Cervical chordoma presenting with intervertebral foramen enlargement mimicking neurofibroma: CT findings

Paraspinal chordoma mimicking a neurofibroma: a rare but important radiological pitfall

We present an unusual case of a chordoma presenting as an extradural spinal tumour with extension through an expanded intervertebral foramen to form a large paraspinal mass. The magnetic resonance imaging appearances closely mimicked a neurofibroma; however, pre-operative biopsy confirmed the diagnosis of chordoma. This is, to our knowledge, the tenth reported case of chordoma presenting as a mass expanding the intervertebral foramen. Thus, while it is a rare form of chordoma, it can lead to a recognised radiological pitfall. Making the distinction from neurofibroma before surgery is essential, as radical dissection of chordoma is required to reduce the risk of local recurrence.

Lumbar chordoma mimicking a neurogenic tumour

Chordomas are rare tumours arising from the primitive notochord along the axial skeleton, typically from the sacrococcygeal region, spheno-occipital region and less commonly, the mobile spine. Midline location associated with bony involvement with extension to the surrounding tissues is the norm. Chordomas presenting laterally, centred within the neural exit foramen and extending to the paraspinal muscles without significant vertebral involvement is rare. We present a 60-year-old woman with lower back pain and radiculopathy. Imaging revealed a unilateral lesion at L4/5 extending through the left neural exit foramen into the paraspinal region. There was only minimal apparent bony involvement. Though these features were highly suggestive of a neurogenic tumour, histopathology revealed the lesion to be a chordoma. Excision of the tumour was performed under neurophysiological monitoring.

Chordoma masquerading as a nerve root tumour -- a clinical lesson

Chordomas usually arise in bone and are most commonly found in the midline axial skeleton. An accurate pre-operative diagnosis of chordoma is crucial, as survival is optimal when radical en bloc resection is performed at primary surgery. We report a rare case of cervical chordoma masquerading radiologically as an extracranial nerve sheath tumour. A laterally situated chordoma (centred extra-osseously in the neural foramen) was diagnosed radiologically as a neurofibroma pre-operatively. We review the key radiological features for diagnosis of chordoma. We consider the importance of pre-operative diagnosis of chordoma in guiding management and in determining survival.

Epidural Chordoma of the Cervical Spine with Secondary Bone Involvement

A 53-year-old man presented with cervical myelopathy. magnetic resonance imagine (MRI) revealed a predominantly extraskeletal, extradural lesion extending along the posterior aspects of the C2 to C5 vertebral bodies, with greater than 60% spinal canal compromise and severe cord compression. Bone involvement was present, but was thought to be secondary. Based on histopathology and immunohistochemical stains, the final pathologic diagnosis was chordoma. The lesion was treated with embolization, surgical resection, and proton beam radiotherapy, and there was no evidence of recurrence or metastasis after five years.

Cervical chordoma with vertebral artery encasement mimicking neurofibroma: MRI findings

A case of cervical chordoma in a 36-year-old white man with hypoesthesia in the neck and right shoulder, neck pain, and restricted neck mobility is presented. Plain radiographs of the cervical spine showed radiolucency of the body of C2 on the right side and enlargement of the right intervertebral foramen at C2-C3 level. Tumor encasement of the vertebral artery was demonstrated by MR imaging and confirmed by conventional arteriography. This proved to be particularly important for preoperative assessment.

MRI of dumbbell-shaped spinal tumors

PURPOSE

The purpose of our study is to review the clinical features and MR findings in patients with dumbbell-shaped spinal tumors that affect the intervertebral foramen.

METHOD

Two radiologists retrospectively evaluated a total of 19 tumors from the period 1989-1994 that exhibited dumbbell configuration. These included 11 benign tumors, including 9 neurogenic ones, and 8 malignant tumors.

RESULTS

The time between onset of symptoms and admission was shorter in patients with malignant tumors (mean 3.9 months) than in patients with benign tumors (mean 41.1 months). There was a statistically significant difference (p < 0.05) in the short/long axis ratios (minimum tumor diameter divided by maximum tumor diameter) in the vertebral canal components between benign and malignant tumors. All malignant tumors in this study were extradural and paraspinal type (p < 0.05). Most benign tumors had regular margins and enlarged intervertebral foramina, while most malignant ones had irregular margins (p < 0.05). Many neurogenic tumors had regular margins and enlarged intervertebral foramina, while most malignant ones had irregular margins (p < 0.05> Many neurogenic tumors had cystic lesions (77.8%) and a string-of-beads structure (44.4%). Those tumors that surrounded the thecal sac in the vertebral canal and whose adjacent vertebral bodies had abnormal signal intensities were infiltrating and malignant.

CONCLUSION

There are many kinds of dumbbell-shaped spinal tumors other than neurogenic ones. MRI is useful in diagnosing dumbbell-shaped spinal tumors, especially those of neurogenic origin, and aids in distinguishing benign from malignant tumors.

Periosteal chondroma of the cervical spine: one more cause of neural foramen enlargement

A case of cervical periosteal chondroma presenting with an enlarged neural foramen is described. Review of the literature showed that cervical chondromas are rare but that their characteristic clinical and computed tomographic findings aid in their diagnosis. The computed tomographic findings of two previously reported cases of cervical periosteal chondroma resembled those of the present case. On computed tomographic scanning, an iso-or high-density mass containing stippled calcifications and originating in a posterior cervical neural arch was observed in all three cases. Extensive spinal canal and extradural involvement was observed in five of the seven reported cases, including the one reported here.