Skip to main content

Advertisement

SpringerLink
Log in

Osseous metastases of chordoma: imaging and clinical findings

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To describe the imaging and clinical characteristics of chordoma osseous metastases (COM).

Materials and Methods

Our study was IRB approved and HIPAA compliant. A retrospective search of our pathology database for pathology-proven COM yielded 15 patients who had undergone MRI, CT, bone scan, and/or FDG-PET/CT. The imaging and clinical features of the COMs were recorded. A control group of age and gender matched chordoma patients without osseous metastasis was evaluated.

Results

The COM mean maximal dimension was 6.4 ± 4.0 cm. The majority (60%) of patients had one lesion. Extra-osseous soft tissue component was present in 85% and was larger than intra-osseous component in 76%. On MRI the lesions were heterogeneous but predominantly T2 hyperintense with hypointense septae, and with variable enhancement. On CT the lesions were typically destructive or permeative; calcifications were rare. The extent of the soft tissue component was isodense to muscle on CT and therefore better evaluated on MRI. COM was in a body part contiguous to the site of the primary tumor. Compared to the controls, COM patients were more likely to have local recurrence (P = 0.0009) and positive resection margins (P = 0.002). At 1 year, 33% of COM patients were deceased and 13% had progressive metastases.

Conclusion

COM are associated with large extra-osseous soft tissue components, which are better visualized by MRI. They are often located in a body part contiguous to the site of the primary tumor, portend poor prognosis, and are associated with positive resection margins and local recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nishiguchi T, Mochizuki K, Tsujio T, Nishita T, Inoue Y. Lumbar vertebral chordoma arising from an intraosseous benign notochordal cell tumour: radiological findings and histopathological description with a good clinical outcome. Br J Radiol. 2010;83:e49–54.

    Article  CAS  PubMed  Google Scholar 

  2. Romeo S, Hogendoorn PCW. Brachyury and chordoma: the chondroid–chordoid dilemma resolved? J Pathol. 2006;209:143–6.

    Article  CAS  PubMed  Google Scholar 

  3. Yamaguchi T, Suzuki S, Ishiiwa H, Shimizu K, Ueda Y. Benign notochordal cell tumors: a comparative histological study of benign notochordal cell tumors, classic chordomas, and notochordal vestiges of fetal intervertebral discs. Am J Surg Pathol. 2004;28:756–61.

    Article  PubMed  Google Scholar 

  4. Vujovic S, Henderson S, Presneau N, Odell E, Jacques TS, Tirabosco R, et al. Brachyury, a crucial regulator of notochordal development, is a novel biomarker for chordomas. J Pathol. 2006;209:157–65.

    Article  CAS  PubMed  Google Scholar 

  5. Shen J, Li C-D, Yang H-L, Lu J, Zou T-M, Wang D-L, et al. Classic chordoma coexisting with benign notochordal cell rest demonstrating different immunohistological expression patterns of brachyury and galectin-3. J Clin Neurosci. 2011;18:96–9.

    Article  CAS  PubMed  Google Scholar 

  6. Walcott BP, Nahed BV, Mohyeldin A, Coumans J-V, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13:e69–76.

    Article  PubMed  Google Scholar 

  7. Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine: a clinicopathologic analysis of 40 patients. Cancer. 1993;71:735–40.

    Article  CAS  PubMed  Google Scholar 

  8. Delank K-S, Kriegsmann J, Drees P, Eckardt A, Eysel P. Metastasizing chordoma of the lumbar spine. Eur Spine J. 2002;11:167–71.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kishimoto R, Omatsu T, Hasegawa A, Imai R, Kandatsu S, Kamada T. Imaging characteristics of metastatic chordoma. Jpn J Radiol. 2012;30:509–16.

    Article  PubMed  Google Scholar 

  10. Chambers PW, Schwinn CP. Chordoma a clinicopathologic study of metastasis. Am J Clin Pathol. 1979;72:765–76.

  11. Young VA, Curtis KM, Temple HT, Eismont FJ, DeLaney TF, Hornicek FJ. Characteristics and patterns of metastatic disease from chordoma. Sarcoma. 2015;2015:517657.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chang CY, Gill CM, Joseph Simeone F, Taneja AK, Huang AJ, Torriani M, et al. Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases. Acta Radiol. 2016;57:58–65.

    Article  PubMed  Google Scholar 

  13. Vergara G, Belinchón B, Valcárcel F, Veiras M, Zapata I, de la Torre A. Metastatic disease from chordoma. Clin Transl Oncol. 2008;10:517–21.

    Article  PubMed  Google Scholar 

  14. Rohatgi S, Ramaiya NH, Jagannathan JP, Howard SA, Shinagare AB, Krajewski KM. Metastatic chordoma: report of the two cases and review of the literature. Eurasian J Med. 2015;47:151–4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Samson IR, Springfield DS, Suit HD, Mankin HJ. Operative treatment of sacrococcygeal chordoma: a review of twenty-one cases. J Bone Joint Surg Am. 1993;75:1476–84.

    Article  CAS  PubMed  Google Scholar 

  16. Sopta J, Tulic G, Mijucic V, Mamontov P, Mandic N. Solitary lymph node metastasis without local recurrence of primary chordoma. Eur Spine J. 2009;18 Suppl 2:191–5.

    Article  PubMed  Google Scholar 

  17. Özkal B, Yaldız C, Temiz P, Temiz C. Combined therapy for distant metastasis of sacral chordoma. Case Rep Surg. 2015;2015:165162.

    PubMed  PubMed Central  Google Scholar 

  18. Volpe R, Mazabraud A. A clinicopathologic review of 25 cases of chordoma (a pleomorphic and metastasizing neoplasm). Am J Surg Pathol. 1983;7:161–70.

    Article  CAS  PubMed  Google Scholar 

  19. Llauger J, Palmer J, Amores S, Bagué S, Camins A. Primary tumors of the sacrum: diagnostic imaging. AJR Am J Roentgenol. 2000;174:417–24.

    Article  CAS  PubMed  Google Scholar 

  20. Yamaguchi T, Iwata J, Sugihara S, McCarthy EF, Karita M, Murakami H, et al. Distinguishing benign notochordal cell tumors from vertebral chordoma. Skelet Radiol. 2008;37:291–9.

    Article  Google Scholar 

  21. Zhou H, Liu Z, Liu C, Ma Q, Liu X, Jiang L, et al. Cervical chordoma in childhood without typical vertebral bony destruction: case report and review of the literature. Spine. 2009;34:E493–7.

    Article  PubMed  Google Scholar 

  22. Soo MY. Chordoma: review of clinicoradiological features and factors affecting survival. Australas Radiol. 2001;45:427–34.

    Article  CAS  PubMed  Google Scholar 

  23. Smolders D, Wang X, Drevelengas A, Vanhoenacker F, De Schepper AM. Value of MRI in the diagnosis of non-clival, non-sacral chordoma. Skelet Radiol. 2003;32:343–50.

    Article  CAS  Google Scholar 

  24. Wippold FJ, Koeller KK, Smirniotopoulos JG. Clinical and imaging features of cervical chordoma. AJR Am J Roentgenol. 1999;172:1423–6.

    Article  PubMed  Google Scholar 

  25. Rossleigh MA, Smith J, Yeh SD. Scintigraphic features of primary sacral tumors. J Nucl Med. 1986;27:627–30.

    CAS  PubMed  Google Scholar 

  26. Ochoa-Figueroa MA, Martínez-Gimeno E, Allende-Riera A, Cabello-García D, Muñoz-Iglesias J, Cárdenas-Negro C. Role of 18F-FDG PET-CT in the study of sacrococcygeal chordoma. Rev Esp Med Nucl Imagen Mol. 2012;31:359–61.

    CAS  PubMed  Google Scholar 

  27. Park S-A, Kim HS. F-18 FDG PET/CT evaluation of sacrococcygeal chordoma. Clin Nucl Med. 2008;33:906–8.

    Article  PubMed  Google Scholar 

  28. Bergh P, Kindblom LG, Gunterberg B, Remotti F, Ryd W, Meis-Kindblom JM. Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients. Cancer. 2000;88:2122–34.

    Article  CAS  PubMed  Google Scholar 

  29. Cheng EY, Ozerdemoglu RA, Transfeldt EE, Thompson RC. Lumbosacral chordoma: prognostic factors and treatment. Spine. 1999;24:1639–45.

    Article  CAS  PubMed  Google Scholar 

  30. York JE, Kaczaraj A, Abi-Said D, Fuller GN, Skibber JM, Janjan NA, et al. Sacral chordoma: 40-year experience at a major cancer center. Neurosurgery. 1999;44:74–80.

  31. Casali PG, Stacchiotti S, Sangalli C, Olmi P, Gronchi A. Chordoma. Curr Opin Oncol. 2007;19:367–70.

    Article  PubMed  Google Scholar 

  32. Selby HM, Sherman RS, Pack GT. A roentgen study of bone metastases from melanoma. Radiology. 1956;67:224–8.

    Article  CAS  PubMed  Google Scholar 

  33. Snell W, Beals RK. Femoral metastases and fractures from breast cancer. Surg Gynecol Obstet. 1964;119:22–4.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA

    Connie Chang, Martin Torriani & Miriam Bredella

  2. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Ivan Chebib

Authors
  1. Connie Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivan Chebib
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Torriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miriam Bredella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Connie Chang.

Ethics declarations

Funding

None

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, C., Chebib, I., Torriani, M. et al. Osseous metastases of chordoma: imaging and clinical findings. Skeletal Radiol 46, 351–358 (2017). https://doi.org/10.1007/s00256-016-2566-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-016-2566-5

Keywords

Search

Navigation