Case Report
Batash R, Simonovich A, Lee
Abstract
Purpose: Chordomas arise from embryonic notochordal remnants along the length of the neuraxis atdevelopmentally 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 fourweeks 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 withpressure on the thecal sac at the level of D6-D9 vertebrae. The lesion was irregular and diagnosed initially as adermoid tumour. After primary debalking and fixation, the pathological biopsy revealed a chordoma. The patient hada 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 multidisciplinarytreatment approach, the patient was prepared for following radiotherapy treatment. Two years after treatment, thereare 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 ispresent. We recommend a multidisciplinary approach in coordination with oncologists, pathologists, the surgicalteam and the radiation centre for management of such cases.