Multiple synchronous spinal extra-osseous intradural chordomas: is it a distinct entity?

A Rare Presentation of Axial Chordoma and the Approach to Management

Patient: Female, 50

Final Diagnosis: Axial chordoma

Symptoms: Back ache • numbness • urine incontinence • weaknes of lower limbs

Medication: —

Clinical Procedure: —

Specialty: Plastic Surgery

Intradural cervical chordoma with diffuse spinal leptomeningeal spread: case report and review of the literature

PURPOSE

Chordoma is a low-grade malignant bone tumor derived from embryonic notochord remnants along the axial skeleton. About 50% of chordomas occur in the sacral vertebrae and 35% in the skull base. Most chordomas are extradural and cause extensive bone destruction. Intradural spinal tumors without bone involvement are rare.

METHODS

We herein describe the clinical features of a patient with a chordoma as well as the imaging and pathological manifestations of the tumor.

RESULTS

We encountered an unusual presentation of a C6 and C7 spinal intradural chordoma in a 23-year-old man. He presented with a 5-day history of discomfort over the lumbosacral region. Magnetic resonance imaging and enhanced scanning of the cervical spine showed an intradural soft tissue mass at C6 and C7 and linear enhancement of the spinal meninges. The tumor was excised because the patient had been previously misdiagnosed with an intraspinal neurogenic tumor with spinal meningitis. Postoperative pathological examination confirmed the diagnosis of chordoma. On postoperative day 7, the patient underwent brain magnetic resonance imaging because of severe headache. The images showed multiple soft tissue nodules in the skull base cistern. To the best of our knowledge, this is the first case report of an entirely extraosseous and spinal intradural chordoma with diffuse spinal leptomeningeal spread. The patient died 2 months postoperatively.

CONCLUSIONS

An intradural spinal chordoma is difficult to distinguish from a neurogenic tumor by imaging. When the lesion is dumbbell-shaped, it is easily misdiagnosed as a schwannoma. In the present case, the tumor was intradural and located at the level of the C6 and C7 vertebrae. Preoperative diagnosis was difficult, and the final diagnosis required pathological examination.

Rare case of an extraosseous cervical chordoma with both intradural and extensive extraspinal involvement

Background:

Chordomas must be considered among the differential diagnoses for extradural spinal tumors, especially involving the clival or sacrococcygeal regions. They are often locally invasive and destructive to the osseous structures from which they arise, but rarely extend intradurally. Here, we report a unique chordoma that was intradural and spanned nearly four subaxial cervical vertebral levels.

Case Description:

We report the case of an atypical intradural chordoma that spanned four subaxial levels of the cervical spine in an 81-year-old female. It also extended through multiple neural foramina but did not invade or destroy the bony elements of the cervical vertebrae. Notably, it demonstrated sizable extension into the deep carotid triangle abutting the internal jugular vein.

Conclusion:

This case involved an extraosseous, intradural, four-level subaxial cervical chordoma that demonstrated significant extraspinal extension into the anterior soft tissues of the neck.

Spine extra-osseous chordoma mimicking neurogenic tumors: report of three cases and review of the literatures

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.

Synchronous metastatic skull base chordoma to the breast: case report and literature review

CLINICAL SCENARIO

During routine staging work-up for a left breast mass, a 68-year-old woman complained of dysphagia and dysphonia. During further investigations, a left-sided lesion at the foramen magnum was observed on brain imaging. Both lesions were biopsied and showed a classical chordoma.

MANAGEMENT

The skull-base lesion and the breast lesion were surgically resected, and adjuvant radiotherapy was given.

SUMMARY

Chordoma is a rare primary central nervous system tumour that seldom metastasizes. The lung is the most common site of metastasis. Synchronous breast metastasis from a skull-base chordoma is very rare, and a safe management option includes a maximum resection followed by adjuvant radiotherapy.

Clivus chordoma: is it enough to image the primary site?

Chordomas are rare malignant tumors arising from embryonic remnants of the primitive notochord, around which the skull base and vertebral column develop. They are locally aggressive but metastasize rarely. To our knowledge, this is the first reported case of synchronous intraosseous chordomas. A 32-year-old man presented with intermittent double vision secondary to a right-side abducent nerve palsy. Imaging revealed a clivus chordoma and an asymptomatic synchronous second primary chordoma in the fifth lumbar vertebra. Both chordomas were surgically excised: the clivus using the endonasal, endoscopic route and the L5 vertebra by total vertebral excision and replacement with a titanium prosthesis. The patient made an uneventful and complete recovery. We have modified our departmental practice as we believe that all patients diagnosed with chordoma should have magnetic resonance imaging of their entire spinal tract to exclude a second primary chordoma.

Epidural Chordoma of the Cervical Spine with Secondary Bone Involvement

A 53-year-old man presented with cervical myelopathy. magnetic resonance imagine (MRI) revealed a predominantly extraskeletal, extradural lesion extending along the posterior aspects of the C2 to C5 vertebral bodies, with greater than 60% spinal canal compromise and severe cord compression. Bone involvement was present, but was thought to be secondary. Based on histopathology and immunohistochemical stains, the final pathologic diagnosis was chordoma. The lesion was treated with embolization, surgical resection, and proton beam radiotherapy, and there was no evidence of recurrence or metastasis after five years.