60 years old patient presenting with a lower back lump and lower limb weakness.
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A large destructive bony mass lesion is centered upon the sacrum and coccyx destroying all sacral vertebrae and coccyx sparing S1 vertebra. The mass is seen showing the following MR features, extensions & relations:-
The mass show a multi-lobulated surface with associated extra-osseous large pre sacral anterior and smaller posterior muscular /subcutaneous soft-tissue components. It measures about 13.8 x 10.4 x 11.3 cm along its maximal anteroposterior, transverse and craniocaudal dimensions. it is seen eliciting a predominantly low-signal-intensity with several areas of higher signal intensity on T1 WI, mixed intermediate and high signal on T2 WI markedly hyper intense signal within the mass on STIR WIs. In post contrast series it show intense heterogeneous enhancement within the mass.
The anteriorly located soft tissue component is seen filling the sacral curvature, right lateral aspect of the pelvis pushing the pelvic viscera (namely rectum and urinary bladder) anteriorly and bulging in front the S1 vertebral body with no signs of visceral infiltration could be seen.
The posteriorly located soft tissue component is seen infiltrating the left gluteus maximus andmedius muscles.
Sacro-coccygeal destructive osseous mass with associated soft tissue components. Patholgically proven sacro-coccygeal chordoma.