Chordoma (C4 vertebra)

Discussion:

The patient went on to have a resection. 

Histology

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular epithelioid tumor, which has a lobulated appearance. It forms sheets, nests and cords in a background of myxomatous stroma. The tumor invades into the bony trabeculae. The tumor cells have moderately enlarged nuclei, focal prominent nucleoli and moderate amounts of eosinophilic cytoplasm. Scattered physaliferous cells are seen and they show cytoplasmic vacuolation. Mitoses are inconspicuous. Lymphovascular or perineural invasion is absent. Some parts of the tumor are surrounded by fibrous tissue with clear diathermied edges. The features are those of chordoma. The tumor cells are diffusely CAM5.2, focally S-100, CK7 and CK20 positive. The Ki-67 index is about 8%. CDX-2, GATA-3 and TTF-1 are negative.

FINAL DIAGNOSIS: Chordoma.

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