Article Figures & Data
Figures
- FIG 1.
Axial MR imaging of the mass. T2 fat-saturated (A), T1 precontrast (B), and postcontrast (C) sequences show a mass centered within the mid and left aspects of the L3 vertebral body (asterisk). Most of the tumor demonstrates substantial T2 prolongation, which is particularly evident with fat saturation. Internal T2-hypointense septations are noted, which enhance with moderate avidity (straight arrows), while the fluid-filled regions lack enhancement. The tumor extends out of the left vertebral body into the adjacent soft tissues, displacing but not invading the left psoas muscle laterally (curved arrows).
- FIG 2.
Coronal imaging and corresponding gross pathology of the tumor. On CT (A), the mass is destructive, with faint small foci of high attenuation, either representing amorphous calcifications or residual/partially destroyed vertebral body trabeculae (dashed arrow). Both the superior and inferior endplates are fractured (curved arrows). The degree of extraosseous extension is best seen on T2 MR imaging (B), where the soft-tissue components are seen to mushroom out along the adjacent intervertebral discs (between the short arrows), with pushing-type margins. The gross pathology specimen (C) confirms the presence of numerous high-water-content loculations (asterisk) separated by small septations, corresponding with areas of T2 hyperintensity.
- FIG 3.
Histology images. The tumor consists of cells arranged in nests and cords (A) within an abundant mucoid matrix (A, asterisk). Most of the tumor cells are large with central nuclei and mildly vacuolated eosinophilic cytoplasm (B, arrows). Scattered physaliphorous cells are also present (B inset, arrows). Immunohistochemistry demonstrates nuclear brachyury (C, arrow) and cytoplasmic keratin CAM 5.2 (D, arrow) expression in tumor cells.
- FIG 4.
An artist’s illustration of a spinal chordoma. The tumors are generally sizable at the time of diagnosis. Extraosseous components are often larger than those within the vertebral bodies and extend along the adjacent spinal segments, compatible with the classically described dumbbell appearance. Image used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.
Tables
Comparison of various demographic, location, and imaging features of chordomas with those of the most common imaging differential diagnoses
Chordoma GCT Chondrosarcoma Plasmacytoma Age at diagnosis (range) (peak yr) 40–60 20–30 30–70 30–60 Most common location in mobile spine Cervical Lumbar (sacrum much more common) Lumbar Thoracic Commonly involves posterior elements – + + + Intratumoral calcification Amorphous – Rings and arcs – T2WI ↑↑ ↓→ ↑ ↑ Extraosseous extension + + + – Characteristic feature Dumbbell or mushroom shape Lytic lesion without sclerotic rim; fluid-fluid levels Intratumoral chondroid matrix Minibrain, soap bubble Note:—GCT indicates Giant cell tumor; –, features absent; +, features present; ↓→, hypo- to iso-intense intralesional signal; ↑, hyperintense intralesional signal.
