioid with abundant eosinophilic cytoplasm and showed a positive reaction for both alpha-smooth muscle actin and HMB-45 antigen. Surgical and pathological findings were consistent with pelvic retroperitoneal LAM. Despite the numerous treatment attempts, the patient suffered from intractable chylous ascites and developed pulmonary LAM and died due to severe respiratory distress.
Abdominal Pain/diagnosis/etiology ; Adult ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/complications/*diagnosis ; Lymphangioleiomyomatosis/complications/*diagnosis ; Pelvic Neoplasms/complications/*diagnosis ; Rare Diseases/complications/diagnosis

A case of postradiation sarcoma, found in a 52-year-old woman, who underwent a total hystrectomy under the diagnosis of cervical cancer 12 years ago, followed by radiation therapy. The tumor invasion was extensive involving the left innominate bon and upper end of the left femur including the head and neck. Histopathological findings revealed sarcomatous change with atypical osteoid formation and stromal proliferation. The case has been followed for 2 years since February 1974 and survives today.
Diagnosis ; Female ; Femur ; Head ; Humans ; Middle Aged ; Neck ; Osteosarcoma ; Pelvic Bones ; Sarcoma ; Uterine Cervical Neoplasms

A 36-year old woman was admitted for menolipsis for 71 days and vaginal bleeding for 38 days and aggravation of vaginal bleeding with abdominal distension for 10 days. Gynecological examination revealed marked hysterauxesis without tenderness with a high HCG level. CT examination led to the misdiagnosis of trophoblastic tumor with lymph node metastasis of the left iliac vessels. The patient underwent subsequent laparotomy, and a huge pelvic hematoma with maximum diameter of 20 cm was found, for which left salpingectomy was performed. Pathologic examination of the surgical specimen supported the diagnosis of old tubal pregnancy. This case represents a rare clinical entity of old ectopic pregnancy manifested as a painless huge pelvic mass that can be easily misdiagnosed based on radiographical findings only.
Adult ; Diagnostic Errors ; Female ; Humans ; Pelvic Neoplasms ; diagnosis ; etiology ; Pregnancy ; Pregnancy Complications ; diagnosis ; Pregnancy, Ectopic ; diagnosis ; Ultrasonography

Cancer of the vulva accounts for approximately 0.5% of all gynecologic malignancies. At diagnosis, one-third of these cases is detected in an advanced stage (FIGO stages III, IV), and local extension of primary vulvar cancer may involve adjacent midline structures such as the clitoris, urethra, vagina, and anus. Initial surgical therapy of such locally advanced primary cancers may compromise the functional integrity of midline structures, necessitating ultraradical surgery including pelvic exenteration. In view of the relatively elderly age of the patients and the morbidity of this ultraradical dissection, concomitant chemoradiation therapy - that the efficacy had been proven in head and neck cancer, anal cancer has approached for patients with locally advanced vulvar cancer. We experienced a case of stage III vulvar cancer patient, who underwent concomitant chemoradiation therapy with 5-fluorouracil(FU) and cisplatin and who showed complete response. So, we report this case with brief review of the literatures.
Aged ; Anal Canal ; Anus Neoplasms ; Cisplatin ; Clitoris ; Diagnosis ; Female ; Head and Neck Neoplasms ; Humans ; Pelvic Exenteration ; Urethra ; Vagina ; Vulvar Neoplasms*

Retroperitoneal fibrosis was first described in 1905 by Albarran, a French urologist, who performed ureterolysis for ureteral compression produced by the disease. However, this disease became an established clinical entity by Ormond's account in the English literature in 1948. Pericystitis plastica has been used the define an extremely rare type of Idiopathic retroperitoneal fibrosis (IRF) constricting the bladder. In this study, we discussed the recovery of 29-year-old woman with pericystitis plastica who was misdiagnosed as pelvic malignancy or a chronic/subacut pelvic inflammation at the first evaluation.
Adult ; Cystitis/*radiography ; Diagnosis, Differential ; Female ; Human ; Pelvic Inflammatory Disease/*radiography ; Pelvic Neoplasms/*radiography ; Retroperitoneal Fibrosis/*radiography ; *Tomography, X-Ray Computed

There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as 8.2~20% after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.
Diagnosis, Differential ; Diagnostic Errors ; Fractures, Stress ; Head ; Humans ; Incidence ; Necrosis ; Neoplasm Metastasis ; Osteonecrosis ; Osteoradionecrosis ; Pelvic Bones ; Pelvic Pain ; Sarcoma ; Stress, Physiological ; Uterine Cervical Neoplasms

PURPOSE: It is generally accepted that bony reconstruction after type III (pubic) internal pelvectomy is not necessary. However, technical problems in type III resection, functional outcome according to the extent of resection, and the usefulness of synthetic material to decrease the risk of hernia has not been well addressed. MATERIALS AND METHODS: Fifteen patients who underwent type III internal pelvectomy were extracted and the pathologic diagnosis, Enneking's stage, location of tumor and size, operation time, amount of transfusion, surgical margin, local recurrence, distant metastasis, and functional outcomes were analyzed according to the extent of resection. RESULTS: Pathologic diagnosis was chondrosarcoma in 9, Ewing's sarcoma in 3, metastatic carcinoma in 2, and osteosarcoma in 1 patient. There were 4 patients with local recurrence and one with concomitant lung metastasis. Average Musculoskeletal Tumor Society functional score was 26.7. According to the extent of resection, functional score of 7 cases with unilateral both rami (6) or ischium (1) resection was 26, 4 cases with unilateral both rami and partial contralateral pubic ramus resection was 25, and 4 cases with unilateral both rami including ischium was 24. Two patients had tumor related complication. One patient with a huge intrapelvic tumor aroused at the symphysis pubis showed urethral invasion at presentation, therefore, urethral resection and permanent suprapubic cystostomy was inevitable. The other patient with bilateral pubic ramus involvement by tumor showed caudal displacement of the uterus after pregnancy (4 years after primary resection). She underwent Caesearian section for delivery. CONCLUSION: Regardless of the extent of pubic bone resection, functional outcome was similar. The risk of abdominal or pelvic organ hernia was minimal even without the use of artificial material for soft tissue reconstruction; however, when the extent of resection crosses the symphysis pubis, selective application of an additional procedure to reinforce the pelvic floor may be considered.
Chondrosarcoma ; Cystostomy ; Diagnosis ; Hemipelvectomy* ; Hernia ; Humans ; Ischium ; Lung ; Neoplasm Metastasis ; Osteosarcoma ; Pelvic Floor ; Pelvic Neoplasms ; Pelvis* ; Pregnancy ; Pubic Bone ; Recurrence ; Sarcoma, Ewing ; Treatment Outcome ; Uterus

Sarcomatous transformation in chordoma (dedifferentiated chordoma) is a very rare condition and has been emphasized as a distinct entity because of its more aggressive clinical course. Here we describe a case of dedifferentiated chordoma (chordoma associated with malignant fibrous histiocytoma) arising from the sacrococcygeal region of a 55-year-old woman. The results of immunohistochemical stain in the chordoma area were strong positive for cytokeratin, epithelial membrane antigen and S-100 protein. The spindle and giant cells in the transitional areas of chordoma and malignant fibrous histiocytoma were positive for cytokeratin and epithelial membrane antigen in addition to vimentin and alpha-1-antichymotrypsin. The spindle and giant cells in the central area of malignant fibrous histiocytoma were negative for cytokeratin and epithelial membrane antigen, but positive for vimentin and alpha-1-antichymotrypsin. This supports the pathogenesis of sarcomatous transformation from chordoma.
Case Report ; Chordoma/diagnosis/*pathology ; Female ; Histiocytoma, Fibrous/diagnosis/*pathology ; Human ; Immunohistochemistry ; Middle Age ; Neoplasms, Multiple Primary/*pathology ; Pelvic Neoplasms/diagnosis/*pathology