대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Mediastinal chordoma

Radiologic Findings

Figure 1-4. Chest CT scan reveals an about 3.0 x 1.9 cm sized well-defined, elongated, homogeneous soft tissue mass (measuring about 40 HU) in the posterior mediastinum at the level of T4-5. The mass abuts the posterior wall of the esophagus, and focal bony erosion of the vertebral body of T4 is noted.

Figure 5. Endoscopic ultrasound reveals an about 2.7-cm sized hypoechoic juxtaesophageal mass.

Brief Review

Chordoma is a rare, slow-growing malignant bone tumor exhibiting notochordal differentiation. It accounts for 1–4% of all primary malignant bone tumors. It affects men twice as frequently as women and is most commonly diagnosed in adults older than 30 (peak around 50 years). Chordoma almost exclusively involves the axial skeleton, and nearly 90% of cases occur in the sacrococcygeal region and in the base of the skull. The remaining cases predominantly develop in the cervical and lumbar spine; chordomas in the thoracic spine are even more uncommon, accounting for 3% of all chordomas.
Radiologically, chodroma may appear as a well-circumscribed soft tissue density mass in the paravertebral region, with or without invasion or involvement of adjacent bony structures. Scalloping of the anterior border of the adjacent vertebral body may be seen, suggesting extrinsic compression by an extrinsic mass, as was the case in our patient. When the mass is large enough, it may also show encasement of vascular structures or extension into paratracheal region.

References

1. Matsubayashi J, Sato E, Masaharu N, et al. A case of paravertebral mediastinal chordoma without bone destruction. Skeletal Radiol (2012) 41:1641–1644.
2. Suster S, Moran CA. Chordomas of the Mediastinum: Clinicopathologic, Immunohistochemical, and Ultrastructural Study of Six Cases Presenting as Posterior Mediastinal Masses. Hum Pathol. 1995 Dec;26(12):1354-62.

Keywords

posterior mediastinum, paravertebral mediastinum, malignant bone tumor, chordoma,