Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

Abstract

Chordomas are rare tumors which originate from the remnants of the notochord. These tumors are locally aggressive and have a predilection for the ends of the axial skeleton. An important prerequisite for optimal management of these tumors is a correct preoperative diagnosis. The present case is the first report of the use of endoscopic ultrasound to obtain transrectal fine needle aspiration biopsy of a presacral chordoma. A review of the prior computer tomography (CT) scans allowed us to calculate the tumor volume doubling time (18.3 mo). Transrectal biopsy of chordomas is controversial, however we believe that such concerns are not justified.

Cytodiagnosis of Sacral Chordoma

“…The cytologic differential diagnosis of chordoma includes chondrosarcoma (conventional/ myxoidchondrosarcoma), metastatic carcinoma, myxoidliposarcoma, myxoid malignant fibrous histiocytoma (MFH), and myxopapillary Ependymoma. 3,[7][8][9] Conventional chondrosarcoma may involve the sacrum but unlikechordoma, the aspirate material shows malignant cartilage cells, sometimes within lacunae, which usually lack the prominent cytoplasmic vacuoles noted in physaliphorous cells. The background cartilaginous matrix of chondrosarcoma is mucicarmine negative whereas the matrix of chordoma is mucicarmine positive.…”

Presacral chordoma diagnosed by transrectal fine-needle aspiration cytology

“…Jin et al ,[ 6 ] described the cytological diagnosis of chordoma without physalipherous cells. Gottlieb et al ,[ 3 ] described the role of transrectal endoscopy- guided FNAC in chordoma diagnosis.Hence, transrectal FNAC of the presacral mass is the easiest and safest method for the preoperative diagnosis and to plan the further surgical management of chordoma.…”