Académique Documents
Professionnel Documents
Culture Documents
.1
Francisc,a T. de BruIne1 The radiologic appearance of chordoma of the cervical (three patients), thoracic (four
Herman M. Kroon patients), and lumbar spine (seven patients) was studied. Eleven patients were over 50
years old and presented with long-standing back pain. All were examined with conven-
tional radiographs; three cases also had CT examinations. In thirteen patients, the tumor
American Journal of Roentgenology 1988.150:861-863.
originated in the vertebral body and, in one patient, in the posterior element of a vertebra.
In nine (64%) of the 14 cases, osteosclerosis was a prominent feature. In the remaining
five cases (36%), the bone lesion was purely osteolytic Involvement of the intervertebral
disk was found in three patients; in two of these the tumor extended to an adjacent
vertebra. In nine patients, a soft-tissue mass was a distinctive additional feature.
A sclerotic and/or osteolytic lesion in a vertebral body with a large, paraspinal soft-
tissue mass in an older patient with long-standing back pain should raise the possibility
of a chordoma.
Chordoma is a rare malignant tumor of the axial skeleton arising from remnants
of the primitive notochord. The tumor tends to occur at either end of the axial
skeleton, the most common sites being the sacrococcygeal and sphenooccipital
regions, where 85% of the lesions are found [1 2]. Involvement of the cervical, ,
thoracic, and lumbar spine is uncommon, occurring in only 15% of cases [1 2]. ,
The tumor grows slowly and is locally invasive. Recurrence after surgical resection
is likely. Distant metastases are uncommon.
We studied retrospectively 1 4 patients in whom the tumor was located in the
cervical, dorsal, or lumbar spine. The radiologic findings in these patients are the
subject of this report.
‘. ‘-1 . #{149} P
Fig. 2.-Chordoma involving second lumbar
vertebra.
A, Lateral tomogram shows osteosclerotic
. . . p
and osteolytic changes.
B, CT of second lumber vertebra shows a
:-.._ huge soft-tissue mass extending from vertebral
body.
Pugh [4]. Osteosclerosis attributed to compression of bone long-standing back pain should raise the possibility of a
or osteoarthritis was described in four of their cases. Pinto et chordoma.
al. [2] mentioned sclerosis in five of eight cases. Firooznia et ACKNOWLEDGMENTS
al. [3J observed a destructive lesion with a sclerotic rim in
The authors gratefully acknowledge Gemt Kracht for his photo-
seven of 1 6 patients (the series, however, consisted of both
graphic work and Ineke Lek for her secretarial assistance.
spinal and sacral chordomas). The authors of several case
reports mention osteosclerosis as a feature of chordoma [5- REFERENCES
8]. Nine (64%) of our 14 patients had osteosclerosis. Eight 1 . Firooznia H, Golimbu C, Rafli M, Reede DL, Kricheft II, Bjorkengren A.
patients showed a mixed osteolytic-osteosclerotic appear- Computed tomography of spinal chordomas. J Comput Tomogr
ance (Figs. 1-3), and one patient had sclerosis as a main 1986;10(1):45-50
2. Pinto RS, Un JP, Firooznia H, Lefleur RS. The osseous and angiographic
feature (Fig. 4). In contrast to earlier reports, the sclerosis in
features of vertebral chordomas. Neuroradiology 1975;9:231-241
our patients was not confined to the periphery of the tumor 3. Firooznia H, Pinto RS, Un JP, Baruch HH, Zausner J. Chordoma: radiologic
and could not be attributed to compression or osteoarthritis evaluation of 20 cases. AiR 1976;127:797-805
only. Osteosclerosis occurred much more frequently in the 4. Utne JR, Pugh DG. The roentgenologic aspects of chordoma. Am J
1 4 patients with spinal chordoma than in the 42 patients with Roentgenol Radium Thor NucI Med 1955:74 :593-608
5. Meyer JE. Lepke RA, Undfors KK. et ai. Chordomas: their CT appearance
sacrococcygeal and sphenooccipital chordomas in our series.
in the cervical thoracic and lumbar spine. Radiology 1984: 1 53(3): 693-696
On the basis of these findings, we believe that chordoma 6. Abdelwahab IF, O’Leary PF, Steiner GC, Zwass A. Case report 357:
should be included in the differential diagnosis of sclerotic or chordoma of the fourth lumbar vertebra metastasizing to the thoracic spine
partially sclerotic solitary vertebral lesions, in addition to much and ribs. Skeletal Radiol 1986;1 5(3): 242-246
7. Murali R, Rovit RH, Benjamin M%/. Chordoma of the cervical spine. Neu-
more common causes such as metastasis, lymphoma, Paget
rosurgery 1981;9(3):253-256
disease, and chronic spinal osteomyelitis. The combination of 8. Schwarz SS, Fisher WS Ill, Pulliam MW, Wanstein ZR. Thoracic chordoma
a sclerotic and/or osteolytic lesion in a vertebral body with a in a patient with paraparesis and ivory vertebral body. Neurosurgery
large, paraspinal, soft-tissue mass in an older patient with 1985:16(1): 100-102