Chordoma Diagnosis

Chordoma is a low-grade malignant tumor originating from residual notochord tissue. Early clinical manifestations are atypical and are easily misdiagnosed as intervertebral disc herniation or lumbar degenerative disease. If not recognized and intervened in time, the tumor will continue to grow and compress the nervous system, eventually leading to limb paralysis or bowel dysfunction. Definitive diagnosis relies on a close combination of imaging and pathological examinations, with precise localization of the lesion and exclusion of other tumors being key.

Diagnostic Basis

1. Magnetic Resonance Imaging (MRI)
MRI is the preferred examination for chordoma, clearly displaying the tumor’s location, extent, and relationship with surrounding tissues. On T2-weighted images, the tumor shows high signal intensity, with blurred signal boundaries suggesting infiltrative characteristics, useful for preoperative evaluation.

2. CT Examination
CT is suitable for observing bone destruction and calcification. Chordomas often present with bone lysis and calcified spots, especially typical in the skull base or sacrococcygeal region. CT-guided biopsy can also be performed, making it an important adjunct for definitive diagnosis.

3. Pathological Examination
Obtaining tumor tissue via biopsy for immunohistochemical staining is the "gold standard" for confirming chordoma. Typical cells appear vacuolated with large, hyperchromatic nuclei. Expression of brachyury protein is a specific marker for diagnosis. Pathology is crucial for differentiating chordoma from other spinal tumors such as chondrosarcoma.

4. Nuclear Bone Scan and PET-CT
These are used to determine whether the tumor has metastasized or recurred. PET-CT can reveal metabolically active regions, making it effective for postoperative follow-up and recurrence monitoring. Bone scans can suggest bone lesions, but specificity is relatively low.

5. Neurophysiological Examination
For patients with neurological symptoms, electromyography and nerve conduction studies can assess the degree of neurological impairment, aiding preoperative evaluation and postoperative rehabilitation planning.

6. Multidisciplinary Diagnosis
Due to the complex location and atypical symptoms of chordoma, collaboration among neurosurgery, radiotherapy, and imaging departments is often required. Integrating imaging, clinical, and pathological findings improves diagnostic accuracy and facilitates individualized treatment planning.

Conclusion

Experts at United Life International Medical Center remind that early recognition of chordoma requires high vigilance. It is recommended that patients with chronic unexplained lumbosacral pain undergo imaging screening and early pathological confirmation, thereby formulating appropriate intervention plans, reducing neurological damage, and improving quality of life.