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Cutaneous Metastasis From Sacral Chordoma.

Kristyna Gleghorn1, Brandon Goodwin, Ramon Sanchez

  • 1*School of Medicine, University of Texas Medical Branch, Galveston, TX; and †Department of Dermatology, University of Texas Medical Branch, Galveston, TX.

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Chordoma, a rare bone cancer, can rarely spread to the skin. This case highlights diagnosing rare cutaneous metastasis from sacral chordoma using dermatopathology.

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Area of Science:

  • Oncology
  • Dermatopathology
  • Skeletal System Neoplasms

Background:

  • Chordoma is a rare bone malignancy originating from notochordal remnants, typically presenting with slow local progression, recurrence, and metastasis.
  • Cutaneous metastasis from chordoma is exceptionally rare, posing diagnostic challenges due to non-specific skin findings and the tumor's infrequency.

Observation:

  • A 61-year-old male with a history of sacral chordoma developed a scalp nodule 8 years post-excision.
  • Physical examination revealed a 1 cm dome-shaped nodule on the left occipital scalp.
  • Histopathology showed a dermal proliferation of ovoid and physaliferous cells with characteristic cytoplasm and nuclei.

Findings:

  • Immunohistochemistry confirmed tumor cells positive for S-100 protein, pancytokeratin (AE1/AE3), and brachyury.
  • Negative staining for smooth muscle actin (SMA), P63, and CK7 supported the diagnosis.
  • The findings were consistent with cutaneous metastasis of sacral chordoma, termed chordoma cutis.

Implications:

  • This case underscores the critical role of dermatopathology in diagnosing rare presentations of chordoma.
  • Accurate diagnosis of cutaneous chordoma metastasis is vital for appropriate patient management and prognosis.
  • Recognizing this rare entity aids in differentiating it from other cutaneous neoplasms.