Abstract
Background A retroclival lesion can represent a notochordal remnant–derived mass. The differential
diagnoses includes benign lesions such as ecchordosis physaliphora (EP) and neuroenteric
cyst or malignant ones such as chordomas. In the case of EP and chordoma, although
both types arise from remnants of fetal notochord tissues, they represent two separate
entities with different radiographic and biologic behaviors.
Case Description We present a case of an incidental finding of a retroclival lesion. The magnetic
resonance imaging (MRI) characteristics of the lesion match the neuroimaging profile
of a benign lesion and are suggestive of an EP. There was no enhancement noted with
the addition of gadolinium. Nonetheless, pathology determined the lesion to be a malignant
chordoma.
Conclusion The differential diagnosis of a retroclival lesion includes benign and malignant
notochordal lesions. Here we present a case of a patient with an incidental finding
of a retroclival lesion. Radiographic findings were suggestive of a benign lesion,
possibly EP, yet the pathology revealed a chordoma. This report suggests that despite
benign imaging, chordoma cannot be excluded and the implications for treatment can
be significant. It is important to achieve the correct diagnosis because the prognostic
and therapeutic implications are different.
Keywords
ecchordosis physaliphora - neuroenteric cyst - chordoma - benign - malignant - gadolinium
- enhancement
