The clinical presentation is consistent with a sacral chordoma. These tumors have a very high local recurrence rate, and therefore close oncologic surveillance is necessary.
Chordomas are notoriously slow growing tumors that often cause insidious symptoms of low back pain, constipation, and problems with sitting due to mass effect. Treatment is wide surgical resection, which is difficult due to the sacral location. Local recurrence is dependent on the surgical margins.
Hulen et al showed in a restrospective review (Level IV) that 12/16 patients had recurrent disease, 15/16 had some bladder/bowel issue post operatively, 3/16 were able to walk without an assistive device.
Guo et al reviewed the clinical outcomes (Level IV) of 50 patients who underwent sacrectomy for various reasons and found an association between S-3 nerve root resection and bowel and bladder issues.
Figure A show an AP pelvis with large lytic area in sacrum. Figure B is a biopsy specimen shows physaliferous cells that appear soap-like. Illustration V is a video which shows the surgical resection of a chordoma from the sacrum.
Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ. Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am. 2006 Jul;88(7):1532-9
PMID:16818979 (Link to Abstract)
Guo Y, Palmer JL, Shen L, Kaur G, Willey J, Zhang T, Bruera E, Wolinsky JP, Gokaslan ZL. Bowel and bladder continence, wound healing, and functional outcomes in patients who underwent sacrectomy. J Neurosurg Spine. 2005 Aug;3(2):106-10.
PMID:16370299 (Link to Abstract)