Chordomas and Their Consideration in the Radiographic Differential of Extra-Axial Lesions of the Central Nervous

Shih-Shan Lang, Jayesh P. Thawani, Anousheh Sayah, Sriram Venneti, Danielle Brewington, Eric L. Zager, Stephen J. Dante

Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, USA.
Department of Pathology and Laboratory Medicine, Division of Neuropathology, University of Pennsylvania Medical Center, Philadelphia, USA.
Department of Radiology, Georgetown University Hospital, Washington DC, USA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.

DOI: 10.4236/ojmn.2012.23012                

Abstract

Due to the rare occurrence of chordomas extra-axially, these lesions have not earned a great deal of consideration in the clinical and radiographic differential diagnoses of extra-axial paraspinal lesions. We describe a case of a patient with a surgically resected extra-axial chordoma and review the radiologic characteristics of chordomas as an entity in the spectrum of extra-axial lesions. A 47-year-old man presented to our institution with four months of intermittent parethesias, pain, and subjective weakness in the left leg. MR imaging of the lumbar spine demonstrated a large heterogeneously- enhancing paraspinal lesion extending from the left L3-4 neural foramen into the psoas muscle. The patient underwent a CT-guided needle biopsy demonstrating features consistent with a chordoma. He then underwent a left retroperitoneal approach and en bloc resection of the lesion from the vertebral column. Pathology confirmed chordoma as the diagnosis. EACs are a rare but important consideration in the diagnosis of extra-axial lesions of the central nervous system.

Keywords

Chordoma; Primitive Notochord Tumor; Extra-Axial Tumor; Spine

Conflicts of Interest

The authors declare no conflicts of interest.

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