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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.
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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
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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.
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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.
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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]
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Couldwell WT, Stillerman CB, Rice D, Maceri D, Sherman R, Fukushima T, Hinton DR. Malignant clival chordoma with postoperative cutaneous metastases. Skull Base Surg 2011; 6:61-6. [PMID: 17170954 PMCID: PMC1656504 DOI: 10.1055/s-2008-1058914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors report the case of a chordoma with malignant cytologic features, presenting as a mass lesion in the clival and infratemporal region at the level of the craniocervical junction in an 8-year-old female. Following gross resection of the mass, the patient subsequently developed distant subcutaneous and peritoneal metastases from the lesion. The rare histologic features, the surgical approach to the lesion, and the follow-up management of this unique case are discussed.
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Lountzis NI, Hogarty MD, Kim HJ, Junkins-Hopkins JM. Cutaneous metastatic chordoma with concomitant tuberous sclerosis. J Am Acad Dermatol 2006; 55:S6-10. [PMID: 16843131 DOI: 10.1016/j.jaad.2005.08.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 08/23/2005] [Accepted: 08/23/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chordomas are rare malignant tumors of notochord origin and are locally aggressive with a metastatic potential. Of noted interest, the skin rarely is seen as a metastatic site. METHODS AND OBSERVATIONS We describe a 20-month-old infant whose primary presentation of a clivus-based chordoma was multiple asymptomatic cutaneous nodules. A skin biopsy showed large vacuolated cells embedded in a myxoid stroma. Immunohistochemical staining was positive for S-100, keratin, and epithelial membrane antigen markers consistent with malignant chordoma. Magnetic resonance imaging revealed a clivus-based chordoma with scattered metastases within the neuraxis and multiple visceral sites. Further examination also revealed a diagnosis of tuberous sclerosis. LIMITATIONS An observed association between chordoma and tuberous sclerosis cannot be established firmly on the basis of a case report. CONCLUSIONS This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor. By reporting our case, we hope to assist in the recognition of this rare dermal condition and highlight the speculated coexistence of tuberous sclerosis with chordoma tumors.
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Abstract
Chordomas are rare malignant primary bone tumors, which most often occur in the sacral area. These tumors uncommonly affect the skin, and may not be recognized by dermatologists. We present a case of an adult woman with cutaneous metastasis of a primary sacral chordoma.
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Affiliation(s)
- Adam I Rubin
- Department of Dermatology, Columbia University, New York, New York 10032, USA.
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Plathow C, Weber MA, Debus J, Kauczor HU. [Imaging of sacral chordoma: comparison between MRI and CT]. Radiologe 2005; 45:63-8. [PMID: 15662521 DOI: 10.1007/s00117-003-1002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Sacral chordoma is a primarily benign tumor with a high tendency to recur. A correct definition of tumor volume is a significant prognostic factor. We compared the value of CT and MRI in diagnosing a sacral chordoma. METHODS 31 patients with a histologically proven sacral chordoma were included in this study. Following parameters were analyzed by two independent radiologists: septation, signs of blood and ossification in the tumor tissue, contrast enhancement, maximal tumor diameter, infiltration of the soft tissue, the dural salc and the cauda equina and multifocality. RESULTS In CT all chordomas showed a hypodensity to the normal tissue and in MRI a hyperintensity on T2w images with a low level of contrast enhancement. On the basis of the more precise soft tissue contrast of MRI compared with CT, MRI was significantly more accurate in all tested parameters (p <0.05) besides in detecting tumor ossification. In CT tumor volume was frequently underestimated. CONCLUSION MRI in sacral chordoma is an essential tool in the pretherapeutic diagnostic regimen and in a state of relapse.
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Affiliation(s)
- C Plathow
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ) Heidelberg.
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Meneghini F, Castellani A, Camelin N, Zanetti U. Metastatic chordoma to the mandibular condyle: an anterior surgical approach. J Oral Maxillofac Surg 2002; 60:1489-93. [PMID: 12465015 DOI: 10.1053/joms.2002.36133] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F Meneghini
- Chief, Operative Unit of Maxillo-Facial Surgery, Villa Maria Cecilia, Cotignola, Ravenna, Italy.
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Abstract
OBJECT Chordomas have a high propensity for local recurrence and progression, as well as for systemic and cerebrospinal fluid metastasis. The authors identified and analyzed a series of patients with chordomas, focusing on an underrecognized pathological entity-surgical seeding of tumor cells. METHODS In a retrospective analysis of 82 patients with chordomas treated over a 10-year period (1990-2000), the authors found six patients (7.3%) in whom surgical seeding had occurred. In five (83%) of these patients the primary tumor was located at the clivus. In one (17%), the tumor was present at the cervical spine. There were two male (33%) and four female patients (67%) whose mean age was 34 years. The seeding sites, which were separate from the primary tumor, were located along the operative route or in the abdomen where fat was removed. The seeding was diagnosed 5 to 15 months (mean 12 months) after surgery. One seeding site was present in five patients, and 17 seeding sites were present in one patient. The involved tissues included mucosa, bone, dura, muscle, and fat. After resection, all seedings were confirmed histologically. CONCLUSIONS Seeding of chordomas occurs along the operative route and at distant locations where tissue is harvested. Early diagnosis and aggressive surgery are recommended. Based on the results of this study, the authors suggest that surgical techniques, postoperative radiotherapy, neuroradiological follow-up protocol, and even research on chordomas should be reevaluated.
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Affiliation(s)
- K I Arnautović
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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Abstract
Object
Chordomas have a high propensity for local recurrence and progression, as well as for systemic and cerebrospinal fluid metastasis. The authors identified and analyzed a series of patients with chordomas, focusing on an underrecognized entity—surgical seeding.
Methods
In a retrospective analysis of 82 patients with chordomas treated over a 10-year period (1990–2000) the authors found six patients (7.3%) in whom surgical seeding had occurred. In five (83%) of these patients the primary tumor was located at the clivus. In one (17%) the tumor was present in the cervical region. There were two male (33%) and four female patients (67%) with a mean age of 34 years. The seeding sites, which were separate from the primary tumor, were located along the operative route or in the abdomen where fat was removed. The seeding was diagnosed 5 to 15 months after surgery (mean 12 months). One seeding site was present in five patients and 17 seeding sites were present in one patient. The involved tissues included mucosa, bone, dura, muscle, and fat. After resection, all seedings were documented histologically.
Conclusions
Seeding of chordomas occurs along the operative route and at distant locations where fat is harvested. Early diagnosis and aggressive surgical treatment are recommended. Based on the results of this study, it is suggested that surgical techniques, postoperative irradiation, the neuroradiological follow-up protocol, and even research on chordomas should be reevaluated.
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Abstract
In cutaneous metastatic disease the histologic pattern may be specific or nonspecific. Carcinoma cutis most often shows only the nonspecific pattern of an adenocarcinoma, a squamous cell carcinoma, or an undifferentiated metastatic tumor. However, certain clinical and histologic characteristics may suggest a primary tumor site and type. In addition, special histologic stains and the use of immunohistochemical and electronmicroscopic techniques may also prove valuable in the diagnosis of carcinoma cutis and other cutaneous metastatic diseases.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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Abstract
The relative frequencies of cutaneous metastases are similar to those of the primary cancers; breast, colon, and melanoma are the most frequent in women and lung, colon, and melanoma are the most common in men. Cutaneous metastases represent an opportunity to detect a potentially treatable cancer before other evidence of it is present, to modify therapy as appropriate to the tumor stage, or possibly to use the cutaneous lesion as a source of easily accessible tumor cells for specific therapy. Cutaneous metastatic disease as the first sign of internal cancer is most commonly seen with cancer of the lung, kidney, and ovary.
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Affiliation(s)
- R A Schwartz
- New Jersey Medical School, Newark 07103-2714, USA
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