Roentgenologic Study of Sacrococcygeal Chordoma

CHORDOMA is a rare tumor which arises from the cellular vestiges of the embryonal notochord. It occurs most frequently in the spheno-occipital and sacrococcygeal regions, but primary chordoma has been reported to occur in other parts of the spinal column and the skull. Recently Stewart (1, 2, 3), Andler (4), Montgomery and Wolman (5), Hass (6), Adson, Kernohan, and Woltman (7), and Fletcher, Woltman, and Adson (8) have presented pathologic and clinical studies of this tumor, but very little has been reported on the roentgenologic diagnosis. In the more recent publications, x-ray examination is included in a larger number of cases, and, occasionally, roentgenograms are reproduced. Opinions, however, still differ widely in the estimation of the value of roentgenologic examinations. Most authors concur in that, in the spheno-occipital region, an x-ray examination would not reveal any characteristic or diagnostic evidence other than undifferentiated destruction when it is present. This is so probably because of the complexity of the neighboring dense structures and the comparatively small size of the tumor. In the sacrococcygeal region, where the bony parts are more accessible to direct roentgenologic examination and the tumor is generally larger in size when pressure symptoms are present, it is reasonable to expect that a roentgenologic examination would show more characteristic findings. In the present study, based on a review of published cases and our three proven cases, we are attempting to evaluate the roentgenologic findings of this tumor in the sacrococcygeal region. Review of Literature Burrow and Stewart (2), in discussing the diagnosis of spheno-occipital chordoma, stated that a good x-ray film taken with a Potter-Bucky diaphragm might show evidence of absorption of bone or the outline of the soft tissue tumor, but, apart from the microscope, the exact pathology must remain obscure. Adson, Kernohan, and Woltman (7) found x-ray examination less helpful in the diagnosis of spheno-occipital chordoma. In one of their three cases, in spite of the fact that the tumor had originated from the region of the spheno-occipital synchrondrosis and had invaded the surrounding bone, little evidence of destruction of the bone was seen in the postmortem roentgenogram, and, in another case, in which the roentgenogram showed erosion of the upper three cervical vertebræ, the tumor behaved grossly more like a neurofibroma than a chordoma. However, in an article on chordomas of the cranium and the cervical spine, Hass (6) expressed the opinion that the clinical diagnosis of this tumor is difficult without the aid of roentgen examination or biopsy.