Chordoma & Lymphoma Flashcards
What age group is primarily affected by Chordomas?
40-70 yrs
What is the origin of a chordoma?
notochord
(NOT spinal cord)
Describe the aggressiveness of a chordoma.
- locally aggressive
- slow growth rate
What is the only tumor to cross a joint and why?
Chordoma
vertebral bodies & discs = notochordal
What are the preferential locations of a chordoma?
- sacrococcygeal (MC)
- clivus
- vertebral
What vertebral level is not affected by chordomas?
C1 (no vertebral body)
What is the clinical presentation of a sacrococcygeal chordoma?
- age 40-70yrs
- obstruction of intestines & urinary tract
- n. root compression (stenosis Sx)
What is the clinical presentation of a clivus chordoma?
- age 40-70yrs
- headaches
- endocrine abnormalities
- visual disturbances (lat. hemianopsia)
(pressure on pontine, ocular, cerebellar structures)
What are the imaging features of a chordoma?
- central vertebral body destruction
- lytic destruction
- amorphous calcification (50%)
- soft tissue mass (dark on T1 MRI)
- enlarged presacral space
What follow-up recommendations would you need to indicate a chordoma?
MRI w/ contrast + labs
What is on your list of differential diagnoses for a sacrococcygeal, calcified soft tissue mass in a 40 year old patient?
- chondrosarcoma
- chordoma
What is on your list of differential diagnoses for a calcified soft tissue mass coming off the ilium in a 40 year old patient?
- chondrosarcoma
(NOT chordoma, b/c not notochordal tissue)
What is the treatment and prognosis of a sacrococcygeal chordoma?
- resection
- poor 5-yr survival rate (8.7%)
What is the treatment and prognosis of a chordoma in the clivus?
- radiation
- high rate of local recurrence
- higher mortality
What is the treatment and prognosis of a spinal chordoma?
- radiation
- better prognosis than sacrococcygeal or clivus
What percent of patients have skeletal involvement secondary to Non-Hodgkin Lymphoma?
30%
What skeletal locations are commonly involved in Non-Hodgkin Lymphoma?
red marrow spaces:
- femur
- tibia
- humerus
- pelvis
- spine
What age group is primarily affected by Non-Hodgkin Lymphoma?
20-40 yrs
What is the clinical presentation of Non-Hodgkin Lymphoma?
- age 20-40 yrs
- intermittent local pain
- pt appears very healthy
- 50% report Sx >1yr (late stage d/t slow growth)
- round cell tumor
What are the imaging findings of Non-Hodgkin Lymphoma?
- permeative medullary destruction
- diaphysis (can be in metaphysis)
- minimal laminated periosteal Rxn
- soft tissue mass
What is the differential diagnosis for Non-Hodgkin Lymphoma on a radiograph?
Ewing sarcoma
(need labs to determine)
What age group is primarily affected by Hodgkin Lymphoma?
10-80 yrs
What percent of patients with Hodgkin Lymphoma will develop osseous metastasis?
10-20%
What skeletal location is most commonly involved in Hodgkin Lymphoma?
vertebral body
What type of bony destruction occurs in Hodgkin Lymphoma?
75% lytic
15% blastic
10% mixed
What radiographic signs may be present in blastic Hodgkin Lymphoma?
- ivory vertebra
- scalloping of anterior and lateral vertebral body
What radiographic characteristics would indicate lymphoma as the first differential diagnosis?
Ivory vertebra with anterior vertebral body scalloping
Give a list of differentials in order from most to least likely.
- Mets
- Myeloma/plasmacytoma
- Chordoma (need MRI w/ contrast)
What would prompt you to put lymphoma first on your list of differentials?
Anterior body scalloping
(ivory vertebra = IHOP)
What is the most likely diagnosis if this lesion is crossing a joint?
Chordoma
