Yuh Sung-Joo, Woulfe John, Corsten Martin J, Carrau Ricardo L, Prevedello Daniel M, Kassam Amin B
Department of Neurosurgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
J Neurol Surg B Skull Base. 2014 Jun;75(3):177-82. doi: 10.1055/s-0033-1363171. Epub 2014 Mar 3.
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.
斜坡后病变可表现为脊索残余来源的肿块。鉴别诊断包括良性病变，如泡状脊索瘤（EP）和神经肠囊肿，或恶性病变，如脊索瘤。对于EP和脊索瘤，尽管这两种类型均起源于胎儿脊索组织的残余，但它们代表具有不同影像学和生物学行为的两个不同实体。病例描述：我们报告一例偶然发现的斜坡后病变病例。该病变的磁共振成像（MRI）特征与良性病变的神经影像学表现相符，提示为EP。注射钆剂后未见强化。然而，病理检查确定该病变为恶性脊索瘤。结论：斜坡后病变的鉴别诊断包括良性和恶性脊索病变。在此我们报告一例偶然发现斜坡后病变的患者。影像学表现提示为良性病变，可能为EP，但病理结果显示为脊索瘤。本报告表明，尽管影像学表现为良性，但不能排除脊索瘤，其对治疗的影响可能很大。正确诊断很重要，因为其预后和治疗意义不同。
