Lumbo-sacral chordoma with high-grade malignant cartilaginous and spindle cell components

A recurrent lumbo-sacral chordoma with high-grade cartilaginous and spindle cell components is described. The tumor was excised from a 71-year-old man who previously had a conventional chordoma resected from his sacrum 26 years earlier. The original conventional chordoma was treated postoperatively with external beam radiation therapy, and the patient was free of disease until he presented at the age of 71 with leg weakness. Computerized tomography revealed a lumbo-sacral soft tissue mass. This was excised and found to have three distinct histologic aspects. The largest component was that of a conventional chordoma. The second component consisted of islands of malignant cartilage intimately admixed with the cells of the conventional chordoma. The third component consisted of high-grade malignant, poorly differentiated spindle cells. This case suggests that chondroid chordomas do exist and that they may also occur outside of the spheno-occipital region.