Weekly Case

Title : Case 455

Age / Sex : 67 / M



Chief complain: Coccygeal pain, 1 year ago

What is your impression? 

Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy : SO YOUNG PARK, Kyung Hee University Hospital at Gangdong




Diagnosis:

Chordoma



Discussion



Answer:  



Chordoma



Findings:



Plain
radiographs: An ill-defined osteolytic lesion in S3-5



MR:



An well-defined
lobulated mass with presacral and epidural soft tissue mass formation



Location –
S2 lower ~ upper coccyx



T1WI –
heterogenous, mainly low signal intensity, with high signal intensity areas



T2WI – high
signal intensity (upper), low signal intensity (lower)



Enhanced
images – enhancement (upper), no or minimal enhancement (lower)



CT: a lobulated
osteolytic lesion with sclerotic foci, forming presacral and epidural soft
tissue mass



 



Differential Diagnosis:



Sarcoma



Giant cell
tumor



Ependymoma



Metastasis



 



Diagnosis:
 



Chordoma



 



Discussion:



Chordoma



-      
The most
common primary malignant sacral tumor arising from the remnants of the
primitive notochord



-      
Low-grade, slow-growing,
and locally aggressive tumor, metastasize infrequently, but generally poor
long-term prognosis



-      
40-59 years,
M:F = 2:1



-      
Sacrococcygeal
(50%), spheno-occipital (35%), vertebral body (15%)



n  Lower sacrum and coccyx,
cervical>thoracic and lumbar



-      
An destructive,
osteolytic lesion with a soft tissue mass, capable of extending across the
adjacent disk space and the sacroiliac joint



-      
Areas of
amorphous calcifications



n  40% of chordomas of the mobile spine



n  ~90% of sacrococcygeal chordomas



-      
72% of Sacrococcygeal
chordomas:



n  T1WI: iso- or hypointense relative
to muscle, high signal intensity (hemorrhage and high protein content of the
myxoid and mucinous collections



n  T2WI: high signal intensity (high
water content), low signal intensity (fibrous septa, hemosiderin)



 



References:



Radiographics
2001; 21:83-104



Radiographics
2008; 28:1019-1041




Correct Answer
Name Institution
Total applicants:24
Correct answers:21
이혜란:석병원, 전문의
전성희:중앙보훈병원, 전공의
이선혜:고대안암병원, 전공의
김현수:병무청, 전문의
이승훈:한양대병원, 전문의
김아람:바른병원, 전문의
김예림:죽전예스병원, 전문의
신재환:서울백병원, 전공의
김지민:순천향대학교 천안병원, 전공의
박상옥:안산21세기병원, 전문의
신윤상:인하대병원, 전공의
강건우:군의관, 전문의
김지현:하이병원, 전문의
하종수:샘병원, 전문의
이승현:세브란스 병원, 전문의
이승민:단국대병원, 전공의
김성관:수도병원, 전문의
노정현:단국대학교 병원, 전공의
노근탁:중앙보훈병원, 전공의
정민선:노원척의원, 전문의
이지현:병무청, 전문의
Semi-correct answers:3
김동환:분당제생병원, 전공의
양지연:순천평화병원, 전문의
최희석:나사렛국제병원, 전문의

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