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Howard K, Han C, Balogh P, Kurisunkal V, Botchu R. Test Yourself Answer: Pain in left hip following previous surgery in a 60-year-old male. Skeletal Radiol 2025; 54:1565-1571. [PMID: 39613976 DOI: 10.1007/s00256-024-04838-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 11/18/2024] [Accepted: 11/21/2024] [Indexed: 12/01/2024]
Affiliation(s)
- K Howard
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - C Han
- Department of Pathology, New Cross Hospital, Black Country Pathology Services, Wolverhampton, UK
| | - P Balogh
- Department of Musculoskeletal Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - V Kurisunkal
- Department of Orthopedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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2
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Li D, Zhang M, Zhang P, Wang T, Jiang C. Misdiagnosis of chordoma: A case report and a review of the literature. Oncol Lett 2025; 29:311. [PMID: 40342726 PMCID: PMC12059618 DOI: 10.3892/ol.2025.15057] [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: 10/22/2024] [Accepted: 02/21/2025] [Indexed: 05/11/2025] Open
Abstract
The present study aimed to investigate the clinicopathological features and diagnostic criteria for differentiating between chordoma and chordoid meningioma. A case of chordoma was retrospectively analyzed using clinical, radiographic, histological and immunohistochemical data, alongside a literature review. A 59-year-old male patient was admitted with headaches and dizziness persisting for 2 months without any obvious precipitating factors. The patient underwent two intracranial tumor resections between March 2022 and December 2023. The pathology report from the first surgery indicated that the tumor was composed of cords of epithelioid cells with vacuolated cytoplasm embedded in a basophilic stroma. Immunohistochemical analysis showed positivity for cytokeratin, vimentin, epithelial membrane antigen, synaptophysin, cytokeratin 8/18 and E-cadherin, with a Ki-67 proliferation index of 3%. Progesterone receptor, D2-40, glial fibrillary acidic protein, S100 and SOX10 staining were negative. Based on the pathology and immunohistochemical findings, the diagnosis was determined to be a chordoma-like meningioma (World Health Organization Grade 2). The pathology report from the second surgery revealed a tumor composed of cords and isolated epithelioid cells with intracytoplasmic vacuoles within a myxoid matrix. However, immunohistochemical analysis indicated positivity for Brachyury, leading to a diagnosis of chordoma. In conclusion, the histological morphology of chordoma is similar to that of chordoid meningioma and lacks clinical specificity. Immunohistochemical staining of tumor markers assists in both the diagnosis and differential diagnosis. Currently, treatment for chordoma and choroid mengioma primarily focuses on surgical resection, which is associated with high rates of relapse. The differential diagnosis predominantly influences the postoperative treatment strategy.
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Affiliation(s)
- Dong Li
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
| | - Mengmeng Zhang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
| | - Ping Zhang
- Department of Gynecology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
| | - Tao Wang
- Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
| | - Chen Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong 266000, P.R. China
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3
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Miladinovic V, Krol ADG, Bloem JL, Bovée JVMG, Lam SW, Peul WC, Cañete AN, Verbist BM. Combining morphological and functional imaging parameters to diagnose primary bone neoplasms in the skull base, spine and sacrum. Skeletal Radiol 2025; 54:287-302. [PMID: 38967687 PMCID: PMC11652577 DOI: 10.1007/s00256-024-04742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Morphological magnetic resonance (MR) and computed tomography (CT) features are used in combination with histology for diagnosis and treatment selection of primary bone neoplasms. Isolated functional MRI parameters have shown potential in diagnosis. Our goal is to facilitate diagnosis of primary bone neoplasms of the skull base, mobile spine and sacrum, by a comprehensive approach, combining morphological and functional imaging parameters. MATERIALS AND METHODS Pre-treatment MR of 80 patients with histologically proven diagnosis of a primary bone neoplasm of the skull base, mobile spine and sacrum were retrospectively analyzed for morphological and functional MRI parameters. Functional parameters were measured in 4 circular regions of interest per tumor placed on non-adjacent scan slices. Differences in values of functional parameters between different histologies were analyzed with Dunn's test. RESULTS Chordomas were the predominant histology (60.0%). Most neoplasms (80.0%) originated in the midline and had geographical (78.2%) bone destruction. Amorphous-type calcification (pre-existing bone) was seen only in chordomas. Homogeneous contrast enhancement pattern was seen only in chondrosarcoma and plasmacytoma. Ktrans and Kep were significantly lower in both chordoma, and chondrosarcoma compared to giant cell tumor of the bone (p = 0.006 - 0.011), and plasmacytoma (p = 0.004 - 0.014). Highest diffusion-weighted MRI apparent diffusion coefficient (ADC) values corresponded to chondrosarcoma and were significantly higher to those of chordoma (p = 0.008). CONCLUSION We identified the most discriminating morphological parameters and added functional MR parameters based on histopathological features that are useful in making a confident diagnosis of primary bone neoplasms in the skull base, mobile spine and sacrum.
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Affiliation(s)
- Vesna Miladinovic
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
- HollandPTC, Delft, The Netherlands.
| | - Augustinus D G Krol
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
- HollandPTC, Delft, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suk Wai Lam
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Ana Navas Cañete
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- HollandPTC, Delft, The Netherlands
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Dudhe S, Nimodia D, Mishra GV, Parihar PH, Bhangale P, Kumari A, Kotla R. Challenging the giant: A case report on a huge sacrococcygeal chordoma and its radiological insights. Radiol Case Rep 2025; 20:1170-1174. [PMID: 39691762 PMCID: PMC11650270 DOI: 10.1016/j.radcr.2024.10.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 10/30/2024] [Indexed: 12/19/2024] Open
Abstract
Sacral chordoma is a rare osseous tumor of malignant origin. Remnants of the notochord in the region of sacrum and coccyx is said to be the origin of these tumors. Patients generally have delayed presentation, which is responsible for larger tumor size. Early detection of sacral chordoma is therefore very important. We present a clinical case on a 56-year-old male patient who presented with chronic lower back pain for 3 years, predominantly in the sacral region. He also had occasional bouts of constipation. Diagnostic imaging modalities used encompass ultrasonography, magnetic resonance imaging, and computed tomography scans. Radiological imaging of this patient revealed a giant mass within the pelvis. The mass was involving the lower sacrum and coccyx region predominantly. Associated local osteolytic changes were also noted, which are a characteristic feature of sacral chordoma. The patient underwent surgical excision of the tumor. Subsequent histopathological analysis gave the diagnosis of chordoma of sacral region. Sacral chordoma should be a consideration in differential diagnosis whenever the patient presents with persistent chronic lumbosacral pain, discomfort, and neurological impairments. Surgical excision followed by radiotherapy is useful in improving clinical outcomes for individuals diagnosed with sacral chordoma. This enhances overall patient prognosis and reduces the risk of local recurrence. The diagnosis of sacral chordoma is a challenge for diagnostic radiologists. Quicker identification, assertive surgical intervention, and suitable adjuvant therapies for chordoma are essential for enhancing patient outcomes and effectively managing this uncommon malignancy called chordoma.
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Affiliation(s)
- Sakshi Dudhe
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Devyansh Nimodia
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Gaurav V. Mishra
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Pratapsingh H. Parihar
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Paritosh Bhangale
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Anjali Kumari
- Department of Radiodiagnosis, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
| | - Rishitha Kotla
- Department of Psychiatry, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra 442001, India
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Adin ME, Woolf G, Hegde R, Elsamadicy AA, Mendel E, Zucconi WB, Pucar D, Aygün N. Sacral tumors: a comprehensive review of imaging, diagnostic challenges, and tumor mimics. Skeletal Radiol 2025:10.1007/s00256-024-04862-6. [PMID: 39821683 DOI: 10.1007/s00256-024-04862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 12/23/2024] [Accepted: 12/29/2024] [Indexed: 01/19/2025]
Abstract
The sacrum can harbor a diverse group of both benign and malignant tumors, including metastases. Primary tumors of the sacrum can arise from bone, cartilage, marrow, notochordal remnants, or surrounding nerves and vessels. Among a variety of primary tumors of the spine, chordoma, germ cell tumors and Ewing's sarcoma are recognized for their propensity to occur in the sacrum. Imaging is essential in diagnosis, pretreatment evaluation, and assessment of response to treatment. Radiography, CT and MRI are the primary modalities in assessing morphology and tumor extent whereas PET/CT is crucial in the evaluation of systemic disease in the setting of myeloma, lymphoproliferative disease, and metastasis. A definitive diagnosis is not always achievable by imaging as some tumors lack specific imaging features. However, as we detail in this comprehensive review, many entities have characteristic clinical and epidemiological factors as well as typical imaging findings that can help make either a confident diagnosis or offer a narrow list of differentials. We discuss a wide range of benign and malignant, primary, and secondary tumors that can involve the sacrum, highlighting the pertinent clinical details and typical imaging findings of these entities, enabling the reader to develop and apply a systematic approach to evaluating sacral masses on imaging. We also briefly describe non-neoplastic tumor mimics, which include developmental entities, infections, and insufficiency fractures.
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Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street TE 2, P.O. Box 208042, New Haven, CT, 06520-8042, USA.
| | - Graham Woolf
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street TE 2, P.O. Box 208042, New Haven, CT, 06520-8042, USA
| | - Rahul Hegde
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street TE 2, P.O. Box 208042, New Haven, CT, 06520-8042, USA
| | | | - Ehud Mendel
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - William B Zucconi
- Department of Radiology, Dartmouth Geisel School of Medicine, Dartmouth, NH, USA
| | - Darko Pucar
- Department of Nuclear Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Nafi Aygün
- Department of Radiology, Moffit Cancer Center Florida, Tampa, FL, USA
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6
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González TMC, Lam SW, van der Wal R, Navas A, van Langevelde K. Sacrococcygeal chordoma with spontaneous regression due to a large hemorrhagic component. Skeletal Radiol 2025; 54:159-163. [PMID: 38735895 PMCID: PMC11573806 DOI: 10.1007/s00256-024-04700-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Chordoma is a malignant bone tumor originating from notochordal remnants, most commonly occurring at the sacrococcygeal junction. We present a case of a 70-year-old male with chronic pain in the lower lumbar spine. MRI performed elsewhere revealed a large tumor that involved S4, S5, and the coccyx with a presacral soft tissue component. The lesion was heterogeneously hyperintense on T2-weighted images with a thick hypointense rim anteriorly. On T1-weighted images, the lesion showed a native hyperintense signal centrally probably due to hemorrhage. Based on this MRI, the diagnosis of chordoma was suggested. A spontaneous marked reduction in size was observed on a 4-week interval MRI performed at our institution before biopsy. Due to spontaneous tumor shrinkage along with peripheral enhancement, a differential diagnosis of infection or bleeding in a retrorectal cyst was proposed. This case teaches us that chordomas may contain a large hemorrhagic component, which is hyperintense on T1-weighted images and shows peripheral rim enhancement. Spontaneous shrinkage of a tumor may occur due to the resolution of a hematoma within weeks. Biopsy is key to obtain the correct diagnosis. Understanding the typical and more rare features of chordomas is key for MSK radiologists as well as pathologists. Chordomas are typically slow-growing tumors, but radiologists should be aware that intratumoral hemorrhage can lead to rapid changes in tumor size, which may be mistaken for either regression or progression of tumor. This case highlights the importance of considering hemorrhagic events within chordomas in the differential diagnosis when observing size fluctuations on imaging.
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Affiliation(s)
- Tania Marlem Chico González
- LUMC: Leiden University Medical Center, Leiden, Netherlands
- Department of Radiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Suk Wai Lam
- LUMC: Leiden University Medical Center, Leiden, Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert van der Wal
- LUMC: Leiden University Medical Center, Leiden, Netherlands
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ana Navas
- LUMC: Leiden University Medical Center, Leiden, Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Kirsten van Langevelde
- LUMC: Leiden University Medical Center, Leiden, Netherlands.
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
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7
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Ghosn Y, Alam R, El Annan T, Haddad G, Khdhir M, Farhat L, Hafez R, Moukaddam H, Khoury N, Khouzami R. Para-articular and intra-articular soft tissue lesions: Radiologic-pathologic correlation. Eur J Radiol 2024; 181:111718. [PMID: 39357286 DOI: 10.1016/j.ejrad.2024.111718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 10/04/2024]
Abstract
Articular masses comprise various disease entities including benign or malignant proliferative processes and other non-neoplastic processes such as infection, deposition diseases, vascular malformations, and other lesions. Many diseases that lead to intra-articular or para-articular masses have distinct imaging features, particularly on MRI. Radiologists can localize masses to the joint space by knowing the articular anatomy and can reach a suggested diagnosis by looking at precise imaging findings. In this review article, we first define the concept of articular space (intraarticular, para-articular) and the normal joint anatomy and histology. We provide a general and comprehensive approach for evaluation of articular lesions on MRI. We then describe specific imaging and histologic features of typical benign and malignant soft tissue articular neoplasms and some non-neoplastic mimickers; and provide a radio-pathologic correlation of the different described entities.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | | | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | | | - Mihran Khdhir
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
| | - Lama Farhat
- Department of Pathology, American University of Beirut, Lebanon.
| | - Rayan Hafez
- Department of Pathology, American University of Beirut, Lebanon.
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | - Nabil Khoury
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | - Riad Khouzami
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
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8
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Potter GM, Siripurapu R, Herwadkar A, Abdulla S, Ikotun O, Broadhurst P, Woodward M, Bhalla RK, Glancz LJ, Hammerbeck-Ward CL, Rutherford SA, Pathmanaban ON, Roncaroli F, Colaco RJ, Pan S, Whitfield GA. Skull Base Chordoma and Chondrosarcoma: Neuroradiologist's Guide to Diagnosis, Surgical Management, and Proton Beam Therapy. Radiographics 2024; 44:e240036. [PMID: 39298353 DOI: 10.1148/rg.240036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Skull base chordomas and chondrosarcomas are distinct types of rare, locally aggressive mesenchymal tumors that share key principles of imaging investigation and multidisciplinary care. Maximal safe surgical resection is the treatment choice for each, often via an expanded endoscopic endonasal approach, with or without multilayer skull base repair. Postoperative adjuvant radiation therapy is frequently administered, usually with particle therapy such as proton beam therapy (PBT). Compared with photon therapy, PBT enables dose escalation while limiting damage to dose-limiting neurologic structures, particularly the brainstem and optic apparatus, due to energy deposition being delivered at a high maximum with a rapid decrease at the end of the penetration range (Bragg peak phenomenon). Essential requirements for PBT following gross total or maximal safe resection are tissue diagnosis, minimal residual tumor after resection, and adequate clearance from PBT dose-limiting structures. The radiologist should understand surgical approaches and surgical techniques, including multilayer skull base repair, and be aware of evolution of postsurgical imaging appearances over time. Accurate radiologic review of all relevant preoperative imaging examinations and of intraoperative and postoperative MRI examinations plays a key role in management. The radiology report should reflect what the skull base surgeon and radiation oncologist need to know, including distance between the tumor and PBT dose-limiting structures, tumor sites that may be difficult to access via the endoscopic endonasal route, the relationship between intradural tumor and neurovascular structures, and tumor sites with implications for postresection stability. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Gillian M Potter
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rekha Siripurapu
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Amit Herwadkar
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Sarah Abdulla
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Oluwaseun Ikotun
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Philip Broadhurst
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Mark Woodward
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rajiv K Bhalla
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Laurence J Glancz
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Charlotte L Hammerbeck-Ward
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Scott A Rutherford
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Omar N Pathmanaban
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Federico Roncaroli
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rovel J Colaco
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Shermaine Pan
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Gillian A Whitfield
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
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9
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Mazzucco M, Hwang S, Linos K, Hameed M, Shahzad F, Schmitt A, Boland P, Vaynrub M. Chordoma arising from the coccygeal disc and mimicking a pilonidal cyst. Skeletal Radiol 2024; 53:1431-1435. [PMID: 37953332 PMCID: PMC11879305 DOI: 10.1007/s00256-023-04492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023]
Abstract
Chordomas are rare, low-grade malignant tumors often found in the sacrococcygeal region and prone to local recurrence. We report an atypical presentation of a 40-year-old patient with a symptomatic midline retrococcygeal lesion that was presumptively treated as a pilonidal cyst due to its clinical and imaging features. After surgical pathology rendered the diagnosis of chordoma, the patient required salvage surgery in the form of partial sacrectomy with soft tissue flap coverage. In addition to the unusually predominant retrococcygeal location, surgical pathology identified an intervertebral disc origin rather than the typical osseous origin. To our knowledge, this presentation of chordoma with coccygeal intervertebral origin and a large subcutaneous mass at imaging has rarely been reported in the literature. We describe this case to raise awareness of atypical presentations of sacrococcygeal chordoma that may lead to erroneous presumptive diagnosis and treatment.
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Affiliation(s)
- Michael Mazzucco
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, 10065, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Konstantinos Linos
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Farooq Shahzad
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Adam Schmitt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Patrick Boland
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Max Vaynrub
- Plastic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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10
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Ponsiglione A, Campo I, Sachs C, Sofia C, Álvarez-Hornia Pérez E, Ciabattoni R, Sharaf DE, Causa-Andrieu P, Stanzione A, Cuocolo R, Zawaideh J, Brembilla G. Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network. Eur J Radiol 2023; 166:110984. [PMID: 37480649 DOI: 10.1016/j.ejrad.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Irene Campo
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Camilla Sachs
- Department of Radiology, Ospedale Ca' Foncello, 31100, Treviso, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | | | - Riccardo Ciabattoni
- Department of Radiology, Ospedale San Salvatore di Pesaro, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy
| | - Doaa E Sharaf
- Department of Radiology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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11
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Zhong J, Xing Y, Zhang G, Hu Y, Ding D, Ge X, Pan Z, Yin Q, Zhang H, Yang Q, Zhang H, Yao W. A systematic review of radiomics in giant cell tumor of bone (GCTB): the potential of analysis on individual radiomics feature for identifying genuine promising imaging biomarkers. J Orthop Surg Res 2023; 18:414. [PMID: 37287036 DOI: 10.1186/s13018-023-03863-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE To systematically assess the quality of radiomics research in giant cell tumor of bone (GCTB) and to test the feasibility of analysis at the level of radiomics feature. METHODS We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data to identify articles of GCTB radiomics until 31 July 2022. The studies were assessed by radiomics quality score (RQS), transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) statement, checklist for artificial intelligence in medical imaging (CLAIM), and modified quality assessment of diagnostic accuracy studies (QUADAS-2) tool. The radiomic features selected for model development were documented. RESULTS Nine articles were included. The average of the ideal percentage of RQS, the TRIPOD adherence rate and the CLAIM adherence rate were 26%, 56%, and 57%, respectively. The risk of bias and applicability concerns were mainly related to the index test. The shortness in external validation and open science were repeatedly emphasized. In GCTB radiomics models, the gray level co-occurrence matrix features (40%), first order features (28%), and gray-level run-length matrix features (18%) were most selected features out of all reported features. However, none of the individual feature has appeared repeatably in multiple studies. It is not possible to meta-analyze radiomics features at present. CONCLUSION The quality of GCTB radiomics studies is suboptimal. The reporting of individual radiomics feature data is encouraged. The analysis at the level of radiomics feature has potential to generate more practicable evidence for translating radiomics into clinical application.
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Affiliation(s)
- Jingyu Zhong
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yue Xing
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Guangcheng Zhang
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yangfan Hu
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Defang Ding
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Xiang Ge
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Zhen Pan
- Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Qian Yin
- Department of Pathology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Huizhen Zhang
- Department of Pathology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Qingcheng Yang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University of Medicine, Shanghai, 200025, China.
| | - Weiwu Yao
- Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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12
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Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J, Botchu R. Primary Osseous Malignancies of the Spine. Diagnostics (Basel) 2023; 13:diagnostics13101801. [PMID: 37238285 DOI: 10.3390/diagnostics13101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Malignant primary vertebral tumours comprise an uncommon group of primary bone malignancies that can pose a diagnostic and therapeutic challenge. The most frequently encountered malignant primary vertebral tumours include chordoma, chondrosarcoma, Ewing sarcoma and osteosarcoma. These tumours often present with nonspecific symptoms, such as back pain, neurologic deficits and spinal instability, which can be confused for the more commonly encountered mechanical back pain and may delay their diagnosis and treatment. Imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is crucial for diagnosis, staging, treatment planning and follow-up. Surgical resection remains the mainstay of treatment for malignant primary vertebral tumours, but adjuvant radiotherapy and chemotherapy may be necessary for achieving complete tumour control depending on the type of tumour. In recent years, advances in imaging techniques and surgical approaches, such as en-bloc resection and spinal reconstruction, have improved the outcomes for patients with malignant primary vertebral tumours. However, the management can be complex due to the anatomy involved and the high morbidity and mortality associated with surgery. The different types of malignant primary vertebral lesions will be discussed in this article with an emphasis on the imaging features.
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Affiliation(s)
| | - Nathan Jenko
- Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | | | - Steven James
- Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
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13
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Muacevic A, Adler JR. A Rare Case of Epithelioid Hemangioma Presenting as an Isolated Sacral Mass. Cureus 2022; 14:e29801. [PMID: 36337816 PMCID: PMC9619154 DOI: 10.7759/cureus.29801] [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] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Epithelioid hemangioma (EH) is an uncommon benign vascular tumor of mesenchymal origin. It mainly presents as expanding nodules around the ear, the forehead, and long bones. Only a handful of cases have been found in cervical, thoracic, lumbar, and sacral vertebrae as lytic lesions with pain and neurological impairment. We present the case of a 36-year-old female with an incidental finding of a sacral mass along with inguinal lymphadenopathy on imaging. Initially, there were no symptoms. The mass gradually progressed and later showed an extraosseous extension with involvement of sacral neural foramina and nerve roots causing severe low back pain and weakness of the left lower extremity. Differential diagnoses initially included secondary metastases and chordoma. However, the biopsy of the mass revealed findings consistent with an EH. To our knowledge, this is the first case of EH presenting as an isolated mass in the sacrum and the third case of EH involving the sacrum in continuation with other vertebrae. EH should be in our differential diagnoses when there is a sacral mass.
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14
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Bone Tumors. Radiol Clin North Am 2022; 60:221-238. [DOI: 10.1016/j.rcl.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Keykhosravi E, Rezaee H, Tavallaii A, Tavassoli A, Maftouh M, Aminzadeh B. A Giant Sacrococcygeal Chordoma: A Case Report. Brain Tumor Res Treat 2022; 10:29-33. [PMID: 35118845 PMCID: PMC8819467 DOI: 10.14791/btrt.2022.10.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/19/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
Sacrococcygeal chordoma is a rare malignant bone tumor. Although there are tough membranes such as the periosteum and presacral fascia (which resist transgression by the tumors), chordoma usually invades the rectal wall. The serious problem with these tumors is the late diagnosis and its high likelihood to become enlarged. The main treatment options for this tumor is surgical resection, radiotherapy, and chemotherapy. Due to the tumor vicinity to important organs such as bladder and its neurovascular structures, it makes surgical excision extremely challenging. The aim of this study is to describe a 50-year-old man with a giant sacrococcygeal mass. The novelty of this case report is the huge and unique size of the tumor which has not reported previously as well the special surgical approaches performed to remove the tumor.
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Affiliation(s)
- Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Tavallaii
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmadreza Tavassoli
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Maftouh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Balci B, Yildiz A, Leventoğlu S, Mentes B. Retrorectal tumors: A challenge for the surgeons. World J Gastrointest Surg 2021; 13:1327-1337. [PMID: 34950423 PMCID: PMC8649566 DOI: 10.4240/wjgs.v13.i11.1327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.
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Affiliation(s)
- Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Ankara 06060, Turkey
| | - Alp Yildiz
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara 06370, Turkey
| | - Sezai Leventoğlu
- Department of Surgery, Gazi University Medical School, Ankara 06530, Turkey
| | - Bulent Mentes
- Department of General Surgery, Memorial Ankara Hospital, Ankara 06060, Turkey
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17
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Abstract
CONTEXT.— Chordomas are uncommon malignant neoplasms with notochordal differentiation encountered by neuropathologists, bone/soft tissue pathologists, and general surgical pathologists. These lesions most commonly arise in the axial skeleton. Optimal therapy typically involves complete surgical resection, which is often technically difficult owing to the anatomic location, leading to a high rate of recurrence. Lesions have been generally resistant to radiation and chemotherapy; however, experimental studies involving targeted therapy and immunotherapy are currently underway. OBJECTIVE.— To summarize the clinical and pathologic findings of the various types of chordoma (conventional chordoma, dedifferentiated chordoma, and poorly differentiated chordoma), the differential diagnosis, and recent advances in molecular pathogenesis and therapeutic modalities that are reliant on accurate diagnosis. DATA SOURCES.— Literature review based on PubMed searches containing the term "chordoma" that address novel targeted and immunomodulatory therapeutic modalities; ongoing clinical trials involved in treating chordoma with novel therapeutic modalities identified through the Chordoma Foundation and ClinicalTrials.gov; and the authors' practice experience combined with various authoritative texts concerning the subject. CONCLUSIONS.— Chordoma is a clinically and histologically unique malignant neoplasm, and numerous diagnostic considerations must be excluded to establish the correct diagnosis. Treatment options have largely been centered on surgical excision with marginal results; however, novel therapeutic options including targeted therapy and immunotherapy are promising means to improve prognosis.
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Affiliation(s)
- Veronica Ulici
- From the Department of Pathology and Laboratory Medicine, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jesse Hart
- From the Department of Pathology and Laboratory Medicine, Rhode Island Hospital, The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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18
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Barber SM, Sadrameli SS, Lee JJ, Fridley JS, Teh BS, Oyelese AA, Telfeian AE, Gokaslan ZL. Chordoma-Current Understanding and Modern Treatment Paradigms. J Clin Med 2021; 10:jcm10051054. [PMID: 33806339 PMCID: PMC7961966 DOI: 10.3390/jcm10051054] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022] Open
Abstract
Chordoma is a low-grade notochordal tumor of the skull base, mobile spine and sacrum which behaves malignantly and confers a poor prognosis despite indolent growth patterns. These tumors often present late in the disease course, tend to encapsulate adjacent neurovascular anatomy, seed resection cavities, recur locally and respond poorly to radiotherapy and conventional chemotherapy, all of which make chordomas challenging to treat. Extent of surgical resection and adequacy of surgical margins are the most important prognostic factors and thus patients with chordoma should be cared for by a highly experienced, multi-disciplinary surgical team in a quaternary center. Ongoing research into the molecular pathophysiology of chordoma has led to the discovery of several pathways that may serve as potential targets for molecular therapy, including a multitude of receptor tyrosine kinases (e.g., platelet-derived growth factor receptor [PDGFR], epidermal growth factor receptor [EGFR]), downstream cascades (e.g., phosphoinositide 3-kinase [PI3K]/protein kinase B [Akt]/mechanistic target of rapamycin [mTOR]), brachyury—a transcription factor expressed ubiquitously in chordoma but not in other tissues—and the fibroblast growth factor [FGF]/mitogen-activated protein kinase kinase [MEK]/extracellular signal-regulated kinase [ERK] pathway. In this review article, the pathophysiology, diagnosis and modern treatment paradigms of chordoma will be discussed with an emphasis on the ongoing research and advances in the field that may lead to improved outcomes for patients with this challenging disease.
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Affiliation(s)
- Sean M. Barber
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Saeed S. Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jonathan J. Lee
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (S.M.B.); (S.S.S.); (J.J.L.)
| | - Jared S. Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Bin S. Teh
- Department of Radiation Oncology, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Adetokunbo A. Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI 02903, USA; (J.S.F.); (A.A.O.); (A.E.T.)
- Correspondence: ; Tel.: +1-(401)-793-9132
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Benson JC, Vizcaino MA, Kim DK, Carr C, Rose P, Eckel L, Diehn F. Exophytic Lumbar Vertebral Body Mass in an Adult with Back Pain. AJNR Am J Neuroradiol 2020; 41:1786-1790. [PMID: 32819895 DOI: 10.3174/ajnr.a6749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient's subsequent outcome.
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Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | | | - D K Kim
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - C Carr
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - P Rose
- Orthopedic Surgery (P.R.), Mayo Clinic, Rochester, Minnesota
| | - L Eckel
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - F Diehn
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
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Recurrence or neurological loss? Resection mode selection for patients with large sacral chordoma: an analysis of prognostic factors and quality of life. Acta Neurochir (Wien) 2019; 161:2433-2441. [PMID: 31620873 DOI: 10.1007/s00701-019-04072-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Surgical resection represents the main therapeutic method for sacral chordoma, but plans for resection mode must weigh neurological loss against complete tumor excision, a difficult balance to strike. The purpose of this study was to provide useful information contributing to surgical decision making in sacral chordoma. METHODS A retrospective review was performed on 47 patients with large sacral chordoma. Prognostic factors affecting recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox proportional hazards model. Quality of life was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire and compared using Student's t test. RESULTS Resection mode was the independent prognostic factor affecting RFS, while independent prognostic factors affecting OS were resection mode and postoperative recurrence. As for quality of life, the en bloc resection group showed a higher score in emotional well-being, while the piecemeal resection group scored better in function well-being. No significant difference was identified in total the FACT-G score between two groups. CONCLUSIONS On the one hand, en bloc resection showed huge advantages in disease control for sacral chordoma. On the other hand, despite the unsatisfaction in functional well-being, en bloc resection did not sacrifice quality of life significantly in terms of the total FACT-G score.
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21
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Segura-Trepichio M, Montoza-Nuñez JM, Candela-Zaplana D, Herrero-Santacruz J, Pla-Mingorance F. Primary Sacral Hydatid Cyst Mimicking a Neurogenic Tumor in Chronic Low Back Pain: Case Report and Review of the Literature. J Neurosci Rural Pract 2019; 7:S112-S116. [PMID: 28163523 PMCID: PMC5244041 DOI: 10.4103/0976-3147.196456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hydatid disease is caused by infection of Echinococcus granulosus. Bone hydatid cyst presentation without hepatic affectation is infrequent and occurs in 0,5-2% of cases. This rare condition makes clinicians not always aware of the disease, and as a result, misdiagnosis of spinal echinococcosis is common. We present a case of a 48-year-old female patient with primary sacral hydatidosis. Chronic low back pain radiating to the left buttock was the only symptom. The magnetic resonance imaging (MRI) suggested a neurogenic tumor versus giant cell tumor. Biopsy and pathological study revealed a hydatid cyst. Anthelmintic and surgical treatment was performed. At 12 months after surgery, the patient is free of recurrence. In patients with chronic low back pain and a MR suggestive of neurogenic tumor, spinal hydatid cyst should be considered in the differential diagnosis. It is recommended the assistance of an anesthesiologist during biopsy to avoid an anaphylactic shock.
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22
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Chetan MR, Lyon PC, Wu F, Phillips R, Cranston D, Gillies MJ, Bojanic S. Role of diffusion-weighted imaging in monitoring treatment response following high-intensity focused ultrasound ablation of recurrent sacral chordoma. Radiol Case Rep 2019; 14:1197-1201. [PMID: 31428215 PMCID: PMC6698304 DOI: 10.1016/j.radcr.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022] Open
Abstract
Chordoma is the most common malignant tumor of the sacrum and is associated with significant neurologic morbidity. Local recurrence is very common, and the long-term prognosis is poor. High-intensity focused ultrasound (HIFU) is a noninvasive and nonionising ablative therapy that has been successful in treating other tumor types and is being evaluated as a new therapy for sacral chordoma. Contrast-enhanced magnetic resonance imaging is typically used to evaluate tumor perfusion following HIFU; however, its utility is limited in poorly perfused tumors. Diffusion-weighted imaging (DWI) provides tissue contrast based on differences in the diffusion of extracellular water without using gadolinium-based contrast agents. We present novel DWI findings following a planned partial HIFU ablation of a large sacral chordoma which had recurred after radiotherapy. Following HIFU, the treated tumor volume demonstrated loss of restriction on DWI correlating with photopenia on positron emission tomography. This suggests successful ablation and tumor necrosis. This novel finding may provide guidance for sequence selection when evaluating HIFU therapy for sacral chordoma and other tumor types for which contrast-enhanced magnetic resonance imaging may have limited utility.
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Affiliation(s)
- Madhurima R Chetan
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Paul C Lyon
- HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Feng Wu
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Rachel Phillips
- Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - David Cranston
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Stana Bojanic
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
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23
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Batouli A, Gholamrezanezhad A, Petrov D, Rudkin S, Matcuk G, Jadvar H. Management of Primary Osseous Spinal Tumors with PET. PET Clin 2018; 14:91-101. [PMID: 30420225 DOI: 10.1016/j.cpet.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Knowledge of the PET imaging findings of osseous spinal neoplasms is essential, because they are common incidental findings on PET scans done for staging of unrelated primary malignancies. Additionally, PET can help differentiate lesions that are not clearly defined by anatomic modalities alone. PET can also be used for follow-up of aggressive tumors to assess response to treatment, often proving superior to CT or MR imaging alone for this purpose. This review discusses the role of PET/CT and PET/MR imaging in the diagnosis and management of primary benign and malignant osseous tumors of the spine.
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Affiliation(s)
- Ali Batouli
- Department of Radiology, Division of Neuroradiology, Oregon Health and Science University, 8833 Southwest 30th Avenue, Portland, OR 97219, USA.
| | - Ali Gholamrezanezhad
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - David Petrov
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - Scott Rudkin
- Department of Radiology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15214, USA
| | - George Matcuk
- Department of Radiology, Division of Musculoskeletal Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
| | - Hossein Jadvar
- Department of Radiology, Division of Nuclear Medicine, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA; Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 102, Los Angeles, CA 90033, USA
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24
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Erazo IS, Galvis CF, Aguirre LE, Iglesias R, Abarca LC. Clival Chondroid Chordoma: A Case Report and Review of the Literature. Cureus 2018; 10:e3381. [PMID: 30519520 PMCID: PMC6263615 DOI: 10.7759/cureus.3381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chordomas are rare, slow-growing, and locally aggressive malignant neoplasms derived from primitive notochord remnants. The chondroid variety represents 14% of all chordomas mainly developing in the spheno-occipital region and presenting between the third and fifth decades of life. When developing intracranially, symptoms can range from headaches and neck pain to cranial nerve neuropathies and facial numbness. We illustrate a case of an adolescent woman who presented with excruciating facial pain, otalgia, decreased visual acuity, quadriparesis, headache, nausea, and dysphagia. Radiological studies revealed a large heterogeneous mass in the spheno-occipital region with clivus destruction. Biopsy and histopathology confirmed the diagnosis. Proper identification with prompt surgical resection and adjuvant radiotherapy remains critical to prevent complications.
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Affiliation(s)
- Ibeth S Erazo
- Department of Emergency Medicine, Hospital Teodoro Maldonado Carbo / Universidad Catolica De Santiago De Guayaquil, Guayaquil, ECU
| | - Claudio F Galvis
- Department of Emergency Medicine, Hospital Teodoro Maldonado Carbo / Universidad Catolica De Santiago De Guayaquil, Guayaquil, ECU
| | - Luis E Aguirre
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, USA
| | - Roman Iglesias
- Department of Pathology, Hospital Teodoro Maldonado Carbo / Universidad Catolica De Santiago De Guayaquil, Guayaquil, ECU
| | - Luz C Abarca
- Department of Internal Medicine, Hospital Teodoro Maldonado Carbo / Universidad Catolica De Santiago De Guayaquil, Guayaquil, ECU
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25
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Summers S, Jose J, Barrera CM, Pretell-Mazzini J, Subhawong T, Nguyen NV, Kerr D, Nielsen GP, Rosenberg AE. Intraosseous schwannomas involving the sacrum: Characteristic imaging findings and review of the literature. Neuroradiol J 2018; 31:531-540. [PMID: 29890877 DOI: 10.1177/1971400918782321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of intraosseous schwannomas is limited. The aim of this study is to formally characterize the radiological appearance of sacral intraosseous schwannomas to differentiate them from other lytic lesions. Materials and methods Imaging studies of 13 pathologically proven intraosseous schwannomas were reviewed from multiple institutions by fellowship-trained radiologists. A PubMed search was performed and identified four papers pertaining to the imaging characteristics of sacral intraosseous schwannomas. The results of these papers were compared to findings from our cases. Results All tumors had heterogeneous signals and were predominately solid but cystic components with fluid-fluid levels were present. The tumors caused a mass effect but none infiltrated the surrounding soft tissues. Post-contrast T1-weighted images revealed heterogeneous enhancement in all 13 tumors and four possessed non-enhancing cysts. A literature review identified 16 other cases of sacral intraosseous schwannomas forming a total of 29 cases examined. Conclusions Sacral intraosseous schwannomas should be considered in the differential diagnosis for both radiologists and pathologists when dealing with large expansile, lytic lesions, with well-defined sclerotic margins involving the sacrum. This is particularly important in middle-aged adults presenting with pathology centered around S2-3.
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Affiliation(s)
- Spencer Summers
- 2 Department of Orthopedics, University of Miami Miller School of Medicine, USA
| | - Jean Jose
- 1 Department of Radiology, University of Miami Miller School of Medicine, USA
| | | | | | - Ty Subhawong
- 1 Department of Radiology, University of Miami Miller School of Medicine, USA
| | - Nguyen V Nguyen
- 1 Department of Radiology, University of Miami Miller School of Medicine, USA
| | - Darcy Kerr
- 4 Department of Pathology, University of Miami Miller School of Medicine, USA
| | - G Petur Nielsen
- 5 Department of Pathology, Massachusetts General Hospital, USA
| | - Andrew E Rosenberg
- 4 Department of Pathology, University of Miami Miller School of Medicine, USA
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26
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Sacral chordoma : A review of literature. J Orthop 2018; 15:679-684. [PMID: 29881220 DOI: 10.1016/j.jor.2018.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/20/2018] [Accepted: 04/29/2018] [Indexed: 11/21/2022] Open
Abstract
Chordoma is a rare malignant tumor with predilection for the sacrum. A favorable outcome depends on early diagnosis and surgical excision with tumor free margins. Aim To review the incidence and prevalence of sacral chordoma and the appropriate surgical management and formulate a criteria for early diagnosis. Materials and methods Thirty eight articles on the subject of sacral chordoma and extrapolated data of clinical and surgical significance. Results The commonest presenting feature in patients with sacral chordoma was lower back pain which was worse on sitting and up to a third of these patients had associated urinary tract infections, constipation or symptoms of disc herniation. The hallmark of sacral chordoma is lower back pain with poor response to non-steroidal anti-inflammatory drugs.Disease free eradication in chordoma is rare and not without neurological deficit. The common sacral levels involved ie. S2,3 have to be sacrificed to achieve adequate margins4. Whilst wide excision via posterior surgery shows a decrease in recurrence, the overall survival still remains low.
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27
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Abstract
Although common nonspecific symptoms (i.e., rectal bleeding, pelvic pressure, and change in bowel habits) are associated with rectal cancer, occasionally these are related to a different underlying disease. Over the past few years, considerable progress has been made in imaging of the rectum. Specifically, new magnetic resonance techniques and capabilities provide impressive high-resolution assessment of the rectal wall and enable evaluation and characterization of the perirectal tissues. This paper reviews imaging findings of uncommon causes of rectal and perirectal pathology that may be clinically confounded with rectal cancer. Radiologists need to be aware of uncommon pathologies in this region in order to facilitate optimal management decisions.
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28
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Carrasco García de León S, Flores Barragán JM, Villasanti Rivas N. Pudendal Neuralgia as the Initial Manifestation of Infiltrative Sacrococcygeal Chordoma. Case Rep Neurol 2016; 8:172-178. [PMID: 27721781 PMCID: PMC5043294 DOI: 10.1159/000448915] [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: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022] Open
Abstract
Sacrococcygeal chordoma is a malignant tumour originating from remnants of the notochord. Chordomas are slow-growing tumours whose symptoms develop insidiously. We present the case of a 72-year-old woman with a 6-month history of genital pain radiating to the perianal area and exacerbating when she was in a sitting position. MRI and PET studies revealed a large mass in the sacrococcygeal region causing bone destruction and invasion of neurovascular structures. The immunohistochemical study of the surgical specimen determined it to be chordoma. This is the first published case of pudendal neuralgia as a form of presentation of sacrococcygeal chordoma.
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Affiliation(s)
| | | | - Natalia Villasanti Rivas
- Department of Anatomic Pathology, University General Hospital of Ciudad Real, Ciudad Real, Spain
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29
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Rohatgi S, Ramaiya NH, Jagannathan JP, Howard SA, Shinagare AB, Krajewski KM. Metastatic Chordoma: Report of the Two Cases and Review of the Literature. Eurasian J Med 2015; 47:151-4. [PMID: 26180502 DOI: 10.5152/eurasianjmed.2015.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/07/2014] [Indexed: 11/22/2022] Open
Abstract
Chordomas are rare malignant bone tumours with a predilection for the axial skeleton, especially the sacrum and skull base. Median survival in patients with metastatic disease is usually dismal. Treatment is challenging due to the propensity for local recurrence, metastatic disease as well as lack of clear consensus regarding the optimal management. Our case report highlights two cases of sacral chordoma with locally recurrent and widespread metastatic disease, stable on molecular targeted therapy.
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Affiliation(s)
- Saurabh Rohatgi
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Nikhil H Ramaiya
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Jyothi P Jagannathan
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Stephanie A Howard
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Atul B Shinagare
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
| | - Katherine M Krajewski
- Brigham and Women's Hospital/Dana Farber Cancer institute/ Harvard Medical School - Radiology Boston, Massachusetts, USA
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30
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31
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Williams SP, Beckerman B, Piña Fonti ME. A 69-year-old presenting with musculoskeletal low back pain: a case of lumbosacral chordoma. J Chiropr Med 2015; 13:144-8. [PMID: 25685125 DOI: 10.1016/j.jcm.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the presentation of a patient with lumbosacral chordoma characterized by somatic chronic low back pain and intermittent sacral nerve impingement. CASE REPORT A 69-year-old male presenting to an emergency department (ED) with low back pain was provided analgesics and muscle relaxants then referred for a series of chiropractic treatments. Chiropractic treatment included manipulation, physical therapy, and rehabilitation. After 3 times per week for a total of 4 weeks, re-examination showed little relief of his symptoms. His pain symptoms worsened and he presented to the ED for the second time. Magnetic resonance imaging was performed and revealed a high intensity mass. INTERVENTION AND OUTCOME The soft tissue mass identified on magnetic resonance imaging was surgically removed. Shortly after the surgery, the patient developed post-operative bleeding and was returned to surgery. During the second procedure, he developed a post-operative hemorrhage related to the development of disseminated intravascular coagulation and subsequently died during the second procedure. A malignant lumbosacral chordoma was diagnosed on pathologic examination. CONCLUSION This case report describes the presentation of a patient with lumbosacral chordoma presenting with musculoskeletal low back pain. Chordomas are rare with few prominent manifestations. An early diagnosis can potentially make a difference in morbidity and mortality. Due to its insidious nature, it is a difficult diagnosis and one that is often delayed.
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Affiliation(s)
- Shawn P Williams
- Associate Professor, Department of Health Professions, CUNY, York College, Jamaica, NY
| | - Bernard Beckerman
- Associate Professor, Department of Health Professions, CUNY, York College, Jamaica, NY
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Sacrococcygeal chordoma presenting as a retro rectal tumour. Int J Surg Case Rep 2014; 5:714-6. [PMID: 25201478 PMCID: PMC4189063 DOI: 10.1016/j.ijscr.2014.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/26/2014] [Accepted: 07/29/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chordomas are rare, slow growing, locally destructive bone tumours arising from the notochord. PRESENTATION OF CASE Presenting a case of a 65 year old man, who presented with complaints of swelling on the right lower back for 1 year associated with pain. On, physical examination, a swelling measuring 5cm×4cm was noted in the lower back with posterior wall indentation on per rectal examination. MRI revealed a mass lesion involving the sacrum (s3-s4) and coccyx. FNAC showed features of a chroma. At surgery, we excised a mass from the retrorectal space and biopsy proved it to be a chondroid chordoma, a variant of chordoma. DISCUSSION Chordomas are solid malignant tumours that arise from vestiges of the foetal notochord. Common locations are the clivus and the sacrococcygeus region. Annual incidence of these tumours is 1 in one million. MRI is the imaging modality of choice. Prognosis improves based on the age, resected margins and postoperative treatment. CONCLUSION Here, we shall discuss the literature, variants, treatment and prognosis of this rare tumour.
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Carey K, Bestic J, Attia S, Cortese C, Jain M. Diffuse skeletal muscle metastases from sacral chordoma. Skeletal Radiol 2014; 43:985-9. [PMID: 24407557 DOI: 10.1007/s00256-013-1794-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/29/2013] [Accepted: 11/29/2013] [Indexed: 02/02/2023]
Abstract
Chordomas are rare, slow-growing tumors arising from cellular remnants of the notochord. They account for 1-4% of primary malignant bone tumors and usually occur in the axial skeleton, most commonly the sacrum. Although typically locally recurrent, chordoma metastasis rates as high as 10-42% have been reported. While spread to multiple organ systems has been documented, metastatic disease to skeletal muscle is extremely rare. We present a case of extensive, multifocal skeletal muscle metastases developing in the setting of recurrent sacral chordoma. Our literature search found only one additional case of metastatic chordoma to a single skeletal muscle.
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Affiliation(s)
- Kathleen Carey
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
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George B, Bresson D, Bouazza S, Froelich S, Mandonnet E, Hamdi S, Orabi M, Polivka M, Cazorla A, Adle-Biassette H, Guichard JP, Duet M, Gayat E, Vallée F, Canova CH, Riet F, Bolle S, Calugaru V, Dendale R, Mazeron JJ, Feuvret L, Boissier E, Vignot S, Puget S, Sainte-Rose C, Beccaria K. [Chordoma]. Neurochirurgie 2014; 60:63-140. [PMID: 24856008 DOI: 10.1016/j.neuchi.2014.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
PURPOSES To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature. MATERIALS The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine. METHODS In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups. RESULTS In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection. CONCLUSIONS Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.
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Affiliation(s)
- B George
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - D Bresson
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Bouazza
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Froelich
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Mandonnet
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Hamdi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Orabi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Cazorla
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - H Adle-Biassette
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-P Guichard
- Service de neuroradiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Duet
- Service de médecine nucléaire, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Gayat
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - F Vallée
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C-H Canova
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Riet
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Bolle
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Calugaru
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Dendale
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Boissier
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Vignot
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Puget
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - C Sainte-Rose
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - K Beccaria
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
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Dyrstad SW, Fowler AM, Jokerst CE, Baker JC, Hillen TJ, Menias C. Abdominal and pelvic tumors with musculoskeletal histology. Curr Probl Diagn Radiol 2014; 43:68-79. [PMID: 24629660 DOI: 10.1067/j.cpradiol.2013.11.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article is a case-based review of the broad spectrum of tumors with musculoskeletal histology that can arise in the abdomen or pelvis and involve the soft tissues, muscle, and bone. In this article, pathology-proven cases are presented with a focus on radiographic, computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography findings. The imaging features that differentiate tumors with musculoskeletal histology from more common abdominal tumors are discussed. Representative cases include malignant fibrous histiocytoma, chondrosarcoma, Ewing sarcoma, hemangiopericytoma, desmoplastic fibroma, neurofibrosarcoma, osteosarcoma, intimal sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, teratoma, and chordoma. A variety of tumors with musculoskeletal histology can arise in the abdomen and pelvis. In some cases, unique imaging characteristics allow a confident diagnosis, whereas other cases have a more nonspecific appearance. Recognition of imaging features that suggest a musculoskeletal tumor including direct extension from a bone or neural foramen, the presence of cartilaginous or osseous matrix, or macroscopic fat would allow the radiologist to suggest the proper diagnosis. Recognizing imaging characteristics of tumors with musculoskeletal histology is important clinically as management and prognosis differ from that of more common abdominal tumors.
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Affiliation(s)
| | - Amy M Fowler
- Mallinckrodt Institute of Radiology, St. Louis, MO
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Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR. Giant Cell Tumor of Bone: Review, Mimics, and New Developments in Treatment. Radiographics 2013; 33:197-211. [DOI: 10.1148/rg.331125089] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Sartoretti–Schefer S, Oberle J, Binkert C, Pfofe D, Gutzeit A. Lumbar vertebral chordoma: diffusion-weighted imaging findings are helpful to narrow the differential diagnosis. A case report. Clin Imaging 2013. [DOI: 10.1016/j.clinimag.2012.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lee J, Bhatia NN, Hoang BH, Ziogas A, Zell JA. Analysis of prognostic factors for patients with chordoma with use of the California Cancer Registry. J Bone Joint Surg Am 2012; 94:356-63. [PMID: 22336975 PMCID: PMC6882537 DOI: 10.2106/jbjs.j.01784] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chordoma is the most common primary malignant tumor of the spine. It is extremely rare and has been studied primarily in single-institution case series. Using data from a large, population-based cancer registry, we designed the present study to examine the outcome for patients with chordoma and to determine relevant prognostic factors. METHODS A retrospective analysis of the California Cancer Registry database was performed to identify patients with a diagnosis of chordoma in the years 1989 to 2007. Comparisons examined differences in demographics, disease characteristics, treatment, and survival. Survival analyses were performed with use of the Kaplan-Meier method with log-rank tests and Cox proportional hazards models. RESULTS Four hundred and nine patients with chordoma were identified; 257 (62.8%) were male and 152 (37.2%) were female. With regard to racial or ethnic distribution, 266 patients (65%) were white; ninety-three (22.7%), Hispanic; forty-three (10.5%), Asian or other; and seven (1.7%), black. The site of presentation was the head in 202 patients (49.4%), spine in 106 patients (25.9%), and pelvis and/or sacrum in 101 patients (24.7%). Hispanic race (p = 0.0002), younger age (less than forty years; p < 0.0001), and female sex (p = 0.009) were associated with cranial presentation, whereas older age (forty years or older; p < 0.0001) was associated with pelvic presentation. After adjustment for clinically relevant factors, a significantly decreased risk of death for chordoma-specific survival was seen for Hispanic race (hazard ratio = 0.51, 95% confidence interval [95% CI], 0.28 to 0.93; p = 0.03), high socioeconomic status (hazard ratio = 0.8, 95% CI, 0.67 to 0.95; p = 0.01), and local excision and/or debulking (hazard ratio = 0.38, 95% CI, 0.18 to 0.81; p = 0.01). Large tumor size was independently associated with an increased risk of death (hazard ratio = 2.05, 95% CI, 1.01 to 4.20; p = 0.048). CONCLUSIONS In this study, the survival of patients with chordoma was significantly better for those who were Hispanic and had a small tumor, high socioeconomic status, and surgical intervention.
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Affiliation(s)
- Joe Lee
- Department of Orthopaedic Surgery (J.L., N.N.B., and B.H.H.), Spine Center (N.N.B.), Chao Family Comprehensive Cancer Center (B.H.H.), University of California, Irvine, 101 The City Drive South, Pavilion 3, Orange, CA 92868
| | - Nitin N. Bhatia
- Department of Orthopaedic Surgery (J.L., N.N.B., and B.H.H.), Spine Center (N.N.B.), Chao Family Comprehensive Cancer Center (B.H.H.), University of California, Irvine, 101 The City Drive South, Pavilion 3, Orange, CA 92868
| | - Bang H. Hoang
- Department of Orthopaedic Surgery (J.L., N.N.B., and B.H.H.), Spine Center (N.N.B.), Chao Family Comprehensive Cancer Center (B.H.H.), University of California, Irvine, 101 The City Drive South, Pavilion 3, Orange, CA 92868
| | - Argyrios Ziogas
- Department of Epidemiology, School of Medicine (A.Z. and J.A.Z.), and the Genetic Epidemiology Research Institute (A.Z.), University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7550. E-mail address for J.A. Zell:
| | - Jason A. Zell
- Department of Epidemiology, School of Medicine (A.Z. and J.A.Z.), and the Genetic Epidemiology Research Institute (A.Z.), University of California, Irvine, 224 Irvine Hall, Irvine, CA 92697-7550. E-mail address for J.A. Zell:
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Abstract
The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of sacral masses and the key imaging characteristics of various sacral masses.
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