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J Neurol Surg B Skull Base 2014; 75(03): 177-182
DOI: 10.1055/s-0033-1363171
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Diagnostic Imaging Dilemma of a Clival Lesion and Its Clinical Management Implications

Sung-Joo Yuh
1   Department of Neurosurgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
,
John Woulfe
2   Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Martin J. Corsten
3   Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
,
Ricardo L. Carrau
4   Department of Otolaryngology, The University of Ohio, Columbus, Ohio, United States
,
Daniel M. Prevedello
5   Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
,
Amin B. Kassam
1   Department of Neurosurgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
› Author Affiliations
Further Information

Publication History

15 January 2013

24 October 2013

Publication Date:
03 March 2014 (online)

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Abstract

Background A retroclival lesion can represent a notochordal remnant–derived mass. The differential diagnoses includes benign lesions such as ecchordosis physaliphora (EP) and neuroenteric cyst or malignant ones such as chordomas. In the case of EP and chordoma, although both types arise from remnants of fetal notochord tissues, they represent two separate entities with different radiographic and biologic behaviors.

Case Description We present a case of an incidental finding of a retroclival lesion. The magnetic resonance imaging (MRI) characteristics of the lesion match the neuroimaging profile of a benign lesion and are suggestive of an EP. There was no enhancement noted with the addition of gadolinium. Nonetheless, pathology determined the lesion to be a malignant chordoma.

Conclusion The differential diagnosis of a retroclival lesion includes benign and malignant notochordal lesions. Here we present a case of a patient with an incidental finding of a retroclival lesion. Radiographic findings were suggestive of a benign lesion, possibly EP, yet the pathology revealed a chordoma. This report suggests that despite benign imaging, chordoma cannot be excluded and the implications for treatment can be significant. It is important to achieve the correct diagnosis because the prognostic and therapeutic implications are different.

Keywords

ecchordosis physaliphora - neuroenteric cyst - chordoma - benign - malignant - gadolinium - enhancement
 

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