Журнал клинических случаев

Chordoma in the Thoracolumbar Spine: A Case Report

Abstract

Batash R, Simonovich A, Lee E, Schaffer M, Debbi R, Livoff A, Lubovsky O and Djabarov R

Purpose: Chordomas arise from embryonic notochordal remnants along the length of the neuraxis at
developmentally active sites. They constitute less than 1% of CNS tumors and r: rely occur in extra-axial locations.
Chordoma in the thoracic spine is considered rare and comprises less than 15% of all chordomas.
Case study: A healthy, 42-year-old male presented with radiculating low back pain, with a sudden onset four
weeks prior to this examination. He complained of paresthesias, unstable walk patterns and difficulties in urination;
however, no neurologic deficits were reported. On CT and MRI, an occupying soft tissue lesion was detected with
pressure on the thecal sac at the level of D6-D9 vertebrae. The lesion was irregular and diagnosed initially as a
dermoid tumour. After primary debalking and fixation, the pathological biopsy revealed a chordoma. The patient had
a second surgery to change the primary fixators to carbon made rods prior to Proton Beam Therapy.
Discussion: According to the imaging and location of the lesion, chordoma was not the suggested diagnosis.
Surprisingly, based on the histopathological results, a chordoma was diagnosed. Due to the multidisciplinary
treatment approach, the patient was prepared for following radiotherapy treatment. Two years after treatment, there
are no signs of a lesion or clinical signs of thecal sac involvement.
Conclusion: When suspicion of an irregular space-occupying lesion arises, always act as if a malignancy is
present. We recommend a multidisciplinary approach in coordination with oncologists, pathologists, the surgical
team and the radiation centre for management of such cases.