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Lee SJ, Paeng SH, Kang MS, Jung SJ, Yoon SA, Park HY, Yoon HK, Yang YI, Cho HJ. Retropharyngeal chordoma extending to the spinal cord, mimicking a neurogenic tumor: a case report and literature review. J Int Med Res 2021; 49:300060521999566. [PMID: 33730897 PMCID: PMC8166386 DOI: 10.1177/0300060521999566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chordomas are rare, locally aggressive bone malignancies with poor prognoses. However, those with minimal or no bone involvement are more easily resectable because of their well-delineated margins and thus have better prognoses. Such extraosseous chordomas of the spine are localized both intradurally and extradurally. Only a few case reports have focused on extraosseous, extradural spinal chordomas. Radiologically, this type of chordoma has a dumbbell shape; however, dumbbell-shaped spinal tumors are traditionally thought to be neurogenic tumors (i.e., schwannomas or neurofibromas). We herein report a unique case involving a woman with a dumbbell-shaped extraosseous chordoma protruding predominantly into the retropharyngeal space. A 44-year-old woman presented for evaluation of a left submandibular mass. A T2-hyperintense, gadolinium-enhancing mass was found in her cervical spinal canal, protruding through the C2/3 neural foramen into the retropharyngeal space with minimal vertebral involvement. The initial diagnosis was a neurogenic tumor, most likely a schwannoma. After subtotal removal, the pathologic diagnosis was a chordoma. Because chordomas and schwannomas have significantly different prognoses, caution is warranted when a dumbbell-shaped tumor is identified in the spine with minimal or no vertebral deterioration on radiology. This report also provides the first thorough review of extraosseous dumbbell-shaped intraspinal–extraspinal chordomas.
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Affiliation(s)
- Sun Joo Lee
- Department of Radiology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Soo Jin Jung
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Shin Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Ha Young Park
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Young Il Yang
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Hwa Jin Cho
- Department of Pathology, Inje University School of Medicine, Busan Paik Hospital, Busan, Republic of Korea
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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.
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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.
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Díaz RC, Berbeo ME, Quintero ST, Acevedo JC, Zorro OF, Feo OH. Craniocervical junction diseases treatment with a minimally invasive approach. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130200314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess(r) surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.
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Abstract
STUDY DESIGN A primary leiomyosarcoma located on the left side of the C2 is reported. Left-sided partial spondylectomy and anterior reconstruction with posterior stabilization was performed by a two-staged operation. OBJECTIVE To emphasize the occurrence of primary leiomyosarcoma and the importance of proper stabilization in the upper cervical spine. SUMMARY OF BACKGROUND DATA Leiomyosarcoma is a rare malignant neoplasm of the bone and the primary leiomyosarcoma of the spine is extremely rare. Radical tumor excision is the goal in case of vertebral leiomyosarcoma, but to both gain surgical access to the upper cervical spine and obtain anterior reconstruction is challenging. METHODS Leiomyosarcoma of the C2 in a 25-year-old woman with mild neurologic deficits is reported. A left-sided partial spondylectomy of C2 was performed. The defect of the vertebral body was reconstructed by expandable titanium prosthesis, and posterior craniocervical fixation was performed by the polyaxial screws in the lateral masses and rod/plates. RESULTS The surgical margin was very small. The pathology of the tumor was reported as leiomyosarcoma. No sign of local recurrence or metastasis was evident 1 year after surgery. CONCLUSION Leiomyosarcoma, although rare, should be kept in mind as one of the possible diagnoses when a patient with an upper cervical tumor is presented and complete tumor removal must be the goal.
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Resection of a retropharyngeal craniovertebral junction chordoma through a posterior cervical approach. ACTA ACUST UNITED AC 2010; 23:359-65. [PMID: 20084032 DOI: 10.1097/bsd.0b013e3181aaca99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN This illustrative case report is designed to provide technical data regarding the use of a posterior approach to resect a retropharyngeal chordoma involving the craniovertebral junction. OBJECTIVE The objective of this report is to emphasize the utility of the posterior approach when treating anterior tumors of the craniovertebral junction. SUMMARY OF BACKGROUND DATA Traditionally, a transoral transpharyngeal or extended anterior approach was used to resect anterior tumors of the craniovertebral junction. These approaches have several limitations unique to these exposures, limitations not applicable to a posterior midline cervical approach. METHODS A case report is provided that illustrates the use of a posterior cervical approach used to resect a retropharyngeal craniovertebral junction chordoma. RESULTS Gross total resection of a retropharyngeal chordoma was achieved using a posterior cervical approach. Although local tumor recurrence did occur, this was resected and adjuvant radiotherapy prescribed. This resulted in an ongoing 4-year recurrence free survival. CONCLUSIONS The posterior cervical midline exposure could be used to dissect and remove anterior retropharyngeal tumors, with minimal morbidity.
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