Chordoma of the cervical spine

Cervical Chordoma with Retropharyngeal Extension Presenting with Impaired Voice

Aims and Background

We report an extremely rare case of cervical chordoma presenting with impaired voice.

Method

Case report and a review of the literature concerning the presentation, diagnosis, and treatment of a cervical chordoma.

Results

A singing teacher complaining of dysphonia was examined and surgically treated for a retropharyngeal extension of a cervical chordoma. A local recurrence was treated with proton beam therapy. Among primary malignant tumors of bone, chordomas account for 3–4% of all cases. Chordoma is typically a locally aggressive tumor with a high propensity for local recurrence. Its management involves surgery, radiotherapy, or both.

Conclusion

To our knowledge this is the first report in the world literature of a retropharyngeal extension of a cervical chordoma presenting with impaired voice. This case indicates that bony tumors of the spine may present first to voice-disorder clinicians. Increased awareness of this neoplasm may lead to earlier diagnosis and better treatment.

En bloc marginal excision of a multilevel cervical chordoma

✓ The purpose of this case report is to demonstrate that an en bloc resection with negative surgical margins can be successfully achieved in a case of a seemingly unresectable C-2 chordoma if appropriate preoperative staging and planning are performed. The management of chordomas is controversial and challenging because of their location and often large size at presentation. Because chordomas are malignant and will aggressively recur locally if intralesional resection is conducted, wide or true en bloc resection is generally recommended. The literature indicates, however, that surgeons are reluctant to perform wide or even marginal resections because of the lesion’s complex surrounding anatomy and the risk of significant neurological compromise when a tumor abuts the dura mater or neural tissues. In this report the authors outline the successful en bloc resection of a large C1–3 chordoma and discuss the importance of preoperative staging and planning.

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.

Chordoma of cervical vertebra protruding into the oral cavity

A 70-year-old man was admitted to hospital because of oral and cervical masses. Computed tomographic scanning revealed a lobulated mass lesion in the retropharyngeal region, with a protruding extension in the oral cavity and with destruction of the second cervical vertebra. A biopsy was performed under the diagnosis of a retropharyngeal tumor. Histologically, this lesion was composed of vacuolated tumor cells in a solid or cord-like arrangement, with an abundant myxoid matrix. Immunohistochemically, the tumor cells were positive for pancytokeratin, epithelial membrane antigen and S-100 protein. The tumor was diagnosed as chordoma. Chordoma presenting as an intra-oral mass lesion is very rare.