Solitary lymph node metastasis without local recurrence of primary chordoma

Chordoma is a malignant neoplasm believed to arise from notochord remnants. Its incidence is highest in the sixth decade and is generally regarded as a locally aggressive tumor with slow progression growth rate. Its metastatic incidence ranges from 5 to 40%, and it is generally believed that metastases without local recurrence of primary neoplasm are extremely rare. We report a case of a 38-year-old male patient with solitary inguinal lymph node metastasis without local recurrence of a previously surgically treated primary sacrococcygeal chordoma

Sacral Chordoma: Can Local Recurrence After Sacrectomy Be Predicted?

Surgical resection margins are reportedly the most important predictor of survival and local recurrence with sacral chordomas. We examined the relevance of invasion of the surrounding posterior pelvic musculature (piriformis and gluteus maximus) at initial diagnosis to local recurrence after sacrectomy. We retrospectively reviewed 18 patients with histologically verified sacral chordoma seen at our institution between 1998 and 2005. There were 14 men and four women with a mean age of 65.1 years (range, 31–78 years). The average overall followup was 4.4 years (range, 0.5–10 years), 5.4 years for the living patients (range, 3–10 years), and 2.8 years for the deceased (range, 0.5–5.4 years). Local recurrence occurred in 12 patients (66%) 29 months postoperatively (range, 2–84 months). Six of these patients had wide excisions at initial surgery, five had marginal excisions, and one had an intralesional excision. Ten patients had wide surgical margins, six of whom (60%) had local recurrences. Tumor invasion of adjacent muscles at presentation was present in 14 patients, 12 of whom (85%) had local recurrences. Sacroiliac joint involvement was seen in 10 patients, nine of whom (90%) had local recurrences. The findings suggest obtaining wide surgical margins posteriorly, by excising parts of the piriformis, gluteus maximus, and sacroiliac joints, may result in better local disease control in patients with sacral chordoma