“ Excluding lymphoproliferative disorders, this is the most common primary malignant tumour of the spine in adults. It is the most common p...
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Excluding lymphoproliferative disorders, this is the most common primary malignant tumour of the spine in adults. It is the most common primary tumour to affect the sacrum. It typically affects men aged 60-70 years and originates from embryonic remnants of the notochord (therefore it is a midline tumour; i.e. sacrum, spine, clivus and coccyx). Rarely metastasises (to the lung).
PLAIN FILM
• Large (average 10 cm) lytic, expansile lesion in the sacrum with moderate internal calcification.
• Sacrum affected most (up to 60%), then clivus/spheno-occipital region (35%).
• Narrow zone of transition.
• Large soft tissue component.
• May extend across the intervertebral disc space or SI joint.
CT
• Bone destruction with lobulated soft tissue mass.
• Mass is mixed density with areas of low attenuation (myxoid) and calcifications 30%-70%.
• Enhances modestly with contrast.
MRI
• Lobulated sacral mass high signal on T2 with foci of T1 high signal (internal haemorrhage and calcification)—this is relatively specific.
NUCLEAR MEDICINE
• Poor uptake of technetium-99m-DTPA (diethylenetriaminepentacetate)
a) Chordoma. Frontal radiograph of the pelvis demonstrating a lytic expansile lesion of the left sacrum. (b) Chordoma. Coronal T2-weighted magnetic resonance image of the pelvis demonstrating a lobulated high-signal mass involving the left sacrum.
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