Answer for BIR CoW 19 Apr 2026
CLIVAL CHORDOMA
Findings
E/o ill defined T1 isointense ,T2/FLAIR heterointense large soft tissue destructive expansile lesion with internal cystic areas showing diffusion restriction with no internal gradient blooming noted arising from clivus. Anteriorly the lesion is extending to bilateral sphenoid sinus and posterior ethmoidal air cells. Anterosuperiorly the lesion is causing mass effect over planum sphenoidale without intracranial extension. Posteroinferiorly the lesion is extending upto tip of dens. Anteroinferiorly the lesion is noted bulging into the nasopharynx. Posteriorly the lesion is not extending to prepontine cistern. Impression- Suggestive of Clival chordoma.
Discussion
Chordomas derive from remnants of the embryonic notochord, which extends from the Rathke pouch to the tip of the coccyx. Chordomas most frequently arise in the midline, predominantly in the clivus or in the sacrococcygeal region. However, they may also be paramedian in location. The spheno-occipital region is the second most common location for chordomas, accounting for 30%–50% of cases. The sacrococcygeal site is the most common site and the vertebral bodies are the least common site . Skull base chordomas are most common in patients aged 20–40 years, while the peak age for sacral chordomas is around 50 years. Four types of chordoma are recognized: conventional, chondroid, dedifferentiated, and poorly differentiated. Chondroid chordomas contain islands of hyaline cartilage. Dedifferentiated and poorly differentiated types carry an unfavorable prognosis. The poorly differentiated type typically occurs in children and young adults
CT features - 1. Well circumscribed ,Destructive, lytic (sometimes with marginal sclerosis) 2. Expansile soft-tissue mass (typically hyperattenuating to brain parenchyma but may be isoattenuating depending on tumoral hemorrhage or necrosis) 3. Irregular tumoral calcification (sequestra of normal bone) 4. Moderate to marked enhancement
MRI features- 1. Low-intermediate T1 signal intensity 2. Majority very high T2 signal intensity 3. Moderate-to-avid heterogeneous enhancement (honeycomb appearance due to areas of low T1 signal intensity)
Findings
E/o ill defined T1 isointense ,T2/FLAIR heterointense large soft tissue destructive expansile lesion with internal cystic areas showing diffusion restriction with no internal gradient blooming noted arising from clivus. Anteriorly the lesion is extending to bilateral sphenoid sinus and posterior ethmoidal air cells. Anterosuperiorly the lesion is causing mass effect over planum sphenoidale without intracranial extension. Posteroinferiorly the lesion is extending upto tip of dens. Anteroinferiorly the lesion is noted bulging into the nasopharynx. Posteriorly the lesion is not extending to prepontine cistern. Impression- Suggestive of Clival chordoma.
Discussion
Chordomas derive from remnants of the embryonic notochord, which extends from the Rathke pouch to the tip of the coccyx. Chordomas most frequently arise in the midline, predominantly in the clivus or in the sacrococcygeal region. However, they may also be paramedian in location. The spheno-occipital region is the second most common location for chordomas, accounting for 30%–50% of cases. The sacrococcygeal site is the most common site and the vertebral bodies are the least common site . Skull base chordomas are most common in patients aged 20–40 years, while the peak age for sacral chordomas is around 50 years. Four types of chordoma are recognized: conventional, chondroid, dedifferentiated, and poorly differentiated. Chondroid chordomas contain islands of hyaline cartilage. Dedifferentiated and poorly differentiated types carry an unfavorable prognosis. The poorly differentiated type typically occurs in children and young adults
CT features - 1. Well circumscribed ,Destructive, lytic (sometimes with marginal sclerosis) 2. Expansile soft-tissue mass (typically hyperattenuating to brain parenchyma but may be isoattenuating depending on tumoral hemorrhage or necrosis) 3. Irregular tumoral calcification (sequestra of normal bone) 4. Moderate to marked enhancement
MRI features- 1. Low-intermediate T1 signal intensity 2. Majority very high T2 signal intensity 3. Moderate-to-avid heterogeneous enhancement (honeycomb appearance due to areas of low T1 signal intensity)
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!