Case report: A 76 year old man with a four month history of rectorrhagia. Succeeding colonoscopy, rectal polypectomy was performed and histologic sections showed moderately differentiated high grade Adenocarcinoma. Subsequently in thoracoabdominal CT scan, a rectal lesion of 25 mm of length and another osseous lesion in S3, S4 and S5 region were diagnosed. A simultaneous surgery was done to resect the two lesions. Firstly, laparoscopic abdominoperineal amputation was performed before a posterior approach complete dissection of rectum from sacral region. Finally en bloc resection of sacrococcigeal region from S3 was performed. Histological studies were reviewed; the rectal lesion had cancerous bone cells formed by mucine nidus separated by fibrous tracts while in the sacral lesion physaliferous cells characteristic of chordoma were seen. A postoperative quimiotherapy and rectal radiotherapy were administered. Patient was followed up after treatment and only presented postoperative lumbar pain without neurologic deficits. Both magnetic resonance imaging and computerized tomography are cancer-free till date.

Discussion: This is a rare and interesting case of a patient diagnosed of 2 different tumors and treated simultaneously in the same surgical act. Including this case there are very few published cases of sacral chordoma associated with rectal neoplasm.