The osseous and angiographic features of vertebral chordomas

Giant vertebral notochordal rest: a lesion distinct from chordoma: discussion of an evolving concept

A 14-year-old boy with severe back pain for several years is described. Roentgenograms, bone scans, and computed tomographic scans of the spine were normal, but magnetic resonance imaging studies showed a lumbar vertebral body lesion, confined to the bone, with low T1- and high T2-weighted signal intensities. Histologically, the lesion consisted of sheet-like notochordal-type tissue, containing physaliphorous cells but lacking the usual features of chordoma. A diagnosis of giant notochordal rest was made. A review of prior possible examples of this recently described and controversial entity is made with a discussion of its embryologic foundations and distinction from chordoma.

Cervical chordoma with vertebral artery encasement mimicking neurofibroma: MRI findings

A case of cervical chordoma in a 36-year-old white man with hypoesthesia in the neck and right shoulder, neck pain, and restricted neck mobility is presented. Plain radiographs of the cervical spine showed radiolucency of the body of C2 on the right side and enlargement of the right intervertebral foramen at C2-C3 level. Tumor encasement of the vertebral artery was demonstrated by MR imaging and confirmed by conventional arteriography. This proved to be particularly important for preoperative assessment.

An unusual cervical chordoma: CT and MRI

We report CT and MRI findings of an unusual cervical chordoma. CT showed only minimal bony destruction with a lobulated prevertebral mass. Sagittal MRI, however, clearly demonstrated a lesion involving the body of C2 extending prevertebrally and into the spinal canal.

Low cervical chordoma: case report

We report a case of a 32-year old woman with radicular symptoms associated with a low cervical chordoma. According to our knowledge this is the 10th case of low cervical chordoma reported in the literature.

A lumbar chordoma treated with a wide resection

Chordomas are rare skeletal tumors arising from the embryonic remains of the notochord [18, 30]. These tumors tend to appear in midline regions, particularly at the upper and lower extremities of the spinal column. We report the case of a 74-year-old woman with radicular compression associated with an L3 chordoma that was treated with a wide resection.

Transarticular invasion of joints by bone tumors: hypothesis

Eight bone tumors with associated transarticular invasion of the sacroiliac joints are described. All invaded the true synovial joint and spread to the opposing bone. One tumor was benign, and the other seven were malignant. Five of the seven were primary and two were metastatic cancer. One, a myeloma, invaded the disc spaces between the fourth and fifth lumbar vertebrae and the fifth lumbar vertebra and sacrum as well as the sacroiliac joint. The right facet joints of the two vertebrae were also invaded. After a thorough search of the literature, we find that the sacroiliac joint is the most common joint to be invaded by tumors. This is followed by the vertebral disc spaces and, last, the facet joints. Apart from these joints, we were unable to find any radiographic documentation of other joints being transarticularly invaded by tumors. We noted that there is a direct relation between transarticular tumor spread and joints that lack mobility and that certain tumors, benign and malignant, tend to invade these joints.

Primary sacral bone tumours in children (report of 16 cases with a short literature review)

16 cases of primary sacral bone tumours in children are reported. These include 13 patients with Ewing's sarcoma and 3 with very rare primary sacral bone tumours in childhood--chordoma, haemangiopericytoma and osteoblastoma. All sacral bone tumours, with the exception of Ewing's sarcoma are very rare in childhood. The possibility of a sacral tumour should be considered in a child with radiculopathy. CT and MR make the diagnosis of primary sacral bone tumours much easier with the added possibility of recognition of the true nature of the lesion in many instances. Reports of primary sacral bone tumours in children are scarce. Most of the patients are incorporated in adult series which do not specify the age of the child and the site of the tumour. The purpose of this paper is to describe 16 children with primary sacral bone tumours.

Thoracic chordoma with unusual radiographic features

A case of chordoma involving the thoracic spine (T12) is reported. The plain film findings included lytic obstruction and partial collapse of a single vertebral body. Noncontrast CT and CT following Metrizamide myelography revealed vertebral body destruction with paravertebral and intraspinal soft tissue masses. Unusual findings in the case included a photon deficient area on nuclear medicine corresponding to the lesion and normal vascularity on spinal angiography. We know of no previous report describing chordoma as a "cold" defect on bone scanning.

Sacrococcygeal chordoma. A clinicoradiological study of 60 patients

Sixty patients with sacrococcygeal chordoma, who were seen at this center between 1946 and 1985, were studied with particular attention to the radiographic findings. This study was undertaken because of the large number of these cases and comparison was made between the plain films available in 39 patients and the computed tomography CT studies in 22. Bone destruction was found in 78% on plain films but in 90% on CT. A soft tissue mass was identified in plain films in 60% but in 90% on CT. Calcific debris was found in plain films in 44% but in 87% on CT. Mostly the debris consisted of coarse irregular fragments and probably represented sequestrated necrotic bone. Myelography was performed in only 15 patients. Angiography was studied in 10 cases. Of the 60 patients 88% underwent surgical resection. The tumor recurred in 80% and in only 20% was there no evidence of recurrence. Distant metastases occurred in 24% of patients. Fifty percent survived 5 years; 28% survived 10 years; mean survival 7.5 years.

Computed tomography of spinal chordomas

Computed tomography of 16 spinal chordomas revealed lytic lesions, or lytic and blastic lesions, of 2 or more adjacent vertebrae and a fairly well-delineated soft tissue mass in 16 patients. Intravenous contrast enhancement revealed multiple zones of hypodensity in 5 tumors pathologically proved to contain areas of cystic degeneration. Invasion of the epidural space was noted on computed tomography in 2 vertebral and 7 sacral lesions, and on myelography in 7 vertebral lesions. Computed tomography is ideal for delineation of the soft tissue component of these lesions, detection of sacral lesions at an early stage, planning of surgical excision or irradiation treatment, and detection of recurrence.

Sacrococcygeal chordoma in young adults

Sacrococcygeal chordoma in young adults is rare. Two patients, aged 29 and 34 years, are presented. Computed tomography plays an important role in delineating the extent of bony destruction and soft-tissue involvement. This information is necessary for treatment which may include surgery, radiotherapy and/or chemotherapy. A review of sacrococcygeal chordomas is presented.

Scintigraphic photopenia in sacrococcygeal chordoma

A case with a photon deficient or cold lesion on bone scintigraphy due to sacrococcygeal chordoma is presented. The proposed mechanism is also explained.