RESUMO
INTRODUCTION: Chordoma is a rare malignant bone tumor. The outcome depends on the adequate surgical treatment with complete excision of the tumor with microscopic clear margins. MATERIALS AND METHODS: We performed a retrospective review of 13 cases of chordomas operated in our center between 1988 and 2009. RESULTS: All cases were treated with wide excision. Inadequate margins were found in seven patients. There were complications in ten patients and long-term sequels in 11 patients. Nine had recurrence within the first 2 years, six of which had inadequate margins. Five had metastatic disease, three of them with inadequate margins. During the follow-up, four patients died. In a posterior review, three patients survive and all of them had clear margins. CONCLUSIONS: In our experience, the best treatment is complete excision of the tumor with clear microscopic margins. When this is not possible, local recurrences increase and survival rate decreases.
Assuntos
Neoplasias Ósseas/terapia , Cordoma/terapia , Doenças Raras/terapia , Sacro/patologia , Idoso , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Cordoma/epidemiologia , Cordoma/patologia , Cordoma/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Doenças Raras/epidemiologia , Doenças Raras/patologia , Doenças Raras/cirurgia , Estudos Retrospectivos , Sacro/cirurgia , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Carga TumoralRESUMO
Cordomas são neoplasias raras que se originam dos remanescentes da notocorda primitiva 50% dos casos têm localização sacral, sendo mais frequente ao nível de S4/S5. Nós descrevemos um caso de cordoma sacral ao nível de S1 e discutimos a apresentação clínica, achados de imagem, tratamento cirúrgico e evolução.
Chordomas are rare neoplasias originating from the remaining primitive notochord. 50% of the cases have sacral localization, being more frequent at levels S4/S5. Here we report a case of sacral chordoma at level S1 and discuss its clinical presentation, imaging findings, surgical treatment, and progress.
Assuntos
Humanos , Feminino , Idoso , Cordoma/complicações , Cordoma/diagnóstico , Cordoma/epidemiologia , Cordoma/etiologia , Cordoma/mortalidade , Cordoma/patologia , Cordoma/terapia , Diagnóstico Diferencial , Tomografia Computadorizada de Emissão , Espectroscopia de Ressonância Magnética , Região SacrococcígeaRESUMO
We report four new cases of chordoma of "the mobile spine", all at the L2 level. Diagnosis was often delayed due to predominantly nonspecific low back symptoms; however, neurological involvement is more frequent than in chordoma with a sacrococcygeal localization. No pathognomonic images have been described for any imaging modality, and differential diagnosis should include metastases, chondrosarcoma, and giant-cell tumor. Histopathological analysis can be performed on CT-guided puncture biopsy samples, but a high level of suspicion must be present and, if there is any doubt, immunohistochemical studies should be carried out. Despite being the treatment of choice, complete tumor resection by a double-approach spondylectomy is barely feasible at the L2 level.
Assuntos
Cordoma , Vértebras Lombares , Neoplasias da Coluna Vertebral , Idoso , Cordoma/diagnóstico , Cordoma/epidemiologia , Cordoma/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/cirurgiaRESUMO
This paper describes the pathobiology of some of the more common skull base tumors. In addition to clinicopathologic features, emphasis is placed upon methods of diagnosis utilizing immunoperoxidase stains and molecular markers that may or may not impact upon prognosis.