Transrectal EUS-guided FNA biopsy of a presacral chordoma--report of a case and review of the literature

Abstract

Chordomas are rare tumors which originate from the remnants of the notochord. These tumors are locally aggressive and have a predilection for the ends of the axial skeleton. An important prerequisite for optimal management of these tumors is a correct preoperative diagnosis. The present case is the first report of the use of endoscopic ultrasound to obtain transrectal fine needle aspiration biopsy of a presacral chordoma. A review of the prior computer tomography (CT) scans allowed us to calculate the tumor volume doubling time (18.3 mo). Transrectal biopsy of chordomas is controversial, however we believe that such concerns are not justified.

Figure 1

Post processing sagittal reconstruction of non-contrast pelvic CT demonstrating a hypo attenuating spherical lesion anterior to the coccyx.

Figure 2

Endoscopic ultrasound with the Olympus GF-UM160 radial echoendoscope demonstrates a well circumscribed hyperechoic lesion, with some focal areas of heterogeneous echotexture, corresponding to the lesion described in Figure 1.

Figure 3

Tissue section of the aspirate sample shows sheets of vacuolated "physaliphorous" cells, classic of chordoma. These cells demonstrate immunorea-ctivity with pan-cytokeratin and epithelial membrane antigen stains.