Chordoma - clivus
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Selected images from contrast-enhanced CT demonstrates clival destruction with a large soft tissue component extending anteriorly and appearing to occlude the nasopharynx. The mass is of relatively low attenuation (lower than the brain, slightly higher than CSF) and has spicules of bone within it.
The patient went on to have a biopsy.
The biopsy consists of myxoid tissue containing polygonal cells with prominent cell borders and pink cytoplasm. Some of the cells are vacuolated. Immunohistochemistry has been carried out and this shows that the tumour cells stain strongly with both epithelial markers (pan-keratin, cam5.2, EMA) and with S100, typical of chordoma.
FINAL DIAGNOSIS: chordoma