Challenging the giant: A case report on a huge sacrococcygeal chordoma and its radiological insights

Abstract

Sacral chordoma is a rare osseous tumor of malignant origin. Remnants of the notochord in the region of sacrum and coccyx is said to be the origin of these tumors. Patients generally have delayed presentation, which is responsible for larger tumor size. Early detection of sacral chordoma is therefore very important. We present a clinical case on a 56-year-old male patient who presented with chronic lower back pain for 3 years, predominantly in the sacral region. He also had occasional bouts of constipation. Diagnostic imaging modalities used encompass ultrasonography, magnetic resonance imaging, and computed tomography scans. Radiological imaging of this patient revealed a giant mass within the pelvis. The mass was involving the lower sacrum and coccyx region predominantly. Associated local osteolytic changes were also noted, which are a characteristic feature of sacral chordoma. The patient underwent surgical excision of the tumor. Subsequent histopathological analysis gave the diagnosis of chordoma of sacral region.

Sacral chordoma should be a consideration in differential diagnosis whenever the patient presents with persistent chronic lumbosacral pain, discomfort, and neurological impairments. Surgical excision followed by radiotherapy is useful in improving clinical outcomes for individuals diagnosed with sacral chordoma. This enhances overall patient prognosis and reduces the risk of local recurrence. The diagnosis of sacral chordoma is a challenge for diagnostic radiologists. Quicker identification, assertive surgical intervention, and suitable adjuvant therapies for chordoma are essential for enhancing patient outcomes and effectively managing this uncommon malignancy called chordoma.