Sacrococcygeal chordoma

Case contributed by Prashant Mudgal
Diagnosis probable


Elderly male presented with lower backache, urinary and bowel symptoms.

Patient Data

Age: 55 years
Gender: Male

A large, lobulated mass arising from the sacrum, with soft-tissue extension anteriorly, posteriorly, and into the sacral epidural space. 
On T1WI it's isointense relative to that in muscle, with scattered areas of hyperintensity signify hemorrhage or mucinous material. On T2WI the mass has heterogeneous high signal intensities with areas of low signal intensity. Some of the areas of low signal intensity corresponded to areas of high signal intensity on T1-weighted images. There is abnormal high signal intensity the lower sacral segments and in the coccyx. 
On STIR, the lesion is markedly heterogeneously hyperintense.

Imaging features are most likely represent  sacral chordoma.

Case Discussion

Chordomas are rare malignant however slowly growing tumors of skull base and vertebrae with the most common location being sacrococcyx followed by clivus and rest of the vertebrae.

It is commonly presented as dull lower backache, urinary or bowel symptoms and rarely as a palpable mass. 

Most of the cases rendered inoperable at the time of initial presentation. Recurrence rate is very high. 

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