Enchondroma of the Iliac Crest as un–Unusual Case of Sciatica-like Symptoms: Case Report
Jacopo Conteduca*, Damiano Longo, Marco Filipponi Asl Lecce, Giuseppe Rollo Asl Lecce
Università Tor Vergata, Via Cracovia, 90, 00133 Roma RM, Italy
*Corresponding author
*Jacopo Conteduca, Università Tor Vergata, Via Cracovia, 90, 00133 Roma RM, Italy
DOI: 10.55920/JCRMHS.2024.07.001318
Figure 1: RMI image of the neoformation at the iliac crest.
Figure 2: CT scan image with dimensions
Surgical treatment: Under general anaesthesia, surgery was performed via the posterior approach with the patient in the prone position. The neoformation was in contact with the superior gluteal nerve and vascular structures (Fig 3).
Tumour resection was performed, and a section was sent for histological assessment. The vascular and neurological structures were pinched but intact after the lesion was removed.
After 3 days, the patient was discharged home. He was allowed to bear weight on the affected leg to his tolerance, and he gradually recovered the ability to perform daily activities.
The results of the histological examination revealed the appearance typical of an enchondroma (Fig. 4).
After 2 months, the patient had returned to normal daily activities, including driving. At the 16-month follow-up, the patient had resumed all activities. He has no strength deficit. He is neurologically intact throughout the lower extremities.
The range of motion of the right hip is limited compared with that of the contralateral hip, although that does not limit his daily or sporting activities.
A control CT scan revealed no signs of recurrence.
Figure 3: Intraoperative image of the the neoformation in contact with the superior gluteal nerve and vascu-lar structures.
Figure 4: The results of the histological examination revealed the appearance typical of an enchondroma
Sciatica can have both spinal and extraspinal sources and, in some cases, can have both origins simultaneously. Sciatica of lumbar spine origin is likely the most common cause of sciatica overall. However, the incidence of pseudosciatica and sciatica mimics could be far greater; we simply do not know how prevalent extraspinal sciatica is among the vast number of patients presenting with sciatica.
Possible extraspinal origins are piriformis syndrome, wallet neuritis, Lotus neuropathy, piriformis pyomyositis, and superior cluneal nerve disorders [1].
The schwannoma is the most common benign peripheral nerve sheath tumour of the sciatic nerve. In the case of sciatica-like pain with negative lumbar MRI for disc herniation, potential schwannomas along the pelvic and extrapelvic courses of the sciatic nerve (near the ischial tuberosity, gluteal region, posterior to the hip joint, and lower thigh) should be investigated.
In this case, the superior gluteal nerve was compressed by an enchondroma of the iliac crest.
Lesson learnt: Solitary enchondromas are frequently benign, often asymptomatic, cartilage tumours.
The presence of an enchondroma is not an absolute indication for surgical resection. An watch and wait approach is taken in cases in which there are no clinical manifestations. Surgery is indicated when there is compression of nerves, arteries or tendons or when there are functional and anatomical alterations. Therefore, in the present case, persistent symptoms were the formal indication for surgery. En bloc resection was performed (Fig. 3).
In the literature, the bone tumour of the pelvis causing sciatica that have been reported have been an ischial osteochondroma [2-5], an Ewing sarcoma of the pelvis [6], and a chondrosarcoma of the posterior iliac crest extending into the spinal canal [7].
This is the first English-language report that we know of describing an isolated enchondroma of the iliac crest causing sciatica like symptoms.
Consent: The patient represented in this study was informed that the data from the case would be deidentified and used in a medical publication.
Conflicts of Interest: The authors declare that there are no conflicts of interest related to this case report.