Vercio Robert C, Elsissy Joseph G, Williams Nadine L, Zuckerman Lee M
Arrowhead Orthopaedics, 1801Orange Tree Lane, Redlands, CA 92374, USA.
Department of Orthopaedic Surgery, Loma Linda University Health, 11406 Loma Linda Drive, Suite 226, Loma Linda, CA 92354, USA.
J Orthop Case Rep. 2020 Aug-Sep;10(5):53-56. doi: 10.13107/jocr.2020.v10.i05.1836.
Secondary chondrosarcoma is a rare entity arising from a pre-existing cartilaginous lesion. Transformation of an osteochondroma to a chondrosarcoma occurs in <1% of cases. Sciatica is a common problem that can cause significant pain, weakness, and numbness.
A 36-year-old male presented to the Orthopedic Oncology Service after being treated for sciatica for 3 years. Magnetic resonance imaging of the lumbar spine demonstrated degenerative disc disease with mild inferior foraminal narrowing at L5-S1. He had undergone multiple epidural steroid injections without improvement in his symptoms. A chondrosarcoma encasing the peroneal nerve was found arising from an underlying osteochondroma in the proximal fibula. The patient underwent resection of the tumor which included resection of the peroneal nerve. Five years after resection, the patient is disease free and uses an ankle-foot orthosis for ambulation.
This case demonstrates the importance of evaluating a patient with peripheral nerve symptoms for a lesion within the involved extremity along the entire length of the nerve. Extraspinal lesions can compress peripheral nerves and cause radicular symptoms. Timely treatment is important to prevent malignant transformation or worsening of the tumor as well as to provide better functional outcome.
继发性软骨肉瘤是一种罕见的由先前存在的软骨病变发展而来的疾病。骨软骨瘤转变为软骨肉瘤的情况发生率低于1%。坐骨神经痛是一个常见问题，可导致严重疼痛、无力和麻木。
一名36岁男性在接受了3年的坐骨神经痛治疗后就诊于骨肿瘤科。腰椎磁共振成像显示椎间盘退变，L5 - S1水平轻度椎间孔狭窄。他接受了多次硬膜外类固醇注射，但症状并无改善。发现腓骨近端的一个骨软骨瘤发生了软骨肉瘤，肿瘤包绕腓总神经。患者接受了肿瘤切除术，包括切除腓总神经。切除术后5年，患者无疾病复发，行走时使用踝足矫形器。
本病例表明，对于有周围神经症状的患者，评估受累肢体沿神经全长的病变非常重要。脊柱外病变可压迫周围神经并引起神经根症状。及时治疗对于预防肿瘤恶变或恶化以及获得更好的功能结局很重要。
