21-year-old son of a policeman was diagnosed with an exceptionally large chondrosarcoma, a malignant bone tumour, arising from lower ulna, the forearm bone. In such large bone cancer, with involvement of surrounding vitals structures, limb may have to be amputated. However, doctors at Indian Spinal Injuries Centre performed a delicate surgery in removing the tumour, eliminating cancer risk and ensuring that the young college student can lead a normal life.
New Delhi, 8th August, 2018: In a rare case, of exceptionally large chondrosarcoma of ulna a 21-year-old Vijay (name changed) was operated at the Delhi-based Indian Spinal Injuries Centre. The swelling, which was nothing more than a small bump a year back, started growing rapidly restricting the movement of the right wrist and hand.
In last 6 months the tumour grew to become almost the size of a cricket ball, badly restricting the use of dependant hand, while Vijay’s father ran from pillar to post for his son’s treatment.
“Before Vijay came to us with a badly swollen limb, he had visited two different tertiary care hospitals in Delhi; however, due to various factors he could not be treated there. He was extensively investigated, having undergone blood tests, X-ray, MRI, CT scan and bone scans. He also had undergone biopsy from the swelling, which confirmed the cause as a uncommon bone tumour, chondrosarcoma, of the forearm bone. He presented to us with a large swelling near the wrist, compressing the surrounding nerves, veins and muscles. It had even involved the overlying skin. The forearm skin was stretched and engorged veins could be seen from a distance. The circumference of the wrist was 12 inches (30 cms). Such cases are highly complicated and adequate treatment requires very careful excision, without opening the tumour. Most of such cases end up with amputation,” says Prof Sudhir Kapoor HOD-Orthopaedics & Chief of Ortho Oncology, ISIC.
A radical procedure to remove the malignant bone tumour was initiated. Joining Prof Kapoor for the surgery was Dr Charanjeev Sobti, Plastic Surgeon, ISIC, because of extensive adherence of the tumour to the skin and resultant expected skin loss.
“Vijay underwent a very delicate and careful surgical excision of the tumour, wherein, without interfering with the tumour, wide incisions were made away from the tumour. The tumour which was arising from the ulna bone was carefully removed with involved skin over it. After excision of the tumour, there was a large soft tissue gap which needed a flap cover. Dr Charanjeev Sobti performed a successful flap cover surgery, which is an important technique in plastic and reconstructive surgery. The complete procedure lasted for 4 hours.”,
Much to his family’s relief, who feared that the young college student may lose his hand, Vijay responded well to the surgery and was discharged from the hospital within four days. He was on regular follow-up and the wounds healed well. The residual functional deficit of the hand is now scheduled to be minimized by tendon transfer. The patient is now cancer free and will be able to use his right hand for activities of daily living in future.
Bone tumours like Chondrosarcoma are rare type of cancers and present with increasing pain, swelling, and may even cause fracture as the bone weakens. Caused by mutations in genes, the cancer can grow rapidly if not identified and treated in time. In case they reach very large size, amputation may be the choice. Experienced ortho-oncho surgeon’s with the help of plastic surgeries may be able to excise the tumour.