Classification and external resources

MRI of extensive clival chordoma in 17-year old male patient, axial view. Tumor in the nasopharynx extending from nasal cavity to brainstem posteriorly is clearly visible.
ICD-O: M9370/3
OMIM 215400
DiseasesDB 31483
eMedicine med/2992 radio/169 orthoped/49
MeSH D002817

Chordoma is a rare slow-growing malignant neoplasm thought to arise from cellular remnants of the notochord. The evidence for this is the location of the tumors (along the neuraxis), the similar immunohistochemical staining patterns, and the demonstration that notochordal cells are preferentially left behind in the clivus and sacrococcygeal regions when the remainder of the notochord regresses during fetal life.



MRI of extensive clival chordoma in 17-year old male patient, sagittal view. Tumor in the nasopharynx extending from nasal cavity to brainstem posteriorly is clearly visible.

Chordomas can arise from bone in the skull base and anywhere along the spine. The two most common locations are cranially at the clivus and in the sacrum at the bottom of the spine.[1]


A small number of families have been reported in which multiple relatives have been affected by chordoma. In four of these families duplication of the brachyury gene was found to be responsible for causing chordoma.

A possible association with tuberous sclerosis complex (TSC1 or TSC2) has been suggested.[2]


In the United States, the annual incidence of chordoma is approximately 1 in one million (300 new patients each year).[3]

There are currently no known genetic or environmental risk factors for chordoma

While most people with chordoma have no other family members with the disease, rare occurrences of multiple cases within families have been documented. This suggests that some people may be genetically predisposed to develop chordoma. Because genetic or hereditary risk factors for chordoma may exist, scientists at the National Cancer Institute are conducting a Familial Chordoma Study to search for genes involved in the development of this tumor.[4]


Micrograph showing a chordoma. HPS stain.

There are three histological variants of chordoma: classical (or "conventional")[5], chondroid and dedifferentiated.

  • The histological appearance of classical chordoma is of a lobulated tumor composed of groups of cells separated by fibrous septa. The cells have small round nuclei and abundant vacuolated cytoplasm, sometimes described as physaliferous (having bubbles or vacuoles).
  • Chondroid chordomas histologically show features of both chordoma and chondrosarcoma.

Tumor Biology

  • mTOR signaling is hyperactive in sporadic sacral chordomas: in one study 10 out of 10 sacral chordomas exhibited phosphorylation of Ribosomal protein s6 and EIF4EBP1 by immunohistochemistry[6]
  • Partial or complete PTEN (gene) deficiency is observed in nearly all sacral chordomas[6]
  • In a study of 49 chordomas Akt, TSC2, and EIF4EBP1 were phosphorylated in 92%, 96% and 98% of cases, respectively.[7]
  • The CDKN2A (p16) and CDKN2B (p15) loci on chromosome 9p21 are frequently deleted in chordomas[9] Another study found CDKN2A immunoreactivity in just 4% of cases.[7]
  • 62% of chordomas express the High Molecular Weight Melanoma Associated Antigen, also known as Chondroitin sulfate proteoglycan 4 (CSPG4) which has been the target of immune therapy.[10]
  • Recently, scientists have discovered that an inherited Gene duplication is responsible for the familial form of this disorder.[11]

Prognosis and treatment

In one study, the 10-year tumor free survival rate for sacral chordoma was 46%.[12] Chondroid chordomas appear to have a more indolent clinical course.

In most cases, complete surgical resection followed by radiation therapy offers the best chance of long-term control.[13] Incomplete resection of the primary tumor makes controlling the disease more difficult and increases the odds of recurrence.

Chordomas are relatively radioresistant, requiring high doses of radiation to be controlled. The proximity of chordomas to vital neurological structures such as the brain stem and nerves limits the dose of radiation that can safely be delivered. Therefore, highly focused radiation such as proton therapy and carbon ion therapy are more effective than conventional x-ray radiation.[14]

There are no drugs currently approved to treat chordoma, however a clinical trial conducted in Italy using the PDGFR inhibitor Imatinib demonstrated a modest response in some chordoma patients.[15] The same group in Italy found that the combination of imatinib and sirolimus caused a response in several patients whose tumors progressed on imatinib alone.

Notable cases

Former NFL player Craig Heyward was treated for a chordoma in 1998. While initially thought to be successfully removed, the tumor returned in 2005, and caused Heyward's death in May 2006.

Josh Sommer, a student researcher at Duke University, created the Chordoma Foundation with his mother, Simone Sommer, after his diagnosis.[3] The Chordoma Foundation has hosted three International Chordoma Research Workshops which together assembled over 100 leading scientists and physicians, many of whom were new to the field of chordoma research. The Foundation has also collected and distributed chordoma cell lines for research into the cancer's molecular cause and possible treatments.[16]

Pro skateboarder Ray Underhill, a member of the Powell-Peralta Bones Brigade, battled chordoma for two years before succumbing to his disease in August 2008.

Cary Tennis, the popular advice columnist for, announced in his column of November 19, 2009, that he has been diagnosed with a chordoma.


  1. ^ "Primary Malignant Bone Tumors: Tumors of Bones and Joints: Merck Manual Professional". Retrieved 2009-01-04. 
  2. ^ Lee-Jones L, Aligianis I, Davies PA, et al. (September 2004). "Sacrococcygeal chordomas in patients with tuberous sclerosis complex show somatic loss of TSC1 or TSC2". Genes Chromosomes Cancer 41 (1): 80–5. doi:10.1002/gcc.20052. PMID 15236319. 
  3. ^ a b "College student fights his own cancer - Yahoo! News". Archived from the original on 2008-02-26. Retrieved 2008-02-20. 
  4. ^ "Familial Chordoma Study". Retrieved 2009-02-03. 
  5. ^ Chugh R, Tawbi H, Lucas DR, Biermann JS, Schuetze SM, Baker LH (November 2007). "Chordoma: the nonsarcoma primary bone tumor". Oncologist 12 (11): 1344–50. doi:10.1634/theoncologist.12-11-1344. PMID 18055855. 
  6. ^ a b Han S, Polizzano C, Nielsen GP, Hornicek FJ, Rosenberg AE, Ramesh V (March 2009). "Aberrant Hyperactivation of Akt and Mammalian Target of Rapamycin Complex 1 Signaling in Sporadic Chordomas". Clinical Cancer Research 15 (6): 1940–6. doi:10.1158/1078-0432.CCR-08-2364. PMC 2701205. PMID 19276265. 
  7. ^ a b Presneau N, Shalaby A, Idowu B, Gikas P, Cannon SR, Gout I, Diss T, Tirabosco R, Flanagan AM (May 2009). "Potential therapeutic targets for chordoma: PI3K/AKT/TSC1/TSC2/mTOR pathway". British Journal of Cancer 100 (9): 1406–14. doi:10.1038/sj.bjc.6605019. PMC 2694420. PMID 19401700. 
  8. ^ Fasig JH, Dupont WD, LaFleur BJ, Olson SJ, Cates JM (February 2008). "Immunohistochemical analysis of receptor tyrosine kinase signal transduction activity in chordoma.". Neuropathology and Applied Neurobiology 34 (1): 95–104. doi:10.1111/j.1365-2990.2007.00873.x. PMID 17973908. 
  9. ^ Hallor KH, Staaf J, Jönsson G, Heidenblad M, Vult von Steyern F, Bauer HC, Ijszenga M, Hogendoorn PC, Mandahl N, Szuhai K, Mertens F. (January 2008). "Frequent deletion of the CDKN2A locus in chordoma: analysis of chromosomal imbalances using array comparative genomic hybridisation.". British Journal of Cancer 98 (2): 434–42. doi:10.1038/sj.bjc.6604130. PMC 2361468. PMID 18071362. 
  10. ^ Schwab JH, Boland PJ, Agaram NP, Socci ND, Guo T, O'Toole GC, Wang X, Ostroumov E, Hunter CJ, Block JA, Doty S, Ferrone S, Healey JH, Antonescu CR. (March 2009). "Chordoma and chondrosarcoma gene profile: implications for immunotherapy.". Cancer Immunology and Immunotherapy 58 (3): 339–49. doi:10.1007/s00262-008-0557-7. PMID 18641983. 
  11. ^
  12. ^ Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH (2005). "Operative management of sacral chordoma". The Journal of bone and joint surgery. American volume 87 (10): 2211–6. doi:10.2106/JBJS.D.02693. PMID 16203885. 
  13. ^ Park L, Delaney TF, Liebsch NJ, Hornicek FJ, Goldberg S, Mankin H, Rosenberg AE, Rosenthal DI, Suit HD. Sacral chordomas: Impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor.. 
  14. ^ Delaney TF, Liebsch NJ, Pedlow FX, Adams J, Dean S, Yeap BY, McManus P, Rosenberg AE, Nielsen GP, Harmon DC, Spiro IJ, Raskin KA, Suit HD, Yoon SS, Hornicek FJ.. Sacral chordomas: Phase II Study of High-Dose Photon/Proton Radiotherapy in the Management of Spine Sarcomas.. 
  15. ^ Casali PG, Messina A, Stacchiotti S, et al. (2004). "Imatinib mesylate in chordoma". Cancer 101 (9): 2086–97. doi:10.1002/cncr.20618. PMID 15372471. 
  16. ^ "The Chordoma Foundation History and Accomplishments". Retrieved 2008-02-20. 

External links

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Look at other dictionaries:

  • Chordoma — nugarinės stygos navikas statusas T sritis gyvūnų raida, augimas, ontogenezė, embriologija atitikmenys: lot. Chordoma ryšiai: platesnis terminas – stuburo ydos sinonimas – chordoma …   Veterinarinės anatomijos, histologijos ir embriologijos terminai

  • Chordoma — nugarinės stygos navikas statusas T sritis embriologija atitikmenys: lot. Chordoma ryšiai: platesnis terminas – stuburo ydos sinonimas – chordoma …   Medicininės histologijos ir embriologijos vardynas

  • chordoma — noun A slow growing, malignant tumor arising from remnants of the notochord …   Wiktionary

  • Chordoma — A form of bone cancer that usually starts in the lower spinal column. * * * A rare neoplasm of skeletal tissue in adults, derived from persistent portions of the notochord; composed of cells arranged in lobules, with abundant myxoid stroma; some… …   Medical dictionary

  • chordoma — n. tumor originating in the nerve cells of the spinal column (Medicine) …   English contemporary dictionary

  • chordoma — chor·do·ma …   English syllables

  • chordoma — n. a rare tumour arising from remnants of the embryologic notochord. The classical sites are the base of skull and the region of the sacrum …   The new mediacal dictionary

  • chordoma — A type of bone cancer that usually starts in the lower spinal cord …   English dictionary of cancer terms

  • chordoma — …   Useful english dictionary

  • Хордома (Chordoma) — редкая опухоль, происходящая из остатков хорды эмбриона. Характерными местами ее развития являются основание черепа и область крестца. Источник: Медицинский словарь …   Медицинские термины