Abstract
During routine staging work-up for a left breast mass, a 68-year-old woman complained of dysphagia and dysphonia. During further investigations, a left-sided lesion at the foramen magnum was observed on brain imaging. Both lesions were biopsied and showed a classical chordoma. The skull-base lesion and the breast lesion were surgically resected, and adjuvant radiotherapy was given. Chordoma is a rare primary central nervous system tumour that seldom metastasizes. The lung is the most common site of metastasis. Synchronous breast metastasis from a skull-base chordoma is very rare, and a safe management option includes a maximum resection followed by adjuvant radiotherapy.
Highlights
Synchronous breast metastasis from a skull-base chordoma is very rare, and a safe management option includes a maximum resection followed by adjuvant radiotherapy
Chordomas are rare tumours that constitute fewer than 1% of bone tumours in the skull base and spine
We report a case of skull-base chordoma presenting with a synchronous breast metastasis, and we review the local therapy of metastatic chordoma in our patient and in the available literature
Summary
Chordomas are rare tumours that constitute fewer than 1% of bone tumours in the skull base and spine. We report a case of skull-base chordoma presenting with a synchronous breast metastasis, and we review the local therapy of metastatic chordoma in our patient and in the available literature. The patient sought medical advice after a 5-month history of progressive tongue weakness, imbalance, dysarthria, and worsening headaches Her examination revealed a left hypoglossal palsy and mild ataxia, with normal motor and sensory function in the extremities. Two weeks after the mastectomy, the patient underwent a left far lateral approach and near total resection of the skull-base tumour, which, on frozen section, was consistent with chordoma. Histology examination of the skull-base tumour (Figure 2) showed a morphology compatible with chordoma (anastomotic cords of cuboidal cells floating in a myxoid and chondroid matrix). The patient received hypofractionated whole-breast radiation (42.5 Gy plus a 15-Gy boost in 22 fractions) and was referred to a proton-beam centre for intensity-modulated proton-beam therapy for the skull-base tumour remnant and operative cavity, receiving an equivalent dose of 68 Gy cobalt
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