Sphenooccipital Chordoma Presenting as a Nasopharyngeal Mass

Abstract

While the nasopharynx is most commonly regarded by the otolaryngologist as a primary site of neoplastic involvement, it is also an avenue of spread of base-of-the-skull tumors presenting as bulging nasopharyngeal masses. The temporal sequence of clinical signs and symptoms may reliably predict the origin of a ventrally extending sphenooccipital chordoma seen on a nasopharyngeal examination. This tumor may cause extensive bony erosion of the petrous apex, sphenoid sinus, and clivus and may suggest a more rapidly growing and aggressive tumor type. The extent of the tumor may be accurately determined by conventional tomography, computerized axial tomography, and arteriography. Severl surgical approaches including the infratemporal fossa approach, transoral transpalatal approach and rhinoseptal transphenoidal approach may be appropriately utilized singly or in combination to remove this tumor in whole or part; however, the rhinoseptal transphenoidal approach is emphasized and regarded as the most rational treatment plan for subtotal resection, recognizing the usual futility of an en bloc resection with its associated high morbidity.

Chordoma of skull base presenting as nasopharyngeal mass

“…In the absence of the mass in FOR but with strong clinical suspicious of NPC, the radiological imaging such as computed tomography scan or magnetic resonance (MR) imaging is valuable to pick up the sub-mucosal type of NPC. [3] In areas of NPC endemics, for example China, the use of MR imaging as a screening…”

“…The extent of the tumor may be accurately determined by conventional tomography, computerized axial tomography, and arteriography. [3] Most are treated with radiotherapy (RT) because of extensive involvement making them unresectable. Because of the risk of severe late complications, the dose is often limited with conventional photon RT, and the probability of cure is low.…”

Chordoma in Nasopharynx in a 70-Year-Old Female: A Rare Occurence

“…The sacrum is the commonest site followed by the base of the skull/clival region. Spheno-occipital chordomas giving rise to the formation of a nasopharyngeal mass have been described in literature [1]- [3]. When skull base chordomas occur at an extraosseous location (without lytic bone destruction), they may mimic other lesions of the nasopharynx.…”

Proliferative Potentials of Intracranial Chordomas with a Reference to Extracranial Chordomas.

“…Many investigators reported the difficulty of predicting distant metastasis on the basis of histological findings [4,9,18,25,35,36], although Chambers and Schwinn suggested a relationship between the metastasis and anaplastic histological features such as pleomorphism and hyperchromatism [5], which are known to be common in chordomas [5,10,26,30]. Many studies suggested the proliferative potentials of neoplasms to be essential for evaluating their biological features [8, 14, 19-22, 24, 29], and thus, the proliferative potentials of chordomas should be elucidated with reference to the clinical course including tumor recurrence.…”