Slow but disabling progression

Abstract

Male, 84 years old, presented to the emergency room with obstipation associated with acute severe pain in the lumbar region. He had been living in the bed because he wasn´t able to do anything because the pain had been too disabling. Personal history of asthma, myocardial infarction, atrial fibrillation, dyslipidemia and obstipation. Physical examination was unremarkable, except for rectal examination which had a palpable posterior mass, without blood on the gloves. Complete body computer tomography with sacrococcygeal mass with 15 cm associated with bone destruction. Compression of the rectum, without invasion. Pelvic MRI: posterior mass with 12,3x15x8,6 cm with adjacent bone destruction without organ invasion. Histology of mass biopsy: sacrococcygeal chordoma. There was no indication for surgical treatment due to the major risks for the patient. Chordomas are rare, slow-growing, locally destructive bone tumours arising from the notochord. The most common locations are the clivus and the sacrococcygeal region. The annual incidence of these tumours is 1 in one million. MRI is the imaging modality of choice. Prognosis improves based on age, resected margins and postoperative treatment.