The etiology of recurrent chordoma presenting as a neck mass: metastasis vs. surgical pathway seeding.Ear Nose Throat J. 2008 Feb;87(2):106-9.

Chordomas are rare tumors of notochordal origin that arise along the vertebral axis. These slowly growing yet highly destructive tumors are associated with an alarming rate of recurrence, although surgical resection followed by proton, proton/photon, or conventional radiotherapy has been somewhat successful in terms of recurrence-free survival. Still, recurrent disease as a result of metastasis or surgical pathway seeding does occur. We retrospectively reviewed the case of a 64-year-old woman who presented with a left neck mass at level II. She had a history of recurrent chordomas involving the occipital portion of the clivus that had been treated with multiple resections and proton-beam irradiations over a period of several years. The new mass was found to have infiltrated the superior end of the sternocleidomastoid muscle. Neck dissection was performed. Pathology revealed no lymphoid tissue in the main specimen and no evidence of chordoma in any of the lymph nodes. We believe that this latest clival chordoma might have occurred as a result of surgical pathway seeding during a previous operation anterior to the sternocleidomastoid muscle, although metastasis cannot be ruled out. We also review the literature on clival and skull base chordomas as it relates to recurrence, metastasis, and seeding.

Thoracic chordoma: an unusual presentation of the spinal tumor. Am J Med Sci. 2008;335(3):239-41.

Chordoma is an uncommon malignant bone tumor that originates from the remnants of the embryonic notochord. In most of the reported cases, chordomas occur at the skull base or in the sacrococcygeal spine but rarely in the thoracic spine. In this report, we describe a case of a large thoracic chordoma with posterior mediastinal extension in a 25-year-old woman who presented with left-hand anhydrosis. The imaging studies, pathology findings, and recent advances in treatment are discussed.

Chordoma of the spinal column.Neurosurg Clin N Am. 2008 Jan;19(1):5-15.

Chordomas are the most common primary malignant tumor of the mobile spine and of the sacrum. Although considered not to possess significant metastatic potential, such lesions are locally aggressive, leading to neurologic compromise and lytic destruction of bone. En bloc resection has afforded patients the greatest chance of local control and disease-free survival. Such radical resections may be associated with significant surgical morbidity, however. Although considered generally resistant to radiation therapy and chemotherapy, recent advances in photon and proton radiation therapy and use of monoclonal antibodies may provide improved outcomes for poor surgical candidates and for tumors that recur after surgery.