Clivus chordoma

CLINICAL HISTORY:
This 24-year old patient complained of headache for many years. Now he presents with progressive hearing loss on the left side and numbness of the left side of his face. Furthermore he notes progressive troubles with equilibrium and gait instability.

NEUROLOGICAL EXAMINATION reveals positive Romberg test with tendency to fall to the left. There is hypoesthesia in the V2-territory, peripheral 7th nerve palsy and hearing loss on the left side.

NON-CONTRAST CT (IMAGES 1 AND 2): A huge mass (arrowheads) is present anteriorly in the posterior fossa. The tumor is well-circumscribed and shows patchy intratumoral calcification. The brainstem and the fourth ventricle (arrow) are markedly displaced posteriorly. The tumor lies in close contact with the clivus.

MRI:
a) TRANSAXIAL T2-WEIGHTED (5100/28/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): Confirmation of the huge mass anteriorly in the posterior fossa, in close contact with the clivus. The tumor is inhomogeneously hyperintense and is crossed by several more hypointense septa. The brainstem is markedly compressed and posteriorly displaced.

b) TRANSAXIAL T1-WEIGHTED (560/15/1) SPIN-ECHO SEQUENCE (IMAGES 5 AND 6): The tumor has an overall hypointense character. Some calcifications can be noted within the tumor as hypointense spots (arrowhead).

c) TRANSAXIAL (IMAGES 7 AND 8), CORONAL (IMAGE 9) AND SAGITTAL (IMAGES 10 AND 11) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The tumor shows moderate, but very inhomogeneous contrast enhancement. The brainstem is markedly displaced posteriorly and is grossly infiltrated (arrows). The tumor has broad contact with the clivus and the dorsum sellae which are focally eroded (arrowhead).

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is clivus chordoma, chondroma or chondrosarcoma.

No surgical or pathological confirmation is available.

Search also:
Chordoma

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