Abstract
ABSTRACT Clival chordomas are rare, malignant tumors arising from remnants of the notochord, comprising less than 1% of all bone tumors. Due to their insidious growth and location at the skull base, they are frequently misdiagnosed as pituitary macroadenomas, which present with similar clinical symptoms, including headaches and visual disturbances. This case study highlights the diagnostic challenges encountered in a 65-year-old male, initially diagnosed with pituitary macroadenoma based on clinical presentation and early imaging findings. Despite the proximity of the lesion to the sellar region, initial CT imaging failed to differentiate the clival chordoma from a pituitary macroadenoma due to overlapping features such as bone destruction and soft-tissue mass appearance. However, subsequent magnetic resonance imaging (MRI) provided crucial details that led to the correct diagnosis. T2-weighted MRI revealed heterogeneous hyperintensity, necrotic and cystic components, and low-signal-intensity septations—features not typically seen in macroadenomas. Post-contrast enhancement patterns and evidence of local invasion into surrounding structures further supported the diagnosis of clival chordoma. This case underscores the importance of MRI in the differential diagnosis of skull base tumors, especially when clinical and initial imaging findings are inconclusive. Early and precise use of MRI can prevent misdiagnosis and guide appropriate treatment planning, particularly in rare pathologies like clival chordomas.
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