Abstract
Study design
Case report and literature review.
Objective
Report the highly unusual presentation of thoracic spine chordoma in an 89-year-old and review existing literature as it impacts treatment in the elderly.
Summary of background data
Chordomas are infrequent tumors of the spine that commonly present during mid-adulthood at the spheno-occipital or sacrococcygeal junctions. The mobile spine is affected in 10–15% of cases but chordomas are extremely rare in the thoracic spine. Chordoma rarely enters the differential diagnosis of spinal tumors in elderly patients, for whom metastases and multiple myeloma are by far the most common.
Methods
A case report is detailed of an 89-year-old male presenting with incapacitating pain and early signs of thoracic myelopathy. A lytic, expanding lesion of the T10 vertebral body with epidural spinal cord compression was identified. In the absence of evidence of other primary tumor, a CT-guided needle biopsy revealed chordoma. A literature review of reported thoracic spine chordomas was also performed.
Results
An intralesional posterolateral resection and reconstruction was performed with good results and no recurrence at 13 months’ follow-up. 30 reports of thoracic spine chordomas were identified in the literature since 1902. Mean age of presentation at 35.7 years is earlier than for most chordomas. The oldest previously reported patient was 68-year-old. Neurological impairment at presentation is rare with the usual presenting symptom being pain. Response to radiation and chemotherapy is limited. 5-year survival rates range from 50 to 60%.
Conclusion
Chordoma is a highly uncommon epidural neoplasm of the thoracic spine and is vanishingly rare in elderly patients. This report documents the oldest reported patient with thoracic spine chordoma at 89-year-old. Their locally aggressive behavior typically prompts consideration of aggressive surgical resection. When tailored to the individual patient, such procedures are feasible without excessive morbidity even in elderly patients.
References
Sundaresan N, Galicich JH, Chu FCH et al (1979) Spinal chordomas. J Neurosurg 50:312–319
Boriani S, Bandiera S, Biagini R et al (2006) Chordoma of the mobile spine: fifty years of experience. Spine 31:493–503
Bjornsson J, Wold LE, Ebersold MJ et al (1993) Chordoma of the mobile spine. Cancer 71:735–740
Topsakal C, Bulut S, Erol FS et al (2002) Chordoma of the thoracic spine—case report. Neurol Med Chirurgica (Tokyo) 42:175–180
Baratti D, Gronchi A, Pennacchioli E et al (2008) Chordoma: natural history and results in 28 patients treated at a single institution. J Surg Oncol 10:291–296
Bergh P, Kindblom LG, Gunterberg B et al (2000) Prognostic factors in chordoma of the sacrum and mobile spine. Cancer 88:2122–2134
Smolders D, Wang X, Drevelengas A et al (2003) Value of MRI in the diagnosis of non-clival, non-sacral chordoma. Skelet Radiol 32:343–350
Cho HY, Lee M, Takei H et al (2009) Immunohistochemical comparison of chordoma with chondrosarcoma, myxopapillary ependymoma, and chordoid meningioma. Appl Immunohistochem Mol Morphol 17:131–138
Ahrendt MN, Wesselhoeft CW (1992) Chordoma presenting as a posterior mediastinal mass in a pediatric patient. J Pediatr Surg 27:1515–1518
Buraczewski J, Rudowski W (1956) Chordoma of the thoracic spine appearing as a mediastinal tumor. J Thorac Surg 34:75–84
Cotler HB, Cotler JM, Cohn HE et al (1983) Intrathoracic chordoma presenting as a posterior superior mediastinal tumor. Spine 8:781–786
Bruine FTd, Kroon HM (1988) Spinal chordoma: radiologic features of 14 cases. Am J Radiol 150:861–863
Delgado R, Bonatelli APF (2008) Thoracic chordoma. Arquiv Neuropsiquiatria 66:405–407
Levowitz B, Khan MY, Rand E et al (1966) Thoracic vertebral chordoma presenting as posterior mediastinal tumor. Ann Thorac Surg 2:75–81
Murphy JM, Wallis F, Toland J et al (1998) CT and MRI appearances of a thoracic chordoma. Eur Radiol 8:1677–1679
Schwartz SS, Fisher WS III, Pulliam MW et al (1985) Thoracic chrodoma in a patient with paraparesis and ivory vertebral body. Neurosurgery 16:100–102
Taki S, Kakuda K, Kakuma K et al (1996) Posterior mediastinal chordoma: MR imaging findings. Am J Radiol 166:26–27
Wang T-J, Shu S-H, Lin C-W et al (2008) Thoracic chordoma: an unusual presentation of the spinal tumor. Am J Med Sci 335:239–241
Crowe C, Muldoon P (1951) Thoracic chordoma. Thorax 6:403–407
Henderson FC, McCool K, Seigle J et al (2009) Treatment of chordomas with Cyberknife: Georgetown university experience and treatment recommendations. Neurosurgery 64:A44–A53
Hardaker WT, Cook WA, Friedman AH et al (1992) Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures. Spine 17:162–171
Schnee CL, Ansell LV (1997) Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit. J Neurosurg 86:48–55
Conflict of interest
None of the authors has any potential conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fontes, R., O’Toole, J.E. Chordoma of the thoracic spine in an 89-year-old. Eur Spine J 21 (Suppl 4), 428–432 (2012). https://doi.org/10.1007/s00586-011-1980-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-011-1980-6