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Reyes M, Kayne A, Collopy S, Prashant G, Kelly P, Evans JJ. Multifocal Ectopic Recurrence of a C2 Chordoma. J Neurol Surg Rep 2023; 84:e146-e155. [PMID: 38026145 PMCID: PMC10673705 DOI: 10.1055/s-0043-1777073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Chordomas are histologically benign but locally aggressive tumors with a high propensity to recur. Our case highlights the importance of long-term vigilance in patients who have undergone chordoma resection. Case Report We report the case of a 47-year-old man with a cervical chordoma who developed multiple musculoskeletal ectopic recurrences in the left supraclavicular region, the proximal right bicep, and the left submandibular region without recurrence in the primary tumor site. Primary tumor resection was achieved via a combination of surgery, adjuvant radiation therapy, and imatinib. All recurrences were successfully resected and confirmed via pathology to be ectopic chordoma. Discussion Ectopic recurrence of cervical chordoma is rare and lung is the most common site of distant spread. Chordoma recurrence in skeletal muscle is particularly rare, with only 10 cases described in the literature. A plausible mechanism of distant metastatic disease in chordoma patients suggests that tumor cells escape the surgical tract via a combination of cytokine release, vasodilation, and microtrauma induced during resection. Conclusion Cervical chordoma with ectopic recurrence in skeletal muscle has not been previously described in the literature. Skull base surgeons should be aware of the phenomenon of chordoma ectopic recurrence in the absence of local recurrence.
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Affiliation(s)
- Maikerly Reyes
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Allison Kayne
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Sarah Collopy
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Giyarpuram Prashant
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Patrick Kelly
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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2
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Matmusaev M, Nagatani T, Kishida Y, Ansari A. Chordoma of the Clivus with Metastasis to Femur. Asian J Neurosurg 2022; 17:536-540. [PMCID: PMC9665977 DOI: 10.1055/s-0042-1756629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chordomas are aggressive and invasive tumors that are notoriously famous for their recurrence and metastasis. They present with diverse manifestations, usually with lower cranial nerve involvement. Here, we present the first reported case of chondroid chordoma with femur metastasis. A 71-year-old lady presented to us with a headache and diplopia. MRI of the brain revealed an enhanced broad and destructive mass in the infrasellar region with complete destruction of the clivus, right cavernous sinus. She underwent multiple surgeries along with gamma knife and proton therapy. The patient later presented with a trochanteric fracture and needed a hip replacement. Biopsy curettage of the femur lesion revealed a chondroid chordoma of the femur. The patient died later of a chest infection. Multimodality treatment is required in chordoma management, including surgery, gamma knife, and proton therapy. A firm discerning eye is required in the elderly toward metastatic spread to the femur in cases presenting with fractures of long bones.
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Affiliation(s)
- Maruf Matmusaev
- Department od Skull Base Surgery, Republican Specialized Scientific Practical Medical Center of Neurosurgery, Republic of Uzbekistan, Tashkent, Uzbekistan,Department of Neurosurgery, Center of Neuroendoscopy, Nagoya Daini Red Cross Hospital, Nagoya, Japan,Address for correspondence Maruf Matmusaev, MD Department of Neurosurgery, Center of Neuroendoscopy, Nagoya Daini Red Cross Hospital2-9 Myoken, Showa, Nagoya, 466-8650Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Center of Neuroendoscopy, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yugo Kishida
- Department of Neurosurgery, Center of Neuroendoscopy, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Ahmed Ansari
- Department of Neurosurgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India,Deparment of Neurosurgery, Fujita Health University Banbuntane Hospital, Nagoya, Japan
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3
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Zhao B, Chen L, Liao J, Xie Z, Lei X, Shen Z. Update of Clown Nose-Like Lesion, a Underrecognized Manifestation of Metastatic Malignancies and Genetic Cancer Predisposition Syndromes. Front Med (Lausanne) 2021; 8:673336. [PMID: 34055844 PMCID: PMC8155271 DOI: 10.3389/fmed.2021.673336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
Clown nose-like lesion refers to the manifestation of a reddish or skin-colored bulge on the tip of the nose or the manifestation of bulbous tip of the nose. More and more clinical cases show that clown nose-like lesion can also be the indication of some genetic syndromes, not just the manifestation of metastatic visceral tumor as it initially proposed. However, the clinical features of clown nose-like lesion indicated by metastatic malignancies, genetic cancer predisposition syndromes or primary diseases involving the nasal tip are lacking. In this study, patients with clown nose-like lesion in our clinical practices and from published literatures were collected and reviewed. We found that clown nose-like lesions caused by metastatic malignancies including lung cancer are often solitary and more common in male (24/31) older individuals (average age 62.3, ranging 40–78 years old). In addition, they usually appear for a short time, and are prone to be misdiagnosed as primary nasal diseases, leading to a poor prognosis (all patients with data available died within 4 months). Clown nose-like lesions associated with genetic cancer predisposition syndromes usually develop at a young age (mean age 15.3) with female preference (9/10). They are accompanied by multiple-systemic involvements, including low hair volume, developmental delay, cancer predisposition or neurological diseases. They show slow development and often positive family history (6/10). These two kinds of clown nose-like lesions are often asymptomatic, which delays the diagnosis and treatment of underlying malignancies or syndromes. In brief, the term of clown nose-like lesion is underrecognized, and should be updated. Clown nose-like lesions can serve as indicators to at least three categories of clinical issues: metastatic visceral tumors, genetic syndromes, and primary diseases involving the nasal tip. Increased awareness of clinical features of updated clown nose-like lesions can alert physicians to these underlying malignancies or syndromes, render earlier detection of associated medical issues, and allow for genetic counseling of family members.
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Affiliation(s)
- Bei Zhao
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Ling Chen
- Department of Dermatology, Daping Hospital, Army Medical University, Chongqing, China
| | - Jinfeng Liao
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhen Xie
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Xia Lei
- Department of Dermatology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhu Shen
- Department of Dermatology, Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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4
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Berlucchi S, Nasi D, Zunarelli E, Valluzzi A, Alicandri Ciufelli M, Presutti L, Pavesi G. Cutaneous Metastasis from Cervical Spinal Chordoma: Case Report and Literature Review. World Neurosurg 2020; 137:296-303. [PMID: 32068172 DOI: 10.1016/j.wneu.2020.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chordomas are rare primary tumors of the bone that arise from embryonic notochord. They are locally aggressive tumors with a high tendency for postsurgical recurrence. On the other hand, distant metastases are rare. When they occur, they involve lungs, liver, lymph nodes, and bones. Skin and subcutaneous tissue involvement is even rarer and usually occurs by direct extension of the primary tumor or by local recurrence. Distant cutaneous metastasis from chordoma is an exceptional finding, with fewer than 20 cases reported in the literature. All the cutaneous metastases described derive from sacral chordomas, except for 2 cases in which the source of metastasis is skull-base chordomas. CASE DESCRIPTION We report the case of a 55-year-old man with skin metastasis from a cervical chordoma. CONCLUSIONS Metastasis has to be taken into account in the differential diagnosis when a new skin lesion appears in a patient with a past medical history of chordoma. To the best of our knowledge, this is the first case of cutaneous metastasis from spinal cervical chordoma. A systematic literature review was performed.
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Affiliation(s)
- Silvia Berlucchi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Davide Nasi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy.
| | - Elena Zunarelli
- Anatomic Pathology Unit, Department of Morphological Sciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Adelaide Valluzzi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Matteo Alicandri Ciufelli
- Otorhinolaryngology-Head and Neck Surgery Department, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Giacomo Pavesi
- Neurosurgery Unit, Department of Neurosciences, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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Sayyid SK, Wong PK, Read W, Monson DK, Umpierrez M, Gonzalez F, Kakarala A, Singer AD. The clincoradiologic spectrum of notochordal derived masses. Clin Imaging 2019; 56:124-134. [PMID: 31029011 DOI: 10.1016/j.clinimag.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
The notochord is an essential part of human development that regresses with age. Masses derived from notochordal tissue may be encountered during imaging of the neuroaxis. Fortunately, the majority of these are benign and can usually be differentiated by radiological and clinical findings. In this manuscript, we discuss the clinical and radiologic presentation of the four notochordal derived masses and present a brief overview of their management.
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Affiliation(s)
- Samia K Sayyid
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Philip K Wong
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - William Read
- Department of Hematology and Oncology, Emory University Hospital, Atlanta, GA, USA
| | - David K Monson
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Aparna Kakarala
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA.
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6
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Multifocal metastatic chordoma to the soft tissues of the fingertips: a case report including sonographic features and a review of the literature. Skeletal Radiol 2018; 47:401-406. [PMID: 28986658 DOI: 10.1007/s00256-017-2785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
Chordoma is a rare, locally aggressive tumor which commonly metastasizes, most often to the lung, liver, and spine. In this case report, a 59-year-old male with history of sacral chordoma and pulmonary metastases presented to the emergency department with swelling and discoloration of multiple left fingertips. The initial radiographs led to a presumptive diagnosis of gout, which did not respond to medical therapy. An ultrasound demonstrated multiple solid masses with vascular hyperechoic septations which were subsequently biopsied and proven to be metastatic chordoma. Metastatic disease to the hand is a well documented but rare manifestation of many malignancies. The clinical presentation and radiographic features of multifocal hand metastases may mimic entities such as systemic deposition and granulomatous diseases. To the best of our knowledge, this is the first case report of soft tissue chordoma metastases to the fingertips as well as the first reported sonographic description of chordoma metastases.
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7
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Delteil C, Malissen N, Appay R, Magis Q, Aubert S, Bouvier C, Richard MA, Macagno N. [Chordoma cutis, an unusual clinical presentation of a rare neoplasm: Chordoma]. Ann Pathol 2018; 38:126-130. [PMID: 29449046 DOI: 10.1016/j.annpat.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/06/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Abstract
Chordoma cutis represents an unusual clinical presentation of a rare neoplasm. The involvement of skin or sub-cutaneous soft tissues can be the consequence of local infiltration or metastasis; the latter may occur several years following the initial diagnosis of chordoma and therefore, may pose a diagnosis challenge when the clinical history of the patient is unknown. The clinical forms, morphology, immuno-histochemical profile and the main differential diagnoses of chordoma cutis are presented here through an anatomoclinical case.
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Affiliation(s)
- Clémence Delteil
- Service d'anatomie pathologique et neuropathologie, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 5, France.
| | - Nausicaa Malissen
- Service de cancérologie cutanée, CHU Timone, Assistance publique hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Romain Appay
- Service d'anatomie pathologique et neuropathologie, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 5, France
| | - Quentin Magis
- Service de cancérologie cutanée, CHU Timone, Assistance publique hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | | | - Corinne Bouvier
- Service d'anatomie pathologique et neuropathologie, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 5, France
| | - Marie-Aleth Richard
- Service de cancérologie cutanée, CHU Timone, Assistance publique hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - Nicolas Macagno
- Service d'anatomie pathologique et neuropathologie, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 5, France
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8
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On a Rare Cutaneous Metastasis from a Sacrococcygeal Chordoma. Case Rep Pathol 2017; 2017:5281239. [PMID: 28409046 PMCID: PMC5376422 DOI: 10.1155/2017/5281239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/20/2017] [Indexed: 11/18/2022] Open
Abstract
Chordomas are rare malignant tumors of notochordal origin and are rare locally aggressive ones with a metastatic potential. The skin rarely is seen as metastatic site. We describe a case of an adult woman with cutaneous metastasis of a primary sacral chordoma excised ten years before, which appeared as a painless cutaneous mass located in the dorsal region. Once removed, the surgical specimen was formalin fixed and in paraffin embedded. Sections were stained with haematoxylin-eosin, and histochemical and immunohistochemical investigations were performed. Histologically, the neoplasia was characterized by cords or single tumor cells with an abundant myxoid stroma, conspicuous pale vacuolated cytoplasm (the classic “physaliphorous cells”), and mild nuclear atypia. Mitotic activity was scanty. At immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, pan-keratins, EMA, and vimentin. A diagnosis of cutaneous metastasis of chordoma was performed. This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor.
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9
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10
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11
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Vogin G, Calugaru V, Bolle S, George B, Oldrini G, Habrand JL, Mammar H, Dendale R, Salleron J, Noël G, Feuvret L. Investigation of ectopic recurrent skull base and cervical chordomas: The Institut Curie's proton therapy center experience. Head Neck 2015; 38 Suppl 1:E1238-46. [DOI: 10.1002/hed.24199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/11/2015] [Accepted: 07/07/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Guillaume Vogin
- Department of Radiation Oncology; Institut de Cancérologie de Lorraine; Nancy France
| | - Valentin Calugaru
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Stéphanie Bolle
- Department of Radiation Oncology; Institut Gustave Roussy; Villejuif France
- Protontherapy Center; Institut Curie; Orsay France
| | - Bernard George
- Department of Neurosurgery; Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris; Paris France
| | - Guillaume Oldrini
- Department of Radiology; Institut de Cancérologie de Lorraine; Nancy France
| | - Jean-Louis Habrand
- Department of Radiation Oncology; Centre François Baclesse; Caen France
- Protontherapy Center; Institut Curie; Orsay France
| | - Hamid Mammar
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Rémi Dendale
- Department of Radiation Oncology; Institut Curie; Paris France
- Protontherapy Center; Institut Curie; Orsay France
| | - Julia Salleron
- Department of Biostatistics; Institut de Cancérologie de Lorraine; Nancy France
| | - Georges Noël
- Department of Radiation Oncology; Centre Paul Strauss; Strasbourg France
| | - Loïc Feuvret
- Protontherapy Center; Institut Curie; Orsay France
- Department of Radiation Oncology; Hôpital La Pitié Salpétrière, Assistance Publique - Hôpitaux de Paris; Paris France
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12
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Kishimoto R, Omatsu T, Hasegawa A, Imai R, Kandatsu S, Kamada T. Imaging characteristics of metastatic chordoma. Jpn J Radiol 2012; 30:509-16. [DOI: 10.1007/s11604-012-0086-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 04/25/2012] [Indexed: 11/29/2022]
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13
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Collins GR, Essary L, Strauss J, Hino P, Cockerell CJ. Incidentally discovered distant cutaneous metastasis of sacral chordoma: a case with variation in S100 protein expression (compared to the primary tumor) and review of the literature. J Cutan Pathol 2012; 39:637-43. [DOI: 10.1111/j.1600-0560.2012.01895.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Skin metastasis is defined as the spread of malignant cells from a primary malignancy to the skin. It is one manifestation of systemic spread of cancer. The tumor cells originate either from an internal malignancy or from a primary skin cancer. This study presents a literature review concerning these issues as well as this author's experience encountered throughout 19 years of surgical pathology and dermatopathology practice. Several conclusions are evident. Generally, skin metastases are encountered in 0.7-9% of all patients with cancer and as such the skin is an uncommon site of metastatic disease when compared to other organs. There is usually a long-time lag between the diagnosis of the primary malignancy and the recognition of the skin metastases. However, these metastases may be the first indication of the clinically silent visceral malignancies. The regional distribution of the skin metastasis, although not always predictable, is related to the location of the primary malignancy and the mechanism of metastatic spread. The relative frequency of skin metastasis correlates with the type of primary cancer, which occurs in each sex. For instance, lung and breast carcinomas are the most common primaries that send skin metastasis in men and women, respectively. The head and neck region and the anterior chest are the areas of greatest predilection in men. The anterior chest wall and the abdomen are the most commonly involved sites in women. Skin metastases usually appear as non-specific groups of discrete firm painless nodules that emerge rapidly without any explanation. They vary in size from so tiny as to be of 'miliary lesions' to as large as 'Hen's egg size'. Some skin metastasis may mimic specific dermatological conditions such as cutaneous cyst, dermatofibroma, pyogenic granuloma, hemangioma, papular eruptions, herpes zoster eruptions, rapidly infiltrating plaques, alopecic patches, cellulitis and erysipelas. Histologically, the skin metastases usually show features reminiscent of the primary malignancy, but with variable degrees of differentiation. Molecularly, skin metastasis is an organized, non-random and organ-selective process orchestrated by interaction among several heterogeneous molecules, which are largely unknown. Metastasis to the skin is often a pre-terminal event that heralds poor outcome.
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Abstract
Chordoma is a rare malignant bone tumor derived from notochordal rests, and the most common site is the sacrococcygeal region. A 52-year-old woman presented with a sacrococcygeal chordoma detected on F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). The F-18 FDG PET/CT showed a large destructive mass that arose anteriorly in the sacrococcygeal region and heterogeneously increased FDG uptake within the mass was observed. After surgery, histology confirmed the presence of a sacrococcygeal chordoma. The physician should take chordoma into consideration if there is a large osteolytic mass with hypermetabolism in the sacral region on FDG PET/CT.
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Affiliation(s)
- Greg Persichetti
- Dermpath Diagnostics, South Florida, Pompano Beach, Florida, USA
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18
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Lountzis NI, Hogarty MD, Kim HJ, Junkins-Hopkins JM. Cutaneous metastatic chordoma with concomitant tuberous sclerosis. J Am Acad Dermatol 2006; 55:S6-10. [PMID: 16843131 DOI: 10.1016/j.jaad.2005.08.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2005] [Revised: 08/23/2005] [Accepted: 08/23/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chordomas are rare malignant tumors of notochord origin and are locally aggressive with a metastatic potential. Of noted interest, the skin rarely is seen as a metastatic site. METHODS AND OBSERVATIONS We describe a 20-month-old infant whose primary presentation of a clivus-based chordoma was multiple asymptomatic cutaneous nodules. A skin biopsy showed large vacuolated cells embedded in a myxoid stroma. Immunohistochemical staining was positive for S-100, keratin, and epithelial membrane antigen markers consistent with malignant chordoma. Magnetic resonance imaging revealed a clivus-based chordoma with scattered metastases within the neuraxis and multiple visceral sites. Further examination also revealed a diagnosis of tuberous sclerosis. LIMITATIONS An observed association between chordoma and tuberous sclerosis cannot be established firmly on the basis of a case report. CONCLUSIONS This case illustrates a diagnostic challenge because of the unusual presentation of an already rare tumor. By reporting our case, we hope to assist in the recognition of this rare dermal condition and highlight the speculated coexistence of tuberous sclerosis with chordoma tumors.
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Abstract
This review correlates the imaging findings and histological appearances seen in chordomas in a series of patients presenting at our institution, together with a published literature review. A parallel presentation of photographs of imaging findings and microscopic histological findings is made, with the aim being to enhance recognition of this uncommon but clinically significant entity.
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Affiliation(s)
- F M Maclean
- Department of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales 2145, Australia.
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20
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Gattoni M, Astolfi S, Tiberio R, Boldorini R, Pia F, Leigheb G. Extension cutanée d’un chordome. Ann Dermatol Venereol 2005; 132:540-3. [PMID: 16142102 DOI: 10.1016/s0151-9638(05)79335-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Chordomas are rare extradural bone tumors arising from notochord remnants, the embryonic structure forming the original axis of the spine. They represent 0.1p. 100 of all intra-cranial tumors. The chordoma is a locally malignant cancer that tends to invade the surrounding tissues. Its localization in the skin is exceptional. OBSERVATION A 56 year-old man developed a nut-sized vegetating nodule on the nasal groove. This lesion appeared a few months following surgery for a frontoglabellar relapse of a chordoma that had developed six years earlier at the base of the skull. DISCUSSION We report this case because of the rareness of cutaneous involvement and the particular conditions in which it occurred. It may have been due to tumoral seeding during the previous surgical interventions.
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Affiliation(s)
- M Gattoni
- Clinique Dermatologique, Università del Piemonte Orientale A. Avogadro, Hopitâl Maggiore della Carità, Novara, Italie.
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21
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Abstract
Chordomas are rare malignant primary bone tumors, which most often occur in the sacral area. These tumors uncommonly affect the skin, and may not be recognized by dermatologists. We present a case of an adult woman with cutaneous metastasis of a primary sacral chordoma.
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Affiliation(s)
- Adam I Rubin
- Department of Dermatology, Columbia University, New York, New York 10032, USA.
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22
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Saqi A, Livolsi V, Mandel SJ, Baloch Z. Cervical chordoma masquerading as a thyroid neoplasm: a case report. Diagn Cytopathol 2005; 32:296-8. [PMID: 15830368 DOI: 10.1002/dc.20230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chordomas are rare neoplasms of notochord derivation that arise along the craniospinal axis. Their incidence along the cervical spine and close proximity to the thyroid can pose diagnostic pitfalls. We report a case of a paraspinal mass juxtaposed adjacent to the thyroid with intranuclear inclusions of papillary carcinoma, abundant eosinophilic cytoplasm of an oncocytic lesion, and pleomorphism of anaplastic carcinoma that expressed thyroglobulin and emulated a malignant thyroid neoplasm. However, subsequent histological examination revealed a chordoma with perithyroidal soft-tissue invasion. This case highlights the significance of including chordoma in the differential diagnosis of a thyroid neoplasm and interpreting thyroglobulin reactivity warily, because its inadvertent tracking during fine-needle aspirates (FNAs) can produce false positive staining of nonthyroidal cells.
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Affiliation(s)
- Anjali Saqi
- Department of Pathology, New York Presbyterian Hospital, Columbia-Presbyterian Medial Center, New York, 10032, USA.
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