Chordoma - sacrococcygeal

Case contributed by Dr Domenico Nicoletti

Presentation

Sacral pain over the past several months that worsened when sitting and was relieved when standing. In addition, occasional bouts of constipation during this time.

Patient Data

Age: 70 years
Gender: Male
CT

At the level of the distal coccyx, is visible a neoformation with regular margins and modest enhancement, extending anteriorly to reach contact with the posterior wall of the rectum and posteriorly with the skin. There are two small nodules with the same density near the gluteus maximus right muscle.

The dystrophic calcifications within the tumor are clearly evident.

MRI

Signal of the coccygeal lesion:

  • T1: intermediate signal intensity with small foci of hyperintensity (intratumoral hemorrhage or a mucus pool).
  • T2: very high signal
  • T1 C+ (Gd): heterogeneous enhancement with a honeycomb appearance.
  • Diffusibility restricted in DWI and low signal in ADC.

Confirm two nodules of the same intensity of mass on the right, near the gluteus maximus muscle. The gluteal muscles are not infiltrated while the last coccygeal vertebrae show osteolysis.

Pathology

The histological report confirms the diagnosis of chordoma.

Case Discussion

Chordoma is a type of cancerous (malignant) tumor that can occur in the bones of the spine and base of the skull.

Chordomas develop in leftover cells from the notochord (a cartilage-like structure). Most of the notochord is replaced by the spine during the first six months of development. Small areas can remain, however, and it is believed that chordomas can form in these areas.

Chordomas can occur anywhere along the spine, but most often occur at the base of the spine (sacrum), in the tailbone (coccyx), or at the base of the skull.

Case courtesy: Dr.ssa Sara Zanzani

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Case information

rID: 65859
Published: 27th Jan 2019
Last edited: 29th Jan 2019
Inclusion in quiz mode: Included

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