Chondrosarcoma of the Pelvis: An Intricate Encounter with the Urinary Bladder – Understanding the Rarity, Challenges, and Therapeutic Approaches

Abstract

Chondrosarcomas are the second-most common bone tumors and are known to occur in the pelvis. However, invasion into the urinary bladder is rare. We report a rare case of a primary chondrosarcoma invading the urinary bladder and the prostate requiring wide excision with cystoprostatectomy and reconstruction. On initial evaluation, a 48-year-old male patient presented with obstructive lower urinary tract symptoms and was suspected to have a prostate mass. He underwent a transurethral resection biopsy of the mass at an outside hospital which showed features of a chondrosarcoma. Further imaging by magnetic resonance imaging scan at our hospital showed a large 9.5 cm × 8.3 cm mass arising from the right pubic bone, infiltrating the urinary bladder and the prostate. Metastatic workup was negative. He underwent wide local excision of the mass, cystoprostatectomy, and diversion with an ileal conduit. The orthopedic team and plastic surgery teams were involved. Reconstruction was done using recon plates and prolene mesh placement to fill the empty cavity. He had a surgical site infection in the postoperative period which required multiple debridements and gracilis flap interposition. He recovered well and was discharged on the postoperative day 20. Final histopathology showed a well-differentiated chondrosarcoma with negative surgical margins. Primary chondrosarcomas are rare and infiltration into the urinary bladder is uncommon. Surgical treatment with negative margins is the mainstay of treatment. These tumors are resistant to chemotherapy and radiotherapy.