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Jenson AV, Taylor DG, Ayala A, Jackson RE, Baskin DS. Indolent multicentric chordoma – A previously undescribed entity: A Case report and literature review. Surg Neurol Int 2022; 13:348. [PMID: 36128155 PMCID: PMC9479634 DOI: 10.25259/sni_507_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Chordomas are rare neuraxial tumors arising from remnants of primitive notochord. They are generally slow-growing malignant neoplasms. Only four adult cases of multicentric chordomas have been reported, all with aggressive and rapid growth. Here, we present an unusual case of indolent multicentric chordomas involving cervical and thoracic spine, sacrum, and calvarium. Case Description: A 60-year-old male was found to have multiple lesions throughout his neuroaxis incidentally on workup for colitis. A needle biopsy documented the diagnosis of chordoma. This has been followed for more than 4 years with no progression. Conclusion: We present the first reported case of indolent multicentric chordomas. Due to the extreme rarity of indolent multicentric chordomas, close follow-up is needed and recommended.
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Affiliation(s)
- Amanda Vilate Jenson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas, United States
| | - Daniel G. Taylor
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Alberto Ayala
- Department of Pathology, Houston Methodist Hospital, Houston, Texas, United States
| | - Robert Evan Jackson
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas, United States
| | - David S. Baskin
- Kenneth R. Peak Presidential Distinguished Chair Vice Chairman and Residency Program Director Department of Neurosurgery Director, Kenneth R. Peak Brain and Pituitary Tumor Treatment Center Professor of Neurosurgery, The Houston Methodist Research Institute, Weill Cornell Medical College and Texas A&M Medical School, Houston, Texas, United States
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Ibn Essayed W, Rassi M, Chi JH, Al-Mefty O. Multicentric Chordoma With Initial Resection by Bilateral Transcondylar Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e37-e38. [DOI: 10.1227/ons.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022] Open
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Elghareeb MM, Allah MYA, Abdallah SS, Eldesoky AR, Halim AA. Sacral Chordoma with Bilateral Inguinal Lymph Node Metastasis and Metachronous Tumor of the Clivus: A Case Report. J Orthop Case Rep 2021; 11:1-3. [PMID: 34557428 PMCID: PMC8422020 DOI: 10.13107/jocr.2021.v11.i05.2180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Chordoma is a malignant neoplasm that arises from notochord remnants. Its incidence is highest above the age of 50 and behaves as a locally aggressive tumor with a slow growth rate. In most cases, complete surgical resection followed by radiotherapy offers the best chance of control. Developing metachronous tumors or distant metastasis is uncommon. CASE REPORT A 56-year-old male patient of sacral chordoma was treated by surgery and radiotherapy. He developed later bilateral inguinal lymph node metastasis and metachronous clivus chordoma. CONCLUSION Chordomas are rare. Multiplicity of primary disease and distant metastasis could happen, so regular follow-up is warranted and more effective therapeutic modalities are needed.
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Affiliation(s)
- Manal Ms Elghareeb
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mona Yy Abd Allah
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sieza S Abdallah
- Department of Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed R Eldesoky
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amal Af Halim
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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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.
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Ribeiro BNDF, Marchiori E. Chordoma of the posterior mediastinum accompanied by synchronous lesion. Radiol Bras 2017; 50:340-341. [PMID: 29085171 PMCID: PMC5656078 DOI: 10.1590/0100-3984.2016.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Multicentric Chordoma : An Uncommon and Incompletely Understood Presentation. Clin Neuroradiol 2017; 28:283-288. [PMID: 28766007 DOI: 10.1007/s00062-017-0610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Abstract
Chordomas are primary malignant bone tumors that arise in the axial skeleton, believed to originate from remnants of embryologic notochordal cell rests. Multicentric origin of chordoma is extremely rare. To our literature search, we found only three cases of multicentric chordoma in adults. We report a first case of multicentric chordoma in pediatric age group. A 14-month-old child presented with torticolis and left upper limb monoparesis, imaging showed expansile bony destructive lesion in clivus and dorsal spine simultaneously. The child underwent laminectomy, decompression of cord, excision of lesion, and histopathology was suggestive of chordoma. Pediatric chordomas are aggressive tumors, require multidisciplinary management with maximal safe resection followed by radiotherapy (conventional and/or proton). Even with multidisciplinary management, pediatric chordomas have high morbidity and mortality.
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Affiliation(s)
- Shighakolli Ramesh
- Department of Neurosurgery, Kamineni Hospitals, Hyderabad, Telangana, India
| | - Raju Subodh
- Department of Neurosurgery, Kamineni Hospitals, Hyderabad, Telangana, India
| | - Srinadh Boppana
- Department of Radio Diagnosis, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India
| | - Erukkambattu Jayashankar
- Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, Telangana, India
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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.
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Goes R, van Overbeeke JJ. A vertebral extra dural chordoma at C5, possibly deriving from a clival chordoma. Surg Neurol Int 2015; 6:94. [PMID: 26097773 PMCID: PMC4455120 DOI: 10.4103/2152-7806.157948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/17/2015] [Indexed: 01/10/2023] Open
Abstract
Background: Clival chordomas are a rare type of cancer with low metastatic potential and primary metastasize to the lung or bones. Case Description: This case report describes a possible metastatic, paravertebral chordoma at level C4-C5 in a patient with a past medical history of a clival chordoma. Conclusion: Chordomas are unpredictable and may metastasise.
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Affiliation(s)
- R Goes
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202AZ Maastricht, The Netherlands
| | - J J van Overbeeke
- Department of Neurosurgery, Maastricht University Medical Center, PO box 5800, 6202AZ Maastricht, The Netherlands
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Kim WS, Park JT, Lee YB, Park WY. Atlantoaxial Chordoma in Two Patients with Occipital Neuralgia and Cervicalgia. J Lifestyle Med 2015; 4:104-8. [PMID: 26064862 PMCID: PMC4391017 DOI: 10.15280/jlm.2014.4.2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022] Open
Abstract
Chordoma arises from cellular remnants of the notochord. It is the most common primary malignancy of the spine in adults. Approximately 50% of chordomas arise from the sacrococcygeal area with other areas of the spine giving rise to another 15% of chordomas. Following complete resection, patients can expect a 5-year survival rate of 85%. Chordoma has a recurrence rate of 40%, which leads to a less favorable prognosis. Here, we report two cases of chordoma presenting with occipital neuralgia and cervicalgia. The first patient presented with a C1-C2 chordoma. He rejected surgical intervention and ultimately died of respiratory failure. The second patient had an atlantoaxial chordoma and underwent surgery because of continued occipital neuralgia and cervicalgia despite nerve block. This patient has remained symptom-free since his operation. The presented cases show that the patients' willingness to participate in treatment can lead to appropriate and aggressive management of cancer pain, resulting in better outcomes in cancer treatment.
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Affiliation(s)
- Won Seop Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Taek Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Bok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Woo Young Park
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Delfini R, Marruzzo D, Tarantino R, Marotta N, Landi A. Multilevel oblique corpectomies as an effective surgical option to treat cervical chordoma in a young girl. World J Clin Cases 2014; 2:57-61. [PMID: 24653986 PMCID: PMC3955801 DOI: 10.12998/wjcc.v2.i3.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/02/2014] [Accepted: 01/20/2014] [Indexed: 02/05/2023] Open
Abstract
Chordomas are malignant tumors arising from notochordal remnants. They are the most frequent tumors of the spine after plasmacytomas. Only 6% of chordomas are localized to the cervical level. In young patients, chordomas are rare and unpredictable. Despite this, the treatment of choice remains the total resection, as much as possible, followed by proton beam radiation. This case was managed using a precarotid and retrocarotid approach at the same time. The tumor was completely resected with the edges free from disease. The cervical spine was stabilized with an anterior plating C2-C4. Eighteen months after surgery the patient is still free from illness. Multilevel oblique corpectomies are an available and safe option for the treatment of upper cervical chordomas.
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Grossbach A, Baimeedi P, McDonald W, Bergman T. Multicentric chordoma: a case report and review of the literature. Neurosurgery 2012; 69:E1327-32. [PMID: 21712742 DOI: 10.1227/neu.0b013e31822a994d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Chordomas are relatively rare tumors that arise from the neuraxis. Most often, chordomas are single lesions that metastasize late. There have been very few cases of chordomas arising from multiple foci along the neuraxis. Here, we present a case of a multicentric chordoma. CLINICAL PRESENTATION The patient presented with pain in her right neck and soreness in her right shoulder that she had experienced for about 2.5 years that she attributed to a muscle strain. She experienced worsening of her symptoms, which prompted her to seek medical care. The patient underwent an occiput-to-C6 posterolateral fusion with autograft and an occiput-to-C6 posterior segmental instrumentation, along with decompression of the spinal cord. One month after the initial surgery, the patient underwent a second surgery. The C2 and C3 vertebral bodies were completely resected, and a C1-C4 anterior fusion was then carried out. A C5 vertebrectomy and C4-C6 fusion were also performed at this time. The patient then received proton beam radiation to the entire affected area. CONCLUSION Recent studies have suggested that chordomas arise from benign notochordal tumors. We suggest that our patient suffered from multicentric chordomas with possible benign notochordal tumors. Although benign notochordal tumors do not require surgical resection, the possibility of transformation to a malignant lesion requires close follow-up.
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Affiliation(s)
- Andrew Grossbach
- Department of Neurosurgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
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