What's the most likely diagnosis?

• 48 year old with back pain

1. Uterine fibroids
2. Ovarian carcinoma
3. Constipation
4. Small bowel obstruction
5. Sacrococcygeal chordoma

Additional Image-Sagittal reformatted CT of the pelvis

 

Additional Image

 

Sagittal Reformatted CT of the Pelvis

Answer:

 

5. Sacrococcygeal chordoma

 

 

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Sacrococcygeal Chordoma

General Considerations 

• Rare primary malignancy of bone
• Originates from embryonic remnants of the notochord
• Location
  • 50% occur in sacrum
• 40% of all sacral tumors
• Most common in 4^th or 5^th sacral segment
• 35% at skull base around clivus
• Benign tumors but may locally invade and compress
• 15% in remainder of spine
• Cervical spine most common
• Occurs between the ages of 30-70 with a 2:1 male:female ratio

 

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