Spontaneous Shrinking and Growing Skull Base Chordoma

Area of Science:

• Neuro-oncology
• Skeletal Tumors

Background:

• Chordomas are rare, slow-growing tumors of the axial skeleton.
• Complete surgical resection and adjuvant radiotherapy are standard treatments.
• This case involves an off-midline petroclival chordoma with atypical behavior.

Observation:

• A 23-year-old woman presented with abducens nerve palsy due to a petroclival lesion.
• Initial imaging suggested chondrosarcoma, but MRI showed spontaneous regression and clinical improvement.
• The lesion recurred, exhibiting growth and intratumoral hemorrhage, despite further MRI-indicated shrinkage.

Findings:

• Histopathology confirmed a conventional chordoma despite its unusual presentation.
• The tumor demonstrated fluctuating cycles of growth and spontaneous regression.
• Intratumoral hemorrhage is a potential factor in the observed tumor behavior.

Implications:

• This case underscores the importance of including chordoma in the differential diagnosis for petroclival lesions, even with atypical presentations.
• The fluctuating behavior of this chordoma warrants further investigation into its etiology.
• Management strategies may need to adapt to such unusual tumor dynamics.