Sacral chordoma in an adult showing an aggressive clinical course: A case report

Endo,Koji; Yamashita,Hideki; Nagashima,Hideki; Teshima,Ryota

doi:10.3892/ol.2014.1892

Sacral chordoma in an adult showing an aggressive clinical course: A case report

Authors:
- Koji Endo
- Hideki Yamashita
- Hideki Nagashima
- Ryota Teshima
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Affiliations: Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori 683‑8504, Japan
Published online on: February 19, 2014 https://doi.org/10.3892/ol.2014.1892
Pages: 1443-1446

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Abstract

The current report presents a case of a 78‑year‑old male with sacral chordoma, showing an aggressive clinical course. The patient underwent sacral resection, however, nine months later, multiple metastases were detected by magnetic resonance imaging. The metastases progressed rapidly and 15 months following surgery the patient succumbed to respiratory dysfunction. An autopsy revealed multiple metastases of the lung, liver, heart, kidneys and vertebrae. Pathologically, the tumors did not show proliferation of anaplastic cells or dedifferentiation; however, the metastatic tumor cells were smaller than the primary tumor cells. The Ki‑67 labeling indices were <5% in all of the patient's tumors, therefore, the capacity for cellular proliferation of the tumors was considered to be low. Chordoma in adults are generally slow‑growing tumors and are associated with a relatively prolonged course and frequent local recurrences. Therefore, it must be recognized that chordoma may grow rapidly and show an aggressive clinical course, even when the Ki‑67 labeling index is low.

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1	Huvos AG: Bone Tumors: Diagnosis, Treatment and Prognosis. WB Saunders; Philadelphia, PA: pp. 373–391. 1979
2	Unni KK: Dahlin’s Bone Tumors: General Aspects and Data on 11,087 cases. 5th edition. Lippincott-Raven; Philadelphia, PA: pp. 291–305. 1996
3	Chambers PW and Schwinn CP: Chordoma: A clinicopathologic study of metastasis. Am J Clin Pathol. 72:765–776. 1979.PubMed/NCBI
4	Hruban RH, May M, Marcove RC and Huvos AG: Lumbo-sacral chordoma with high-grade malignant cartilaginous and spindle cell components. Am J Surg Pathol. 14:384–389. 1990. View Article : Google Scholar
5	Coffin CM, Swanson PE, Wick MR and Dehner LP: Chordoma in childhood and adolescence: A clinicopathologic analysis of 12 cases. Arch Pathol Lab Med. 117:927–933. 1993.PubMed/NCBI
6	Kaneko Y, Sato Y, Iwaki T, Shin RW, Tateishi J and Fukui M: Chordoma in early childhood: a clincopathological study. Neurosurgery. 29:442–446. 1991. View Article : Google Scholar : PubMed/NCBI
7	Volpe R and Mazabraud A: A clinicopathologic review of 25 cases of chordoma (a pleomorphic and metastasizing neoplasm). Am J Surg Pathol. 7:161–170. 1983. View Article : Google Scholar : PubMed/NCBI
8	Osaka S, Kodoh O, Sugita H, Osaka E, Yoshida Y and Ryu J: Clinical significance of a wide excision policy for sacrococcygeal chordoma. J Cancer Res Clin Oncol. 132:213–218. 2006. View Article : Google Scholar : PubMed/NCBI
9	Gennari L, Azzarelli A and Quagliuolo V: A posterior approach for the excision of sacral chordoma. J Bone Joint Surg Br. 69:565–568. 1987.PubMed/NCBI
10	Hulen CA, Temple HT, Fox WP, Sama AA, Green BA and Eismont FJ: Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am. 88:1532–1539. 2006. View Article : Google Scholar : PubMed/NCBI
11	Samson IR, Springfield DS, Suit HD and Mankin HJ: Operative treatment of sacrococcygeal chordoma. A review of twenty-one cases. J Bone Joint Surg Am. 75:1476–1484. 1993.
12	Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY and Sim FH: Operative management of sacral chordoma. J Bone Joint Surg Am. 87:2211–2216. 2005. View Article : Google Scholar : PubMed/NCBI
13	Mirra JM, Rocca CD, Nelson SD and Mertens F: Chordoma. World Health Organization Classification of Tumors. Pathology and Genetics of Tumours of Soft Tissue and Bone. Fletcher CDM: IARC Press; Lyon: pp. 316–317. 2002
14	Shinmura Y, Miura K, Yajima S and Tsutsui Y: Sacrococcygeal chordoma in infancy showing an aggressive clinical course: an autopsy case report. Pathol Int. 53:473–477. 2003. View Article : Google Scholar : PubMed/NCBI
15	Iwasa Y, Nakashima Y, Okajima H and Morishita S: Sacral chordoma in early childhood: clinicopathological and immunohistochemical study. Pediatr Dev Pathol. 1:420–426. 1998. View Article : Google Scholar : PubMed/NCBI
16	Hanna SA, Tirabosco R, Amin A, et al: Dedifferentiated chordoma: a report of four cases arising ‘de novo’. J Bone Joint Surg Br. 90:652–656. 2008.PubMed/NCBI
17	Murad TM and Murthy MS: Ultrastructure of a chordoma. Cancer. 25:1204–1215. 1970. View Article : Google Scholar : PubMed/NCBI
18	Makek M and Leu HJ: Malignant fibrous histiocytoma arising in a recurrent chordoma. Case report and electron microscopic findings. Virchows Arch A Pathol Anat Histol. 397:241–250. 1982. View Article : Google Scholar
19	Scholzen T and Gerdes J: The Ki-67 protein: from the known and the unknown. J Cell Physiol. 182:311–322. 2000. View Article : Google Scholar : PubMed/NCBI
20	Holton JL, Steel T, Luxsuwong M, Crockard HA and Revesz T: Skull base chordomas: correlation of the tumour doubling time with age, mitosis and Ki67 proliferation index. Neuropathol Appl Neurobiol. 26:497–503. 2000. View Article : Google Scholar : PubMed/NCBI
21	Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W and Meis-Kindblom JM: Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 88:2122–2134. 2000. View Article : Google Scholar : PubMed/NCBI
22	Klingler L, Shooks J, Fiedler PN, Marney A, Butler MG and Schwartz HS: Microsatellite instability in sacral chordoma. J Surg Oncol. 73:100–103. 2000. View Article : Google Scholar : PubMed/NCBI
23	Horbinski C, Oakley GJ, Cieply K, et al: The prognostic value of Ki-67, p53, epidermal growth factor receptor, 1p36, 9p21, 10q23, and 17p13 in skull base chordomas. Arch Pathol Lab Med. 134:1170–1176. 2010.PubMed/NCBI
24	York JE, Kaczaraj A, Abi-Said D, et al: Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery. 44:74–80. 1999.PubMed/NCBI
25	Boriani S, Bandiera S, Biagini R, et al: Chordoma of the mobile spine: fifty years of experience. Spine (Phila Pa 1976). 31:493–503. 2006.PubMed/NCBI