1
|
Koka H, Zhou W, McMaster ML, Bai J, Luo W, Klein A, Zhang T, Hua X, Li X, Wang D, Xiong Y, Jones K, Vogt A, Hicks B, Parry D, Goldstein AM, Yang XR. Genomic profiles and clinical presentation of chordoma. Acta Neuropathol Commun 2024; 12:129. [PMID: 39135136 PMCID: PMC11318126 DOI: 10.1186/s40478-024-01833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/30/2024] [Indexed: 08/15/2024] Open
Abstract
Chordoma is a rare bone cancer with variable clinical outcomes. Here, we recruited 184 sporadic chordoma patients from the US and Canada and collected their clinical and treatment data. The average age at diagnosis was 45.5 years (Range 5-78) and the chordoma site distribution was 49.2% clivus, 26.2% spinal, and 24.0% sacral. Most patients (97.5%) received surgery as the primary treatment, among whom 85.3% also received additional treatment. Except for the most prevalent cancers like prostate, lung, breast, and skin cancer, there was no discernible enrichment for any specific cancer type among patients or their family members. Among a subset of patients (N = 70) with tumor materials, we conducted omics analyses and obtained targeted panel sequencing and SNP array genotyping data for 51 and 49 patients, respectively. The most recurrent somatic driver mutations included PIK3CA (12%), followed by chromatin remodeling genes PBRM1 and SETD2. Amplification of the 6q27 region, containing the chordoma susceptibility gene TBXT, was detected in eight patients (16.3%). Clival patients appeared to be less likely to carry driver gene mutations, chromosome arm level deletion events (e.g., 5p, 5p, and 9p), or 6q27 amplification compared to sacral patients. After adjusting for age, sex, tumor site, and additional treatment, patients with somatic deletions of 14q (OR = 13.73, 95% CI 1.96-96.02, P = 0.008) and 18p (OR = 13.68, 95% CI 1.77-105.89, P = 0.012) were more likely to have persistent chordoma. The study highlights genomic heterogeneity in chordoma, potentially linked to location and clinical progression.
Collapse
Affiliation(s)
- Hela Koka
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Weiyin Zhou
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jiwei Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen Luo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Alyssa Klein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tongwu Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xing Hua
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Xin Li
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Difei Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Yujia Xiong
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Aurelie Vogt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Belynda Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Dilys Parry
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alisa M Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
2
|
Genetic Testing Distinguishes Multiple Chondroid Chordomas with Neuraxial Bone Metastases from Multicentric Tumors. Case Rep Genet 2020; 2020:8877722. [PMID: 33312743 PMCID: PMC7719490 DOI: 10.1155/2020/8877722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/10/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background Chordomas are rare malignant bone tumors preferentially forming in neuraxial bones. Chondroid chordoma is a subtype of chordoma. Chordomas reportedly present as synchronous multiple lesions upon initial diagnosis. However, it remains unknown whether these lesions are multicentric or metastatic multiple chordoma tumors. Case Presentation. Here, we present the case of a 57-year-old woman with multiple chordomas at the clivus, C6, and T12 upon initial presentation. Sequential surgeries and radiotherapy were performed for these lesions, and postoperative histological diagnosis revealed that all lesions were chondroid chordomas. Next-generation sequencing revealed that these lesions harbored a common somatic mutation in epidermal growth factor receptor (EGFR), c.3617A>C, which is not considered a pathogenic chordoma mutation, thus indicating that these lesions were not multicentric but rather multiple metastatic tumors. Subsequent multiple metastases to the lung and appendicular and axial bones were detected 15 months after the initial surgery. Recurrent lesions at the clivus progressed despite EGFR-targeted therapy, surgery, and radiotherapy. Conclusion The present evidence indicates that multiple chordomas in this case were caused by multiple metastases rather than multicentric lesions. Multiple presentations of chordoma imply systemic dissemination of tumor cells, and novel efficient systemic therapy is required to treat this disease.
Collapse
|
3
|
Berlucchi S, Nasi D, Zunarelli E, Valluzzi A, Alicandri Ciufelli M, Presutti L, Pavesi G. Cutaneous Metastasis from Cervical Spinal Chordoma: Case Report and Literature Review. World Neurosurg 2020; 137:296-303. [PMID: 32068172 DOI: 10.1016/j.wneu.2020.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chordomas are rare primary tumors of the bone that arise from embryonic notochord. They are locally aggressive tumors with a high tendency for postsurgical recurrence. On the other hand, distant metastases are rare. When they occur, they involve lungs, liver, lymph nodes, and bones. Skin and subcutaneous tissue involvement is even rarer and usually occurs by direct extension of the primary tumor or by local recurrence. Distant cutaneous metastasis from chordoma is an exceptional finding, with fewer than 20 cases reported in the literature. All the cutaneous metastases described derive from sacral chordomas, except for 2 cases in which the source of metastasis is skull-base chordomas. CASE DESCRIPTION We report the case of a 55-year-old man with skin metastasis from a cervical chordoma. CONCLUSIONS Metastasis has to be taken into account in the differential diagnosis when a new skin lesion appears in a patient with a past medical history of chordoma. To the best of our knowledge, this is the first case of cutaneous metastasis from spinal cervical chordoma. A systematic literature review was performed.
Collapse
Affiliation(s)
- Silvia Berlucchi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Davide Nasi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy.
| | - Elena Zunarelli
- Anatomic Pathology Unit, Department of Morphological Sciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Adelaide Valluzzi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Matteo Alicandri Ciufelli
- Otorhinolaryngology-Head and Neck Surgery Department, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| |
Collapse
|
4
|
Sayyid SK, Wong PK, Read W, Monson DK, Umpierrez M, Gonzalez F, Kakarala A, Singer AD. The clincoradiologic spectrum of notochordal derived masses. Clin Imaging 2019; 56:124-134. [PMID: 31029011 DOI: 10.1016/j.clinimag.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
The notochord is an essential part of human development that regresses with age. Masses derived from notochordal tissue may be encountered during imaging of the neuroaxis. Fortunately, the majority of these are benign and can usually be differentiated by radiological and clinical findings. In this manuscript, we discuss the clinical and radiologic presentation of the four notochordal derived masses and present a brief overview of their management.
Collapse
Affiliation(s)
- Samia K Sayyid
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Philip K Wong
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - William Read
- Department of Hematology and Oncology, Emory University Hospital, Atlanta, GA, USA
| | - David K Monson
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Aparna Kakarala
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA.
| |
Collapse
|
5
|
Aydemir E, Kaşikci E, Coşkunçelebi B, Bayrak ÖF, Şahin F. The effect of TWIST silencing in metastatic chordoma cells. Turk J Biol 2019; 42:279-285. [PMID: 30814891 DOI: 10.3906/biy-1801-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chordoma is a slowly growing and invasive bone tumor with a tendency to metastasize locally in advanced stages. It is essential to discover new therapeutics that target genes involved in the metastasis of chordoma. Epithelial-mesenchymal transition (EMT) might robustly influence the metastasis of a tumor bulk. To our knowledge, this is the first time to show that EMT might have a role in chordoma metastasis. In this study, we aim to investigate the possible role of Twist, a key player transcription factor of EMT, in chordoma metastasis. The TWIST gene was silenced by short hairpins in chordoma cell line MUG-Chor1 and effects on metastasis were investigated by wound healing/gap closure and invasion assays. Twist-silenced MUG-Chor1 cells were found to be less migratory and less invasive when compared to the negative control. This study indicates that Twist might have a role in metastatic chordoma cells.
Collapse
Affiliation(s)
- Esra Aydemir
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University , İstanbul , Turkey
| | - Ezgi Kaşikci
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University , İstanbul , Turkey
| | - Burcu Coşkunçelebi
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University , İstanbul , Turkey
| | - Ömer Faruk Bayrak
- Department of Medical Genetics, Yeditepe University Medical School and Yeditepe University Hospital , İstanbul , Turkey
| | - Fikrettin Şahin
- Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University , İstanbul , Turkey
| |
Collapse
|
6
|
Freeman JL, DeMonte F, Al-Holou W, Gidley PW, Hanna EY, Kupferman ME, Su SY, Raza SM. Impact of early access to multidisciplinary care on treatment outcomes in patients with skull base chordoma. Acta Neurochir (Wien) 2018; 160:731-740. [PMID: 29270681 DOI: 10.1007/s00701-017-3409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine if early access to multidisciplinary surgical care affects outcomes in patients with skull base chordoma. METHOD A retrospective chart review of prospectively collected data was performed on 51 patients treated from 1993 to 2014. The cohort was divided into those presenting (1) for initial management (ID, n = 21) or (2) with persistent/progressive disease after prior biopsy/surgery (PD, n = 30) outside of a multidisciplinary setting. The impact of initial surgical management in a multidisciplinary center on progression-free survival (PFS) was assessed with Kaplan-Meier and log-rank analyses. RESULTS Mean follow-up, median PFS, median overall survival (OS), and 10-year OS for the entire cohort was 70 months, 47 months, 159 months, and 19%, respectively. Initial management in a multidisciplinary center resulted in a significant improvement in PFS versus initial surgery with or without radiotherapy (XRT) outside of this setting (64 vs 25 months, p = 0.035). Initial surgical resection outside of a multidisciplinary setting increased the risk of recurrence/progression on univariate (HR, 2.276; p = 0.022) and multivariate analysis (HR, 2.831; p = 0.006), respectively. CONCLUSIONS The results from this study emphasize the impact that coordinated multidisciplinary surgical care has on patient outcomes for chordomas of the clivus. Biopsy followed by attempted radical resection at a dedicated center does not affect PFS and, therefore, represents a reasonable first step in management for patients presenting outside of multidisciplinary setting.
Collapse
|
7
|
Cui F, Su M, Zhang H, Tian R. Humeral metastasis of sacrococcygeal chordoma detected by fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography: A case report. Radiol Case Rep 2018; 13:449-452. [PMID: 29904494 PMCID: PMC6000026 DOI: 10.1016/j.radcr.2018.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/27/2018] [Indexed: 02/05/2023] Open
Abstract
Chordomas are rare, slow-growing, locally aggressive bone tumors arising from embryonic remnants of the notochord. Distant metastases most commonly involve the lung, liver, axial skeleton, skin, and lymph nodes. Humeral metastases are extremely rare. We report the case of a recurrent chordoma with humeral metastasis, complicated with pathologic fracture. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography revealed multiple hypermetabolic skeletal lesions, corresponding to the symptoms. Our report suggests that positron emission tomography-computed tomography is useful for evaluation of recurrence and distant metastases of chordomas.
Collapse
Affiliation(s)
- Futao Cui
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
| | - Han Zhang
- Department of nuclear medicine and molecular imaging, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu, Sichuan 610000, P.R. China
| |
Collapse
|
8
|
Jäger D, Lechel A, Tharehalli U, Seeling C, Möller P, Barth TFE, Mellert K. U-CH17P, -M and -S, a new cell culture system for tumor diversity and progression in chordoma. Int J Cancer 2017; 142:1369-1378. [PMID: 29148152 DOI: 10.1002/ijc.31161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/10/2017] [Accepted: 11/06/2017] [Indexed: 01/29/2023]
Abstract
Chordoma is a rare bone tumor with a known intrinsic heterogeneity. Here, we address this tumor heterogeneity in a new cell culture model for tumor diversity and progression in chordoma. The three cell lines U-CH17P, U-CH17M, and U-CH17S were established from a primary sacral chordoma and its derived metastases, a soft tissue and a skin metastasis, respectively. The lesions had divergent differentiation patterns which are conserved in the derived cell lines making them a suitable in vitro model for the analysis of tumorigenesis in chordoma. A common feature of the three cell lines is the expression of typical chordoma markers, such as Brachyury, vimentin, cytokeratins, EMA and S100 protein. A comparison of the genomic aberrations by array comparative genomic hybridization of the cell lines and the corresponding parental tumor tissues revealed that the precursor cells of U-CH17P, U-CH17M and U-CH17S were already present in the primary tumor. Therefore, we show that clonal diversity of this chordoma exists in the primary tumor and that not all of these subclones tend to metastasize. All cell lines had a CDKN2A loss. A comparison of the gene expression profiles of the cell lines revealed significant differences in the expression of several genes like MAGEC2 and SEMA6A known to be associated with the tendency to metastasize or proliferation and migration. Since the underlying mechanisms of tumor progression in chordoma are still largely unclear, the three U-CH17 cell lines are a suitable in vitro model for elucidating chordoma oncobiology.
Collapse
Affiliation(s)
- D Jäger
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - A Lechel
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - U Tharehalli
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - C Seeling
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - P Möller
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - T F E Barth
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - K Mellert
- Institute of Pathology, University of Ulm, Ulm, Germany
| |
Collapse
|
9
|
|
10
|
Chang C, Chebib I, Torriani M, Bredella M. Osseous metastases of chordoma: imaging and clinical findings. Skeletal Radiol 2017; 46:351-358. [PMID: 28064345 DOI: 10.1007/s00256-016-2566-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/13/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the imaging and clinical characteristics of chordoma osseous metastases (COM). MATERIALS AND METHODS Our study was IRB approved and HIPAA compliant. A retrospective search of our pathology database for pathology-proven COM yielded 15 patients who had undergone MRI, CT, bone scan, and/or FDG-PET/CT. The imaging and clinical features of the COMs were recorded. A control group of age and gender matched chordoma patients without osseous metastasis was evaluated. RESULTS The COM mean maximal dimension was 6.4 ± 4.0 cm. The majority (60%) of patients had one lesion. Extra-osseous soft tissue component was present in 85% and was larger than intra-osseous component in 76%. On MRI the lesions were heterogeneous but predominantly T2 hyperintense with hypointense septae, and with variable enhancement. On CT the lesions were typically destructive or permeative; calcifications were rare. The extent of the soft tissue component was isodense to muscle on CT and therefore better evaluated on MRI. COM was in a body part contiguous to the site of the primary tumor. Compared to the controls, COM patients were more likely to have local recurrence (P = 0.0009) and positive resection margins (P = 0.002). At 1 year, 33% of COM patients were deceased and 13% had progressive metastases. CONCLUSION COM are associated with large extra-osseous soft tissue components, which are better visualized by MRI. They are often located in a body part contiguous to the site of the primary tumor, portend poor prognosis, and are associated with positive resection margins and local recurrence.
Collapse
Affiliation(s)
- Connie Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| | - Miriam Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA
| |
Collapse
|
11
|
Frequency and Risk Factors for Additional Lesions in the Axial Spine in Subjects With Chordoma: Indications for Screening. Spine (Phila Pa 1976) 2017; 42:E37-E40. [PMID: 27254658 DOI: 10.1097/brs.0000000000001723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE We aim to evaluate the frequency and clinical significance of additional lesions in the axial spine in subjects with chordoma and to assess the need for screening. SUMMARY OF BACKGROUND DATA Chordomas are rare tumors that may be multicentric or metastasize and affect several bones in the axial spine. The incidence of multiple lesions in the axial spine is unknown. Understanding the incidence rate of multiple lesions in the spine in subjects with chordomas will help guide utilization of total spine screening imaging. METHODS We performed a retrospective review of medical records of 42 subjects with histologically confirmed chordomas who had complete imaging of the axial spine. Lesions with imaging characteristics suggestive of chordomas/notochordal remnants were identified. Data on age at diagnosis, sex, size (in maximal dimension), type of chordoma (conventional, chondroid, or dedifferentiated), and whether pulmonary metastases were present were recorded. Binomial two-sample tests of proportions were used to compare proportions. Logistic regression was used to assess predictors of additional lesions. RESULTS Forty-two subjects (57.1% male) were identified. The proportion of subjects with additional lesions in the axial spine was 16.7% (7/42). Age, sex, size, and subtype of chordoma were not significant predictors of having additional lesions (P > 0.05 for each variable). However, having pulmonary metastases was a significant predictor of having additional lesions (P < 0.05). CONCLUSION Approximately 17% of subjects with chordomas had additional lesions in the axial spine. It is unclear whether these represent metastases, synchronous primary chordomas or notochordal remnant tissue. Screening imaging of the axial spine may reveal additional lesions in particular in subjects with pulmonary metastases. LEVEL OF EVIDENCE 3.
Collapse
|
12
|
Yang J, Yang X, Miao W, Jia Q, Wan W, Meng T, Wu Z, Cai X, Song D, Xiao J. Spine extra-osseous chordoma mimicking neurogenic tumors: report of three cases and review of the literatures. World J Surg Oncol 2016; 14:206. [PMID: 27491867 PMCID: PMC4973554 DOI: 10.1186/s12957-016-0951-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 07/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background For a long time, chordoma has been known as an osseous tumor mainly found at the clivus and sacrococcygeal region. However, spine extra-osseous chordoma (SEC) with a better prognosis than the classic type has been neglected. According to our literature review, only several case reports have been published in English literatures. Here in this article, three cases of SEC, plus a literature review, are presented. Case presentation Three cases of SEC were presented from our center. Surprisingly, neurologic tumors were considered as the first diagnosis. Thereafter, en bloc resection was performed in all the three cases. Especially, the dumbbell-shaped one in the cervical spine was removed by en bloc through the combined anterior and posterior approach for the first time. Follow-up within 12–58 months after surgeries proved no recurrence or metastasis. Conclusions Spine extra-osseous chordoma, commonly located in the cervical and epidural region, is extremely rarely met. SEC is characterized with less aggressiveness, the lower rate of recurrence and metastasis, and better prognosis than those of the osseous origin. Though complete excision can be achieved generally, differential diagnosis of spine neurogenic tumors and the following en bloc resection should be made as carefully as possible.
Collapse
Affiliation(s)
- Jian Yang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Xinghai Yang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Wujun Miao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Qi Jia
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Wei Wan
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Tong Meng
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Zhipeng Wu
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Xiaopan Cai
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Dianwen Song
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China.
| | - Jianru Xiao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China.
| |
Collapse
|
13
|
Metastatic Chordoma: A Diagnostic Challenge on Fine Needle Aspiration. Case Rep Pathol 2016; 2016:2187290. [PMID: 26881166 PMCID: PMC4735921 DOI: 10.1155/2016/2187290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/24/2015] [Indexed: 11/17/2022] Open
Abstract
Chordomas are primary low grade malignant tumors of bone that usually arise within both ends of axial skeleton. The Notochord is a midline, ectoderm-derived structure that defines the phylum of chordates. Chordomas may pose difficult diagnostic challenges when encountered in secondary locations, such as lungs or other parenchymatous organs. We report the cytologic findings of a metastatic chordoma sampled through CT-scan guided fine needle aspiration (FNA) of lower lobe lung nodule in a 54-year-old man diagnosed with recurrent chordoma involving the lumber spine and paraspinal region.
Collapse
|
14
|
Young VA, Curtis KM, Temple HT, Eismont FJ, DeLaney TF, Hornicek FJ. Characteristics and Patterns of Metastatic Disease from Chordoma. Sarcoma 2015; 2015:517657. [PMID: 26843835 PMCID: PMC4710904 DOI: 10.1155/2015/517657] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
Abstract
Chordoma is a rare, slow-growing malignant tumor arising from notochordal remnants. A retrospective review of patient records at two major referral centers was undertaken to assess the incidence, location, and prognostic factors of metastatic disease from chordoma. 219 patients with chordoma (1962-2009) were identified. 39 patients (17.8%) developed metastatic disease, most frequently to lung (>50%). Median survival from the time of initial diagnosis was 130.4 months for patients who developed metastatic disease and 159.3 months for those who did not (P = 0.05). Metastatic disease was most common in the youngest patients (P = 0.07), and it was 2.5 times more frequent among patients with local recurrence (26.3%) than in those without (10.8%) (P = 0.003). Patient survival with metastatic disease was highly variable, and it was dependent on both the location of the tumor primary and the site of metastasis. Metastasis to distal bone was the most rapid to develop and had the worst prognosis.
Collapse
Affiliation(s)
- Victoria A. Young
- Department of Orthopaedics, University of Miami Miller School of Medicine, P.O. Box 016960 Miami, FL 33101, USA
- University of Miami Tissue Bank, 1951 NW 7th Avenue, Suite 200, Miami, FL 33136, USA
| | - Kevin M. Curtis
- Department of Biochemistry & Molecular Biology, University of Miami Miller School of Medicine, P.O. Box 016960 Miami, FL 33101, USA
- Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - H. Thomas Temple
- Department of Orthopaedics, University of Miami Miller School of Medicine, P.O. Box 016960 Miami, FL 33101, USA
- University of Miami Tissue Bank, 1951 NW 7th Avenue, Suite 200, Miami, FL 33136, USA
| | - Frank J. Eismont
- Department of Orthopaedics, University of Miami Miller School of Medicine, P.O. Box 016960 Miami, FL 33101, USA
| | - Thomas F. DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Francis H. Burr Proton Therapy Center (FHBPTC), 55 Fruit Street, Boston, MA 02114, USA
| | - Francis J. Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Orthopaedic Associates, 55 Fruit Street Yawkey 3B, Boston, MA 02114, USA
| |
Collapse
|
15
|
Rohatgi S, Ramaiya NH, Jagannathan JP, Howard SA, Shinagare AB, Krajewski KM. Metastatic Chordoma: Report of the Two Cases and Review of the Literature. Eurasian J Med 2015; 47:151-4. [PMID: 26180502 DOI: 10.5152/eurasianjmed.2015.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/07/2014] [Indexed: 11/22/2022] Open
Abstract
Chordomas are rare malignant bone tumours with a predilection for the axial skeleton, especially the sacrum and skull base. Median survival in patients with metastatic disease is usually dismal. Treatment is challenging due to the propensity for local recurrence, metastatic disease as well as lack of clear consensus regarding the optimal management. Our case report highlights two cases of sacral chordoma with locally recurrent and widespread metastatic disease, stable on molecular targeted therapy.
Collapse
Affiliation(s)
- Saurabh Rohatgi
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Nikhil H Ramaiya
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Jyothi P Jagannathan
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Stephanie A Howard
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Atul B Shinagare
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Katherine M Krajewski
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| |
Collapse
|
16
|
Erkmen CP, Barth RJ, Raman V. Case report: Successful treatment of recurrent chordoma and bilateral pulmonary metastases following an 11-year disease-free period. Int J Surg Case Rep 2014; 5:424-7. [PMID: 24907541 PMCID: PMC4064395 DOI: 10.1016/j.ijscr.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/01/2014] [Accepted: 02/07/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Chordomas are rare but aggressive tumors due to local recurrence and distant metastases. They originate commonly in the sphenooccipital and sacrococcygeal regions, and metastasize to the lungs, bone, skin, liver, and lymph nodes. They occur more frequently in men and people over the age of 40. PRESENTATION OF CASE A 28 year-old female presented with sacrococcygeal chordoma for which she received wide local excision and adjuvant radiation therapy. She enjoyed an unusual disease-free survival for 11 years until a routine surveillance scan of the pelvis identified local recurrence. Further work up revealed bilateral pulmonary metastases. She underwent local excision of the recurrent tumor and video-assisted thoracoscopic (VATS) wedge resection of pulmonary metastases. She also received adjuvant radiation therapy to the recurrent resection bed. Two years later, she remains free of disease and symptoms. DISCUSSION Chordomas are commonly insensitive to chemotherapy and radiation, making surgery the most successful therapeutic modality. However, there are few guidelines on the surveillance and treatment of recurrent chordoma. We report success with aggressive surgical resection of recurrence and metastasis as well as adjuvant radiation therapy. CONCLUSION The prolonged survival of our patient underscores the importance of (1) aggressive surgical resection of chordoma, whether primary, recurrent, or metastatic, with adjuvant radiation therapy, (2) minimization of surgical seeding of tumor, and (3) diligent cancer surveillance.
Collapse
Affiliation(s)
- Cherie P Erkmen
- Division of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States.
| | - Richard J Barth
- Section of Surgical Oncology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States
| | - Vignesh Raman
- Division of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States
| |
Collapse
|
17
|
Abstract
Chordomas are rare neoplasms that do not often metastasize. Of the small percent that do metastasize, they very infrequently involve skeletal muscle. Only a few cases of skeletal muscle metastases have been reported in the literature. We report an unusual case of a patient with a primary sacrococcygeal chordoma who experienced a long period of remission but who subsequently developed recurrence and multiple metastatic lesions to skeletal muscles including the deltoid, triceps, and pectineus.
Collapse
|
18
|
Di Maio S, Kong E, Yip S, Rostomily R. Converging paths to progress for skull base chordoma: Review of current therapy and future molecular targets. Surg Neurol Int 2013; 4:72. [PMID: 23776758 PMCID: PMC3683175 DOI: 10.4103/2152-7806.112822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/12/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chordomas of the skull base are rare locally aggressive neoplasms with a predilection for encapsulating critical neurovascular structures, bony destruction and irregular growth patterns, and from which patients succumb to recurrence and treatment failures. METHODS A review of the medical literature is performed, using standard search engines and identifying articles related to skull base chordomas, surgery, radiation therapy, chemotherapy, molecular genetics, and prospective trials. RESULTS A synthesis of the literature is presented, including sections on pathology, treatment, molecular genetics, challenges, and future directions. CONCLUSION Beyond an understanding of the current treatment paradigms for skull base chordomas, the reader gains insight into the collaborative approach applied to orphan diseases, of which chordomas is a prime exemplar.
Collapse
Affiliation(s)
- Salvatore Di Maio
- Division of Neurosurgery, McGill University, Jewish General Hospital, Montreal, QC, Canada
| | | | | | | |
Collapse
|
19
|
Demetriou GA, Marcou M, Demetriou A, Kyriakides C. A fast growing sternal mass. BMJ Case Rep 2013; 2013:bcr-2013-008673. [PMID: 23417390 DOI: 10.1136/bcr-2013-008673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
20
|
Collins GR, Essary L, Strauss J, Hino P, Cockerell CJ. Incidentally discovered distant cutaneous metastasis of sacral chordoma: a case with variation in S100 protein expression (compared to the primary tumor) and review of the literature. J Cutan Pathol 2012; 39:637-43. [DOI: 10.1111/j.1600-0560.2012.01895.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Azarpira N, Solooki S, Sepidbakht S, Mardani R. Humeral metastasis from a sacrococcygeal chordoma: a case report. J Med Case Rep 2011; 5:339. [PMID: 24576343 PMCID: PMC3170342 DOI: 10.1186/1752-1947-5-339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 08/01/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Chordomas are rare tumors of the skeletal system that arise from an intra-osseous benign precursor of notochordal cells. They are mainly locally aggressive. However, metastases to other sites, including the humeri, resulting in pathological fractures have been reported. We report the case of a patient with a metastatic chordoma that produced a pathologic fracture of the humerus. Case presentation We report the case of a 60-year-old Iranian woman who presented with a fracture of her right humerus following a minor trauma. She had a history of a sacrococcygeal chordoma. Histological and immunohistochemical studies of the fracture site suggested the diagnosis of a chordoma. Conclusions Chordoma is a rare tumor and rarely metastasizes, but it should be considered in the differential diagnosis of epithelioid bone tumors. The only current effective treatment for this type of tumor is carbon ion therapy. There is currently no effective medical therapy available for advanced chordoma, and this type of tumor is not very responsive to radiotherapy.
Collapse
Affiliation(s)
- Negar Azarpira
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | |
Collapse
|
22
|
Kanthan R, Senger JL. Fine-needle aspiration cytology with histological correlation of chordoma metastatic to the lung: a diagnostic dilemma. Diagn Cytopathol 2010; 39:927-32. [PMID: 22081530 DOI: 10.1002/dc.21548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/19/2010] [Indexed: 11/11/2022]
Abstract
Chordoma is an uncommon tumor initially believed to be benign due to the rarity of its metastasis. Cytological, morphological, and immunohistochemical features of chordoma, relating to its origin from notochordal remnants, allows for its accurate diagnosis. A 75-year-old man with a known history of tuberculosis (TB) presented with shortness of breath and a dry cough. A chest X-ray demonstrated a diffuse, infiltrative miliary pattern in both lungs. Bronchial washings submitted for culture and cytological examination did not identify any tuberculous bacilli. Fine needle aspiration cytology (FNAC) showed focal areas of myxoid regions with small, round, uniform mononuclear cells. There was a documented past history of chordoma arising from the L2 vertebrae. Because of the rarity of this lesion in the lung and the limited diagnostic material available with a clinical history of TB and lumbar chordoma, the pathological report rendered on the FNAC was "atypical cells suspicious for metastatic chordoma." A wedge biopsy of the lung confirmed the presence of metastatic pulmonary chordoma. Despite palliative treatment, he died within a year. Although the metastatic potential of chordomas has been recognized and documented, to the best of our knowledge, metastasis of chordoma to the lung diagnosed by FNAC with cytohistological correlation has not been previously reported in the English literature.
Collapse
Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon SK, Canada.
| | | |
Collapse
|
23
|
Singh H, Harrop J, Schiffmacher P, Rosen M, Evans J. Ventral Surgical Approaches to Craniovertebral Junction Chordomas. Neurosurgery 2010; 66:A96-A103. [DOI: 10.1227/01.neu.0000365855.12257.d1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
24
|
Stacchiotti S, Casali PG, Lo Vullo S, Mariani L, Palassini E, Mercuri M, Alberghini M, Pilotti S, Zanella L, Gronchi A, Picci P. Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol 2009; 17:211-9. [PMID: 19847568 DOI: 10.1245/s10434-009-0740-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chordoma is a rare tumor, and its natural history is still not well known. MATERIALS AND METHODS All patients affected by localized chordoma surgically treated at Istituto Ortopedico Rizzoli, Bologna, and Istituto Nazionale Tumori, Milan, Italy, between 1980 and 2008 were reviewed. Local recurrence, distant metastasis, and overall survival (OS) were analyzed both from time of diagnosis and from time of local recurrence/distant metastasis. A multivariable analysis to identify independent prognostic factors was carried out. RESULTS A total of 138 consecutive patients were identified (sacrum 78%, lumbar spine 15%, cervical-dorsal spine 7%). Of these, 130 underwent surgical resection. Median follow-up was 142 months. The 5- and 10-year OS, local relapse-free survival (LRFS), and distant relapse-free survival (DRFS) were, respectively, 78% and 54%, 52% and 33%, and 86% and 72%. Size was an independent prognostic factor for OS (P value < .001), LRFS (P value: .038), and DRFS (P value: .004), while surgical margins independently predicted LRFS (P value: .003) with a trend for OS. The 5- and 10-year OS, LRFS, and DRFS after the first local relapse were 50% and 26%, 47% and 31%, and 64% and 61%. The size of the recurrence and quality of surgical margins did not influence postrelapse OS. The 5-year OS after the second local relapse was 19%. 22% of patients developed distant metastases with a 5-year post-metastases OS of 33%. CONCLUSIONS Tumor size and surgical margins affected outcome only on initial presentation. However, wide surgery was feasible in a minority of cases. Most patients died of local-regional disease even when metastases occurred. Indeed, long-term prognosis was such that disease-free survival at 10 years was only 26%.
Collapse
|