Sacrococcygeal Chordoma

(Cases Report)
Gatot Aji Prihartomo, Suzy Indharty, Abdul Gofar Sastrodiningrat
Departement of Neurosurgery
Medical Faculty Sumatera Utara University / H. Adam Malik General Hospital, Medan

INTRODUCTIO
N
Chordoma is a primary sacral neoplasm of ectodermal origin from notochordal crests and makes up 1%- 4% of all primary
bone tumors. The estimated yearly chordoma incidence is 0.5 cases per million inhabitants. It is usually present on the midline
cerebrospinal axis and the most common locations are the spheno-clival region and the sacrum. About 50% of chordomas are
sacrococcygeal in origin. They have little metastatic potential, but considerable local destructiveness 1.

CASE REPORT CASE REPORT

1 2
A 57-year-old man with weakness in his lower extremity was A 30-year-old woman came with weakness in both of her legs
admitted to our neurosurgery department. He also suffered severe and sphincter disturbances. In the radiological evaluation,
pain in the sacral region. In his initial physical exam, a rough lumbosacral magnetic resonance imaging (MRI) was performed and
palpable mass lesion was present at the sacral region. Upon anal the tests revealed the mass arising from L4 to S2. Lession was
tonus examination, a dense mass lesion was placed on the hypointense to the bone in T1-W sequens and hyperintense in T2-W
posterior wall of the rectum. The rectal tonus and perianal sequens. After contrast gadolinium administration, the lession
examinations were normal. In the radiological evaluation, showed the enhancing. (Figure 3)
lumbosacral magnetic resonance imaging (MRI) was performed and
the tests revealed the mass arising from S2 to the coccyx. Lession
was hypointense to the bone in T1-W sequens and hyperintense in
T2-W sequens. After contrast gadolinium administration, the lession T1-W
didnt showed the enhancing. (Figure 1)
T1-W T2-W T1-W+C

T1-W T2-W T1-W+C T1-W

D
D
T2-W+C
T2-W

A B C E A B C E
Figure 1. Lumbo-sacral MRI showing an isointense in T1-W Figure 3. Lumbo-sacral MRI showing an isointense in T1-W
sequens and hyperintens in T2-W sequens. After gadolinium sequens and hyperintens in T2-W sequens. After gadolinium
administration the lession wasnt enhanced. administration the lession was enhanced.

In the operating room, after We performed

prone position, we performed laminectomy and the
laminectomy. The hard and dark mucous-like and dark red
red color tumor was identified color tumor was identified
B
B on S2 to coccyx. In the on L4 to S2. The lession
pathology evaluation, the was suctionable. In the
pathologists reported the tumor pathology evaluation, the
as chordoma. (Figure 2) pathologists reported the
tumor as chordoma. (Figure
4)
A Chordoma isCa malignant tumor thought to arise from notochordal crests.AThese are slow-growing C tumors with a long doubling time. They may
appear anywhere on the midline cerebrospinal axis; however, the most common locations are the spheno-clival region and the sacrum 2. Clinical
Figure 2. A. Laminectomy was performed and B. The mucous-like and Figure 4. A. Laminectomy L4-S2 was performed and B. The mucous-like and
signs and symptoms may vary depending on the location and the size of the tumor and the extent of neural invasion. Diagnostic procedures consist
dark red tumor was identified, C. Lobulation,2 myxoid and chondroid matrix dark red tumor was identified, C. Pysaliferous which has myxoid matrix
of vacuolated
and radiological and
cells pathologic
with a chording evaluation
arrangement.were
Unfortunately, the lesion is poorly and
seen in HE 100X. accessible by conventional
vacuolisation radiography.
were seen in HE 200x. Contrast-enhanced MRI is the
DISCUSSIO
gold standard when it comes to radiological tools. MRI studies demonstrate a sacral region showing the isointensity to the vertebra in a T1 image
with cystic lesion, while a T2 image shows high signal intensity 3. The primary therapeutic choice for a sacrococcygeal chordoma is surgical excision.
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Furthermore, the surgical approach is difficult because of the site and size of the tumor and its anatomical relation and involvement with
surrounding tissues and organs. The literature provides different suggestions and experiences about surgical approaches, but no method has
become a standard because of the heterogeneity of these tumors. Sacral tumors may present a difficult problem to the surgeon who desires to
obtain a clear margin of excision4.

Refference:
1. Sabuncuoglu H, Osdogan S, Dogan H, Ataoglu O, Timurkaynak E. Total Resection of Inferiorly Located Sacral Chordoma with Posterior Only Approach: Case Report and Review of The Literature. Turkish Neurosurgery. 2010. 20. 4:527-
532.
2. Konya D, Gercek A, Toktas ZO, Ozgen S, Yegen C, Pamir NM: Sacrococcygeal chordoma mimicking lipoma: Case Report. World Spine Journal 2(3):148-151, 2007
3. Sung MS, Lee GK, Kang HS, Kwon ST, Park JG, Suh JS, Cho GH, Lee SM, Chung MH, Resnick D: Sacrococcygeal chordoma: MR imaging in 30 patients. Skeletal Radiol 34:87-94, 2005
4. Gennari L, Azzarelli A, Quagliuolo V: A Posterior approach for the excision of sacral chordoma. The Journal of Bone and Joint Surgery 69-B(4):565-568, 1987