Cervical spine chordoma: Imaging features and diagnostic challenges of a rare C6 localization

Chordomas are rare malignant tumors arising from remnants of the embryonic notochord. They are slow-growing but locally aggressive. They most frequently occur in the sacrococcygeal and skull base regions, while cervical spine involvement is rare. Their proximity to critical neurovascular structures makes diagnosis and management challenging. We report the case of a 62-year-old man presenting with a progressive left cervical mass, dysphonia, and a foreign body sensation in the lower neck. Clinical examination revealed a firm, immobile cervical swelling with mild displacement of adjacent laryngeal structures. MRI demonstrated a large, destructive osteolytic lesion centered at the C6 vertebra, suggestive of chordoma. Surgical treatment was performed. Histopathological and immunohistochemical analyses confirmed a conventional chordoma. The postoperative course was uneventful, with no neurological deficit. Chordoma should be considered in the differential diagnosis of aggressive cervical spine lesions, particularly at atypical lower cervical levels. Multimodal imaging is essential for diagnosis, surgical planning, and assessment of tumor extent.