Presentation
Radicular pain.
Patient Data
There is a large destructive tumor centered on the right side of the C4 vertebral body, and extending into the right C4 lateral mass, pedicle and lamina. It protrudes into the spinal canal at this level although there is no obvious impingement on the spinal cord within the limits of this CT.
There is very slight erosion of the right posterior corner of the adjacent C3 inferior endplate and the right posterior corner of the adjacent C5 superior endplate.
CONCLUSION: MRI is recommended for further evaluation of the extent of the mass, better evaluation of the spinal cord.
A right C4 vertebral body mass with avid homogeneous enhancement and vividly high T2 signal. Posteriorly, the extraosseous portion of the mass indents the thecal sac and slightly flattens the right ventral spinal cord, without abnormal cord signal. There is complete obliteration of the right C3/4 andC4/5 intervertebral foramen. Near complete encasement of the right vertebral artery at the level of the C4 transverse foramen, with normal flow void maintained in the vessel, displaced anterolaterally.
Case 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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