Abstract
Background: Paget’s disease of the sacrum is rare. A monostotic lesion in the sacrum is reported. A case with an unusual presentation is discussed.
Introduction: A 53 years old man was referred to our unit with a 5–6 months history of abdomen discomfort and tenesmus.
He had a history of low back pain and was noted to have an area of increasing numbness over the left buttock. A prominence of the left sacroiliac region was noticed and on rectal examination a bony hard mass was palpable posteriorly.
A plain x-ray of the pelvis showed a gross expansion and enlargement of the sacrum with lucent area and widespread new bone formation.
Biochemical test revealed a raised alkaline phosphatase level.
A MRI scan reported a large tumour arising from the sacrum. with a differential of chordoma, paget’s sarcoma or an osteochondroma.
In addition a bone scan reported raised uptake in the pelvis.
An open incision biopsy was performed and the histology report was consistent with appearance of paget’s disease with no evidence of sarcoma.
Interestingly the patient symptoms improved after the biopsy. He was commenced on biphosphonates. A surveillance scan is to be performed in due course.
Conclusion: This case was unusual in terms of clinical presentation and location.
Furthermore even the most sophisticated imaging modalities may fail to establish the diagnosis and biopsy is then necessary. This should always be performed in specialized centers, in order to minimise complications.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN
