Presentation
A postoperative patient for nasopharyngeal chordoma was confirmed by pathology as a conventional type chordoma and still has recurrent headaches.
Patient Data
At the level of the clivus, an irregular lesion is observed, with partially defined edges, which erodes the clivus bone, has an isointense behavior to substantia nigra on T1 and FLAIR, hyperintense on T2 with some areas of an absence of signal, without diffusion restriction no areas of magnetic susceptibility, it does not present enhancement after applying paramagnetic contrast, said lesion is directed anteriorly and infiltrates the intracanalicular portion of the ipsilateral optic nerve, extending towards the sphenoid sinus, intratemporal fossa, pterygopalatine, carotid space involving the carotid artery without causing stenosis of the carotid artery. It is laterally and ventrally adjacent to the space of the pharyngeal mucosa at the level of the roof of the palate, infiltrating both the long muscles of the head and the medial and lateral pterygoid muscles. Said mass measures 2.1 x 4.2 x 5.6 cm in its transverse, anteroposterior, and axes. longitudinal respectively with a volume of 25 cc.
In the right maxillary, mastoid, anterior, and posterior ethmoid sinuses, a hyperintense image is observed on T2 and FLAIR concerning mucous secretion, and the rest of the sinuses without alterations.
Presents absence of right osteomeatal complex about post-surgical changes.
In addition, the presence of an artifact in the oral cavity in dental treatment characterized by areas of signal absence at this level is commented.
Conclusion:
Extradural lesion at the level of the clivus causing its erosion, associated with infiltration of the intracanalicular portion of the right optic nerve and long muscles of the head, medial and lateral pterygoid presenting caudal extension towards the pterygopalatine fossa about nasopharyngeal chordoma.
Post-surgical changes at the level of the right nasal passage.
Case Discussion
MRI images were obtained identifying the typical honeycomb sign compatible with chordoma already confirmed by pathology as a conventional type chordoma is the most frequent of all.
Chordomas are rare malignant tumors of notochordal origin and may occur at any site along the course of the embryonic notochord. It is found in the second most frequent site, being the sacrococcygeal the most frequent location.
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