Multifocal metastatic chordoma to the soft tissues of the fingertips: a case report including sonographic features and a review of the literature

Multifocal Ectopic Recurrence of a C2 Chordoma

Background  Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection. Case Report  We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site. Primary tumor resection was achieved via a combination of surgery, adjuvant radiation therapy, and imatinib. All recurrences were successfully resected and confirmed via pathology to be ectopic chordoma. Discussion  Ectopic recurrence of cervical chordoma is rare and lung is the most common site of distant spread. Chordoma recurrence in skeletal muscle is particularly rare, with only 10 cases described in the literature. A plausible mechanism of distant metastatic disease in chordoma patients suggests that tumor cells escape the surgical tract via a combination of cytokine release, vasodilation, and microtrauma induced during resection. Conclusion  Cervical chordoma with ectopic recurrence in skeletal muscle has not been previously described in the literature. Skull base surgeons should be aware of the phenomenon of chordoma ectopic recurrence in the absence of local recurrence.

Metastatic tumor of the hand of unknown primary origin

Acral metastases in the hand are exceedingly rare. We present the unusual case of a metastatic tumor of the hand of unknown primary site in a 77-year-old man with no known cancer history. The patient presented with pain and swelling in the tip of the left ring finger, which had previously been diagnosed as gout at another clinic. Laboratory tests, including white blood cell count, erythrocyte sedimentation rate/C-reactive protein, and uric acid were all within normal limits. Excisional biopsy was taken by amputation of the distal phalanx of the left ring finger through the distal third of the middle phalanx. Pathology confirmed the presence of a moderately differentiated adenocarcinoma of unknown primary site. Roentgenographic examination of the chest revealed no pathologic findings. The patient refused further investigation and adequate treatment. He died 4 months later. The current description confirms the rarity of metastatic malignancy of the hand and its poor prognosis.