Skull base chordoma presenting as nasopharyngeal mass with lymph node metastasis

Abstract

Spheno-occipital chordomas can rarely present as nasopharyngeal mass. Metastases occur only in advanced disease. They can pose a diagnostic dilemma when information about diagnosis of the primary tumor is not available. We present cytological findings in upper cervical lymph node of a case of nasopharyngeal chordoma and discuss possible differential in such a location.

A vertebral extra dural chordoma at C5, possibly deriving from a clival chordoma

“…More important, the cutaneous tumor cannot be explained by this metastatic pathway. Spreading through the lymph system as described by Jain et al [ 7 ] might explain why the tumor metastasized to the dermis and the cervical vertebrae, however, histological examination of the removed tissue did not show evidence of lymphoid tissue. Leaving hematogenous spreading as the only option, Zemmouna et al explains that hematogenous dissemination by clival chordomas is rare, because the dura at the clivus is very adherent to the periosteum effectively isolating the venous sinus from the tumor and protecting it from tumor expansion toward the venous sinus.…”

“…Metastasis are uncommon for clival chordomas, as 73% of the metastatic chordomas originate from the sacrococcygeal region, and most frequently appear in lung, liver, lymph node, or bone. [ 4 5 6 7 8 14 ] There are a number of possible pathways for tumor dissemination: Through the lymph system, hematogenous of by liquor transport. [ 4 6 7 12 ] A drop metastasis by the liquor transportation, as described by Uggowitzer et al ,[ 12 ] is unlikely in this specific case, because the vertebral primary tumor did not infiltrate trough the dura and the dura remained intact during the first surgery.…”

Primary Chordoma of the Nasopharynx: A Rare Case Report and Review of the Literatures

“…Chordomas arising from the skull base/clivus with extension into the nasopharynx area are excluded in the list of primary nasopharyngeal chordomas [1]. They are preferably diagnosed as clival chordomas presenting as nasopharyngeal mass [11, 12].…”

“…In all cases of reported nasopharyngeal chordomas, metastasis was not observed. However, there had been reports of cases of chordoma that metastasized to the peritoneum, pleura [24], liver [1, 24], lung, bone, soft tissue, skin [1, 2, 24], and lymph node [12].…”

Aneurysmal Bone Cyst of Sphenoid Bone and Clivus Misdiagnosed as Chordoma: A Case Report

“…ABCs are relatively uncommon, well differentiated benign tumors that present most frequently before the age of 20 years [ 3 4 ]. The knee joint and vertebrae are the most frequently affected sites.…”