1
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Mahmoud AA, Wei ET, Naser-Tavakolian K, Gupta A. Mediastinal extraosseous chordoma in a teenager: Diagnosis by ultrasound-guided percutaneous biopsy. Radiol Case Rep 2022; 17:3859-3862. [PMID: 35982720 PMCID: PMC9379981 DOI: 10.1016/j.radcr.2022.07.085] [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: 07/06/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022] Open
Abstract
Pediatric chordomas are rarely described in the literature with most cases being managed surgically followed by adjuvant radiotherapy for local control. We present a case of an 18-year-old female with thoracic chordoma causing significant mass effect resulting in tracheal deviation, esophageal compression, and splaying of the great vessels. Ultrasound-guided anterior left transcervical percutaneous biopsy of the neck with surgical pathology immunohistochemistry confirmed the presence of chordoma. The patient underwent extensive palliative debulking followed by radiation therapy leading to clinical improvement. This case demonstrated that an ultrasound-guided percutaneous biopsy is an essential procedure in the diagnosis and treatment of chordoma, which led to successful treatment when followed by surgery and radiation.
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Affiliation(s)
- Amir-Ali Mahmoud
- Stony Brook Renaissance School of Medicine, 100 Nicolls Rd, Stony Brook, NY 11794, USA
- Corresponding author.
| | - Eric T. Wei
- Stony Brook University Hospital, Department of Radiology, 101 Nicolls Rd level 4, Stony Brook, NY 11794, USA
| | - Kiyon Naser-Tavakolian
- Stony Brook University Hospital, Department of Radiology, 101 Nicolls Rd level 4, Stony Brook, NY 11794, USA
| | - Amit Gupta
- Stony Brook University Hospital, Department of Radiology, 101 Nicolls Rd level 4, Stony Brook, NY 11794, USA
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2
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Lee S, Halpern JL, Liang J. Pediatric Extra-Axial Chordoma: Case Report and Literature Review. Pediatr Dev Pathol 2021; 24:585-591. [PMID: 34176365 DOI: 10.1177/10935266211027429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-axial chordomas in the pediatric population are extremely rare and diagnostically challenging; only four cases have been previously reported with ages ranging from 13 to 20 years. We report a primary extra-axial chordoma involving the soft tissue directly dorsal and ulnar to proximal phalanx in the right thumb of a 12-year-old girl who presented with worsening right thumb pain for 1.5 years. The diagnosis was confirmed by excisional biopsy demonstrating proliferation of large, polygonal epithelioid cells with diffuse expression of pan-cytokeratin and brachyury. The patient required repeat excision for local recurrence seven months later. Since then, she has remained disease free through 15 months surveillance. Extra-axial chordomas share the same histopathological and immunohistochemical characteristics with their axial counterparts and should be considered in the differential diagnosis for any extra-axial bone or soft tissue mass with epithelioid morphology.
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Affiliation(s)
- Sean Lee
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer L Halpern
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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3
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Wen X, Cimera R, Aryeequaye R, Abhinta M, Athanasian E, Healey J, Fabbri N, Boland P, Zhang Y, Hameed M. Recurrent loss of chromosome 22 and SMARCB1 deletion in extra-axial chordoma: A clinicopathological and molecular analysis. Genes Chromosomes Cancer 2021; 60:796-807. [PMID: 34392582 DOI: 10.1002/gcc.22992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
Extra-axial chordoma is a rare neoplasm of extra-axial skeleton and soft tissue that shares identical histomorphologic and immunophenotypic features with midline chordoma. While genetic changes in conventional chordoma have been well-studied, the genomic alterations of extra-axial chordoma have not been reported. It is well known that conventional chordoma is a tumor with predominantly non-random copy number alterations and low mutational burden. Herein we describe the clinicopathologic and genomic characteristics of six cases of extra-axial chordoma, with genome-wide high-resolution single nucleotide polymorphism array, fluorescence in situ hybridization and targeted next-generation sequencing (NGS) analysis. The patients presented at a mean age of 33 years (range: 21-54) with a female to male ratio of 5:1. Four cases were histologically conventional type, presented with bone lesions and three of them had local recurrence. Two cases were poorly differentiated chordomas, presented with intra-articular soft tissue masses and both developed distant metastases. All cases showed brachyury positivity and the two poorly differentiated chordomas showed in addition loss of INI-1 expression by immunohistochemical analysis. Three of four extra-axial conventional chordomas showed simple genome with loss of chromosome 22 or a heterozygous deletion of SMARCB1. Both poorly differentiated chordomas demonstrated a complex hyperdiploid genomic profile with gain of multiple chromosomes and homozygous deletion of SMARCB1. Our findings show that heterozygous deletion of SMARCB1 or the loss of chromosome 22 is a consistent abnormality in extra-axial chordoma and transformation to poorly differentiated chordoma is characterized by homozygous loss of SMARCB1 associated with genomic complexity and instability such as hyperdiploidy.
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Affiliation(s)
- Xiaoyun Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Cimera
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ruth Aryeequaye
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mohanty Abhinta
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Edward Athanasian
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John Healey
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicola Fabbri
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick Boland
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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4
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Ball S, Dash A, Igid HP, Thein KZ, Sharma U, Tijani L. Primary Extra-axial Chordoma Masquerading as Lung Cancer: Case Report and Review of the Literature. Clin Lung Cancer 2020; 21:e560-e563. [DOI: 10.1016/j.cllc.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/04/2020] [Accepted: 05/01/2020] [Indexed: 01/19/2023]
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5
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Shintaku M, Kikuchi R. Benign notochordal cell tumor of the lung: Report of a case. Pathol Int 2020; 70:871-875. [PMID: 32827236 DOI: 10.1111/pin.13005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Abstract
A surgical case of a benign notochordal cell tumor of the lung is reported. The patient was an asymptomatic 41-year-old man, who was incidentally found to have a small tumor in the subpleural region of the left lingular segment. Since wedge resection of the tumor, the patient has been free from recurrence. The tumor measured 12 mm in diameter and showed a central cystic change. It consisted of a diffuse proliferation of polygonal cells with abundant, uni- or multi-vacuolated cytoplasm and bland nuclei. The tumor did not show a lobular architecture and lacked a myxoid or fibrous connective tissue containing blood vessels. In the peripheral region of the tumor, a small number of alveolar epithelial cells were entrapped. The nuclei of tumor cells were immunoreactive for brachyury, and the cytoplasm was positive for cytokeratin and S-100 protein. The entrapment of alveolar epithelial cells suggests infiltrative growth of the tumor, and the almost complete absence of blood vessels within the tumor may have restricted tumor growth and induced a cystic change in the central region.
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Affiliation(s)
| | - Ryutaro Kikuchi
- Department of Thoracic Surgery, Shiga General Hospital, Shiga, Japan
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6
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Ueda T, Kubota K, Shiroma N, Maeda S, Furuie H, Taruya T, Hamamoto T, Takeno S. Extra-axial chordoma of the gingiva. Auris Nasus Larynx 2019; 47:299-304. [PMID: 30904199 DOI: 10.1016/j.anl.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extra-axial chordomas are exceedingly rare malignant tumours. Herein, we present the first case of an extra-axial chordoma in the gingivae. METHODS AND RESULTS A 21-year-old man presented with a suspected chordoma in the upper right gingiva. Diagnosis was difficult; however, owing to strong expression of the chordoma marker brachyury, extra-axial chordoma was ultimately diagnosed. The tumour was completely resected without performing a facial incision. To ensure its safety and effectiveness, the surgical procedure was simulated several times before its performance using a three-dimensional (3D) model. Twenty-four months after surgery, the patient remains disease-free. CONCLUSION A diagnosis of extra-axial chordoma can be confirmed by immunohistochemical staining for brachyury.
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Affiliation(s)
- Tsutomu Ueda
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan.
| | - Kazunori Kubota
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan
| | - Noriyuki Shiroma
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shogo Maeda
- Department of Diagnostic Radiology, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Hiroshima University, Japan
| | - Hiromi Furuie
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan
| | - Takayuki Taruya
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan
| | - Takao Hamamoto
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan
| | - Sachio Takeno
- Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan
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7
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Parosteal extra-axial chordoma of the second metacarpal bone: a case report with literature review. Skeletal Radiol 2018; 47:579-585. [PMID: 29151144 DOI: 10.1007/s00256-017-2818-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/20/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
Extra-axial chordoma is a chordoma that occurs in non-axial locations. It is a very rare tumor, with 20 cases reported to date; 14 in bone and six in soft tissue. Of the 14 skeletal extra-axial chordomas, ten were intramedullary and four were intracortical. We report the first case of parosteal extra-axial chordoma arising in the second metacarpal bone, expressing brachyury on immunohistochemical analysis, and describe the pathologic and radiologic findings. We suggest that extra-axial chordoma can occur in parosteal bone lesions or the hand, without features of bone distribution or bone-specific sites.
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8
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Huang J, Bhojwani N, Oakley FD, Jordanov MI. Proximal tibial extra-axial chordoma masquerading as renal cell carcinoma metastasis. Skeletal Radiol 2017; 46:1567-1573. [PMID: 28702752 DOI: 10.1007/s00256-017-2711-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 02/02/2023]
Abstract
Chordomas are rare, locally aggressive notochordal tumors, which most frequently occur in the neuraxis. We describe the case of a 74-year-old male with a history of renal cell carcinoma, who presented with a slowly enlarging mass in his left leg. While the clinical history and imaging suggested metastatic renal cell carcinoma, immunohistochemical staining with brachyury ultimately made the diagnosis of extra-axial chordoma. At 74 years of age, our patient is the oldest ever reported with bony extra-axial chordoma objectively confirmed by brachyury staining. A detailed case discussion and a review of the available literature on this rare clinicopathologic entity are provided.
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Affiliation(s)
- Jennifer Huang
- Department of Radiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
| | - Nicholas Bhojwani
- Department of Radiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Fredrick D Oakley
- Department of Pathology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Martin I Jordanov
- Department of Radiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
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9
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Bitzer A, McCarthy EF, Morris CD. Extra-Axial Chordoma of the Hand. J Hand Surg Am 2017; 42:933.e1-933.e5. [PMID: 28709789 DOI: 10.1016/j.jhsa.2017.05.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 02/02/2023]
Abstract
Chordomas are low-grade malignant tumors that are locally aggressive and have the potential to metastasize. They most often occur in the sacrococcygeal and spheno-occipital portions of the vertebral column. Morphologically similar tumors have been found outside the axial skeleton and are referred to as extra-axial chordomas. Several case reports have described the radiologic, microscopic, and immunologic profiles of these tumors and their similarities to axial chordomas. The authors report a 24-year-old man who presented with a mass in his left hand and underwent surgical excision. Specimens stained positive for pancytokeratin, S100, and brachyury. Brachyury is a protein that is present during embryogenesis and is expressed by chordomas. This is the first report of an extra-axial chordoma within the interosseous muscle compartment of the hand in a young patient.
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Affiliation(s)
- Alexander Bitzer
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | | | - Carol D Morris
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD.
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10
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Abstract
INTRODUCTION A chordoma is a slow growing malignant tumour of notochordal origin. A tumour with histological features that are identical to those of a chordoma may arise outside the axial skeleton. To date, there is little in the literature documenting their clinical course. METHODS Our large orthopaedic oncology database was used to document the clinical course of extra-axial chordoma. RESULTS Over a 30-year period, 131 patients diagnosed with a chordoma were treated at our unit. Only three (2.3%) of these cases were extra-axial chordomas: one in the femur, one in the ulna and one in the proximal fibula. All underwent surgical resection. CONCLUSIONS In view of the rarity of this tumour and the difficulty in confirming its diagnosis, we suggest that any suspected case is discussed with a specialist sarcoma multidisciplinary team so that the correct diagnosis can be achieved and treatment tailored accordingly.
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Affiliation(s)
- S Evans
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - Z Khan
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
- Rehman Medical Institute , Pakistan
| | - L Jeys
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust , UK
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11
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Rekhi B. Primary, large extra-axial chordoma in proximal tibia: a rare case report with literature review and diagnostic implications. APMIS 2015; 124:238-42. [DOI: 10.1111/apm.12468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology; Tata Memorial Centre; Mumbai India
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12
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Radzikowska J, Gronkiewicz Z, Kukwa A, Lisik W, Czarnecka AM, Krzeski A, Kukwa W. Nasopharyngeal chordoma in a patient with a severe form of sleep-disordered breathing: A case report. Oncol Lett 2015; 10:1805-1809. [PMID: 26622754 DOI: 10.3892/ol.2015.3393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/22/2015] [Indexed: 12/18/2022] Open
Abstract
Nasopharyngeal chordoma is a rare type of malignant neoplasm that originates in the remnants of the notochord, a primitive tissue of embryonic origin preserved outside the axial skeleton. Approximately one-third of chordomas are located in the base of the skull, in the midline of the body. The slow growth rate of the tumor, which gradually fills the nasopharyngeal cavity, contributes to a delayed oncological diagnosis. Among its isolated and non-specific symptoms, the obstruction of the nasopharynx is dominant, thus, sleep-disordered breathing (SDB) may occur. The current study presents the case of a 32-year-old female patient who was incidentally diagnosed with a nasopharyngeal chordoma during a diagnostic examination for SDB. The diagnostic examination was performed as a part of a research program for pathologically obese patients who qualified for bariatric surgery. Following tumor resection, a significant improvement in various polysomnographic parameters occurred, including a decrease in the apnea hypopnea index from 53.5 to 6.4 and an increase in the mean saturation rate from 92.5 to 95%, confirming that an association exists between tumor obstruction of the nasopharynx and SDB. The incidental diagnosis of this rare type of neoplasm drew attention to diagnostic and therapeutic problems associated with nasopharyngeal chordomas. Furthermore, it indicated the necessity for the accurate laryngological examination of patients with SDB.
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Affiliation(s)
- Joanna Radzikowska
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Zuzanna Gronkiewicz
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Andrzej Kukwa
- Department of Otolaryngology and Head and Neck Disease, University of Varmia and Mazuria School of Medicine, Olsztyn 10-082, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
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13
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Takahashi Y, Motoi T, Harada M, Fukuda Y, Hishima T, Horio H. Extraosseous benign notochordal cell tumor originating in the lung: a case report. Medicine (Baltimore) 2015; 94:e366. [PMID: 25569657 PMCID: PMC4602839 DOI: 10.1097/md.0000000000000366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Benign notochordal cell tumors (BNCTs) are tumors originating in the axial skeleton, where chordomas occur. Although very rare, some cases of extraosseous chordoma, such as in the soft tissue and lungs, have been reported. We report a case of a primary tumor showing the notochordal characteristics of BNCTs within the axial skeleton.An asymptomatic 57-year-old woman presented with an abnormal shadow on her chest radiograph; chest computed tomography revealed a well-defined round nodule. The resected sample tissue contained a jelly-like small nodule. Histologically, it was identified as a BNCT, based on minimal nuclear atypia, extremely low mitotic activity within the tumor cells lying in a sheet-like arrangement, and focal immunopositivity for brachyury.This is the third case report of BNCT originating in the lungs; BNCTs are considered asymptomatic tumors that are identified by using highly developed chest imaging technology; however, our findings also suggest that these notochordal tumors may potentially originate from extraosseous sites that lack ideal precursor cells. Our case suggests that notochordal tumors can arise from organs that are unrelated to known notochordal development.
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Affiliation(s)
- Yusuke Takahashi
- From the Department of Thoracic Surgery (YT, MH, HH); and Department of Pathology (TM, YF, TH), Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
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14
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George B, Bresson D, Bouazza S, Froelich S, Mandonnet E, Hamdi S, Orabi M, Polivka M, Cazorla A, Adle-Biassette H, Guichard JP, Duet M, Gayat E, Vallée F, Canova CH, Riet F, Bolle S, Calugaru V, Dendale R, Mazeron JJ, Feuvret L, Boissier E, Vignot S, Puget S, Sainte-Rose C, Beccaria K. [Chordoma]. Neurochirurgie 2014; 60:63-140. [PMID: 24856008 DOI: 10.1016/j.neuchi.2014.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
PURPOSES To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature. MATERIALS The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine. METHODS In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups. RESULTS In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection. CONCLUSIONS Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.
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Affiliation(s)
- B George
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - D Bresson
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Bouazza
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Froelich
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Mandonnet
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Hamdi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Orabi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Cazorla
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - H Adle-Biassette
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-P Guichard
- Service de neuroradiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Duet
- Service de médecine nucléaire, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Gayat
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - F Vallée
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C-H Canova
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Riet
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Bolle
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Calugaru
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Dendale
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Boissier
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Vignot
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Puget
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - C Sainte-Rose
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - K Beccaria
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
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Muro K, Das S, Raizer JJ. Chordomas of the craniospinal axis: multimodality surgical, radiation and medical management strategies. Expert Rev Neurother 2014; 7:1295-312. [DOI: 10.1586/14737175.7.10.1295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Recurrent skeletal extra-axial chordoma confirmed with brachyury: imaging features and review of the literature. Skeletal Radiol 2013; 42:1451-9. [PMID: 23653219 DOI: 10.1007/s00256-013-1615-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 03/28/2013] [Accepted: 04/01/2013] [Indexed: 02/02/2023]
Abstract
A small number of tumors bearing histological resemblance to axial chordoma arising from the bone or soft tissue outside the axial skeleton have been reported. These lesions have historically been referred to as parachordoma, chordoma periphericum (CP), or extra-axial chordoma (EAC). With the introduction of the immunohistochemical stain brachyury, a sensitive and specific marker for notochordal origin, chordomas arising in extra-axial locations (i.e., CP, EAC), are now diagnosed with more accuracy and distinguished from parachordoma, which resembles chordoma on histology. The distinction between EAC and parachordoma is clinically important because EAC confirmed by immunoreactivity for brachyury tends to grow and recur with local bone destruction. Prior to the introduction of brachyury, the diagnosis of EAC was challenging and therefore the imaging features of EAC have not been comprehensively described. We report two cases of recurrent EAC confirmed by the expression of brachyury arising from the distal femur and distal tibia and describe the imaging findings from radiography and MRI at initial diagnosis and at recurrence.
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Cates JMM, Coffin CM. Extraskeletal cartilaginous, osseous, and chordoid tumors in children and adolescents. Pediatr Dev Pathol 2012; 15:255-66. [PMID: 22420731 DOI: 10.2350/10-07-0875-pb.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Extraskeletal cartilaginous, osseous, and chordoid tumors are extraordinarily rare in children and adolescents. These lesions are diagnostically challenging due to their rarity and their overlap with metastatic osteosarcoma, reactive or metabolic calcifying and bone-forming masses, various pseudosarcomatous proliferations such as myositis ossificans, and other rare genetic or metabolic disorders. This article reviews the clinicopathologic features and differential diagnosis of extraskeletal cartilaginous, osseous, and chordoid neoplasms in the first two decades of life and highlights the use of diagnostic adjuncts.
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Affiliation(s)
- Justin M M Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA
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Suzuki H, Yamashiro K, Takeda H, Nojima T, Usui M. Extra-axial soft tissue chordoma of wrist. Pathol Res Pract 2011; 207:327-31. [DOI: 10.1016/j.prp.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/17/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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20
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DeComas AM, Penfornis P, Harris MR, Meyer MS, Pochampally RR. Derivation and characterization of an extra-axial chordoma cell line (EACH-1) from a scapular tumor. J Bone Joint Surg Am 2010; 92:1231-40. [PMID: 20439670 PMCID: PMC7000130 DOI: 10.2106/jbjs.i.00594] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extra-axial chordomas are rare low-grade malignant tumors thought to arise from notochordal remnants in the extra-axial skeleton. Few studies have been done on this neoplasm because of its rarity. In addition, there is a lack of a good in vitro model on which to perform more characterization. METHODS We describe a twenty-eight-year-old man with a mass in the right scapula. Cytomorphology and immunohistochemistry, including brachyury staining, were used to formulate the final diagnosis. A fragment of the tumor was placed in culture, and cells obtained were injected subcutaneously in an immunocompromised mouse. From the tumor developed in mice, a cell line has been derived and characterized by fluorescence-activated cell-sorting analysis, karyotyping, clonogenicity, and cell and tumor growth curves. RESULTS Cytomorphology on the tumor showed nests of round cells with vacuoles and also physaliferous-like cells with uniform nuclei. Immunochemistry revealed a tumor positive for vimentin, moderately positive for S-100 and cytokeratin AE1/AE3, weakly positive for epithelial membrane antigen, and negative for p63 and cytokeratin (CK)-7. Further analysis revealed the tumor was diffusely and strongly positive for brachyury. The cell line derived from the tumor showed rapid doubling-time, a strong expression of mesenchymal cell surface markers, a karyotype of diploid or hypotetraploid clones with numerous chromosomal aberrations, and the ability to form colonies without attachment and to form tumors in immunocompromised mice. CONCLUSIONS The diagnosis of the extra-axial chordoma is difficult but can be resolved by the detection of a strong brachyury expression. In addition, the derivation of a human extra-axial chordoma cell line could be a useful tool for the basic research of this rare neoplasm.
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Affiliation(s)
- Amalia M. DeComas
- Department of Orthopaedics, University of Texas M.D. Anderson Cancer Center, 1400 Pressler Boulevard, Suite FCT 10.5067, Houston, TX 77030
| | - Patrice Penfornis
- Tulane Center for Gene Therapy, Tulane University Health Sciences Center, JBJ Building, 1324 Tulane Avenue, SL-99, New Orleans, LA 70112. E-mail address for R.R. Pochampally:
| | - Michael R. Harris
- Tulane Center for Gene Therapy, Tulane University Health Sciences Center, JBJ Building, 1324 Tulane Avenue, SL-99, New Orleans, LA 70112. E-mail address for R.R. Pochampally:
| | - Mark S. Meyer
- Department of Orthopaedics, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121
| | - Radhika R. Pochampally
- Tulane Center for Gene Therapy, Tulane University Health Sciences Center, JBJ Building, 1324 Tulane Avenue, SL-99, New Orleans, LA 70112. E-mail address for R.R. Pochampally:
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Ridenour RV, Ahrens WA, Folpe AL, Miller DV. Clinical and histopathologic features of chordomas in children and young adults. Pediatr Dev Pathol 2010; 13:9-17. [PMID: 19348512 DOI: 10.2350/09-01-0584.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chordoma is a tumor of the axial skeleton that is distinctly uncommon in children and adolescents. Previous observations have suggested that chordomas in pediatric patients differ from adult chordomas in presentation, morphology, and behavior. This study examines the clinical and histologic features of chordomas in young patients (< or =25 years old). All cases from the Mayo Clinic files were graphed according to age and a bimodal distribution was observed. The 35 cases representing the youngest population were selected for review. Histopathology ranged from low cellularity tumors with lobulated architecture and abundant myxoid matrix (conventional chordoma), to those with varying amounts of chondroid matrix (chondroid chordoma), to more cellular tumors (atypical chordoma), and finally to neoplasms with high-grade spindle-cell differentiation (dedifferentiated chordoma). Over an average follow-up period of 129 months (range 1 to 501 months), there were 13 deaths (37%) and 3 patients with metastasis. This survival rate was slightly better than the reported mortality rate for adults with chordoma, but there was a subset of young patients (those with atypical chordoma) that had a significantly worse survival rate, suggesting that histologic subtyping may be predictive of prognosis.
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Affiliation(s)
- Robert V Ridenour
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Brennan PM, Summers DM, Ironside J, Fitzpatrick MO. Chordoma masquerading as a nerve root tumour -- a clinical lesson. Br J Radiol 2009; 82:e231-4. [PMID: 19890117 DOI: 10.1259/bjr/13776141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chordomas usually arise in bone and are most commonly found in the midline axial skeleton. An accurate pre-operative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery. We report a rare case of cervical chordoma masquerading radiologically as an extracranial nerve sheath tumour. A laterally situated chordoma (centred extra-osseously in the neural foramen) was diagnosed radiologically as a neurofibroma pre-operatively. We review the key radiological features for diagnosis of chordoma. We consider the importance of pre-operative diagnosis of chordoma in guiding management and in determining survival.
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Affiliation(s)
- P M Brennan
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
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Nguyen RP, Salzman KL, Stambuk HE, Ahuja AT, Harnsberger HR. Extraosseous chordoma of the nasopharynx. AJNR Am J Neuroradiol 2009; 30:803-7. [PMID: 19193749 PMCID: PMC7051767 DOI: 10.3174/ajnr.a1446] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 11/10/2008] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chordoma is a relatively rare tumor of the skull base and sacrum thought to originate from embryonic remnants of the notochord. Chordomas arising from the skull base/clivus are typically locally aggressive with lytic bone destruction. When chordomas occur in an extraosseous location, they may mimic other lesions of the nasopharynx. We present 5 cases of primarily extraosseous chordoma involving the nasopharynx in an effort to improve the preoperative diagnosis of this rare tumor. In addition, we review regional notochordal embryology to explain this variant tumor location. MATERIALS AND METHODS We reviewed the clinical and imaging data of 5 pathologically proved cases of extraosseous chordoma of the nasopharynx seen or reviewed at our institution during the last decade. All cases had both CT and MR imaging. The study had institutional review board approval. RESULTS The primary clinical complaint in the 5 patients with extraosseous nasopharyngeal chordoma was nasal obstruction. The extraosseous chordomas were centered in the nasopharynx. Bony lytic changes along the anterior surface of the clivus were seen on 5 of 5 CT studies. A midline sinus tract was seen in 3 of 5 patients. MR imaging showed heterogeneous hyperintense T2 signal intensity (5/5). CONCLUSIONS Extraosseous nasopharyngeal chordoma is a rare but important lesion to be considered in the differential diagnosis of nasopharyngeal masses. When a midline nasopharyngeal mass is found with an associated clival sinus tract, extraosseous chordoma moves to the top of the differential diagnosis list. Complete removal of the soft-tissue tumor and the clival sinus tract is the treatment of choice in such cases.
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Affiliation(s)
- R P Nguyen
- Department of Radiology, University of Utah Medical Center, Salt Lake City, Utah 84132, USA
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Brachyury Expression in Extra-axial Skeletal and Soft Tissue Chordomas: A Marker that Distinguishes Chordoma From Mixed Tumor/Myoepithelioma/Parachordoma in Soft Tissue. Am J Surg Pathol 2008; 32:572-80. [DOI: 10.1097/pas.0b013e31815b693a] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Champeaux K, San-Galli F, Eimer S, Liguoro D. Métastase radiculaire d’un chordome secondaire à une dissémination dans le liquide cérébrospinal. Neurochirurgie 2008; 54:41-5. [DOI: 10.1016/j.neuchi.2008.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 05/05/2007] [Indexed: 10/22/2022]
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Brachury—A Specific and Sensitive Marker for Chordoma. Adv Anat Pathol 2007. [DOI: 10.1097/pap.0b013e3180ca8ab0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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