Case Series of Chordoma in Three Different Locations: Clival, Cervical Spine, and Sacrococcygeal

Background: Chordoma is a relatively rare malignant, slow growing, and locally aggressive tumour that arise from embryonic remnants of the primitive notochord. It accounts for 4% of all primary bone tumours. Chordomas can present a diagnostic challenge due to the rare occurrence and a tendency to involve any region within the craniospinal axis.
Case Presentation: First case, 25-y-o female with cephalgia. CT scan shows lytic clival bone destruction. MRI show lobulated isointense mass on T1-WI, hyperintense on T2-WI and heterogenous contrast-enhancement. The mass extending to the many structures, destructing the Atlas, infiltrating perivertebral and epidural space. The patient received endoscopic tumour excision and confirmed as chordoma. Second case, 50-y-o male with tetraparesis, urinary and bowel incontinence. CT scan shows destruction of the first and second cervical spine. MRI shows the same characteristics as the first case. The mass compressing spinal cord, infiltrating the right perivertebral and orophrayngeal space. The patient received laminectomy and confirmed as chordoma. Third case, 50-y-o male with large soft tissue bulging at gluteal region. CT scan 3D surface rendering shows destruction of the first sacral spine until coccygeal. MRI shows the same characteristics as the first and second case. The mass infiltrating gluteal and piriform muscles, encasing left internal iliac artery. The mass further pathologically confirmed as chordoma.
Conclusion: Patients might experience different symptoms. Imaging studies classically show a destructive bone mass with lobular growth, high water content (high T2 signal intensity), foci of haemorrhage and calcification. Differential diagnosis are also depend on the location. Physaliferous cells is the hallmark of chordoma. Surgical intervention is the recommended treatment modality.