Chordoma (C4 vertebra)

Case contributed by A.Prof Frank Gaillard

Presentation

Radicular pain.

Patient Data

Age: 65 years
Modality: CT

There is a large destructive tumour centred on the right side of the C4 vertebral body, and extending into the right C4 lateral mass, pedicle and lamina. It protrudes into the spinal canal at this level although there is no obvious impingement on the spinal cord within the limits of this CT.

There is very slight erosion of the right posterior corner of the adjacent C3 inferior endplate and the right posterior corner of the adjacent C5 superior endplate.

CONCLUSION: MRI is recommended for further evaluation of the extent of the mass, better evaluation of the spinal cord. 

Modality: MRI

A right C4 vertebral body mass with avid homogeneous enhancement and vividly high T2 signal. Posteriorly, the extraosseous portion of the mass indents the thecal sac and slightly flattens the right ventral spinal cord, without abnormal cord signal. There is complete obliteration of the right C3/4 andC4/5 intervertebral foramen. Near complete encasement of the right vertebral artery at the level of the C4 transverse foramen, with normal flow void maintained in the vessel, displaced anterolaterally.

 

Case Discussion

The patient went on to have a resection. 

Histology

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular epithelioid tumour, which has a lobulated appearance. It forms sheets, nests and cords in a background of myxomatous stroma. The tumour invades into the bony trabeculae. The tumour cells have moderately enlarged nuclei, focal prominent nucleoli and moderate amounts of eosinophilic cytoplasm. Scattered physaliferous cells are seen and they show cytoplasmic vacuolation. Mitoses are inconspicuous. Lymphovascular or perineural invasion is absent. Some parts of the tumour are surrounded by fibrous tissue with clear diathermied edges. The features are those of chordoma. The tumour cells are diffusely CAM5.2, focally S-100, CK7 and CK20 positive. The Ki-67 index is about 8%. CDX-2, GATA-3 and TTF-1 are negative.

FINAL DIAGNOSIS: Chordoma.

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Case Information

rID: 47561
Case created: 21st Aug 2016
Last edited: 18th Jan 2017
System: Spine
Inclusion in quiz mode: Included

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