Yutma güçlüğüne neden olan retrofarengeal kitle: servikal kordoma

Kordomalar, notokordun embriyolojik artıklarından kaynaklanan nadir primer kemik tümörleridir. Servikal bölge yerleşimli kordomalar oldukça nadir görülmektedir. Tüm kordomaların %5 kadarını oluşturan servikal kordomalar, komşu oldukları parafarengeal bölge, orofarenks gibi anatomik boşluklara uzanım gösterip; boyunda şişlik, orofarenkste kitle, yutma güçlüğü, nefes darlığı benzeri klinik bulgular verebilirler. Bu olgu sunumunda yutma güçlüğü şikayeti ile başvuran ve orofarenkste kitle olarak bulgu veren servikal kordoma olgusunun klinik özellikleri sunulmuş, tanıda yaşanan güçlükler ve cerrahi bulgular tartışılmıştır.

Retropharyngeal mass presenting with dysphagia: cervical chordoma

Chordomas are rare primary bone tumors tought to originate from embryological remnants of the notochord. Upper cervical spine chordomas constitute about 5% of all chordomas. Extension from upper cervical spine to nasopharynx, oropharynx or parapharyngeal space extremely uncommon in head and neck surgical practice. These tumors present with features of compression of adjacent structures resulting in dysphagia, dyspnea or as a palpable neck mass, oropharyngeal mass. In this case report, chordoma originating from upper cervical spine involving the oropharyx is presented. The difficulty of diagnosis, its radiological features along with surgical findings is discussed.

___

1.Walcott PB, Nahed VB, Mohyeldin A, Coumans VJ, Kahle TK, Ferreira JM. Chordoma:current concepts, management, and future directions. Lancet Oncol 2012; 13- e69-76.

2. Vasudevan V, Manjunath V, Devaraju D, Murali R. Chordoma arising from cranial base extending to oropharynx: an unusual presentation. J Maxillofac Oral Surg 2015; 14(suppl 1):103–7.

3. Wang Y, Xıao J, Wu Z, Huang Q, Huang W, Zhu Q, et al. Primary chordomas of cervical spine: a consecutive series of 14 surgically managed cases. J Neurosurg Spine 2012; 17 - 292-99.

4. Gladstone HB, Bailet JW, Rowland JP. Chordoma of the oropharynx; an usual presentation and review of the literature. Otolaryngol Head Neck Surg. 1998;118:104–7.

5. Wang YP, Lee KS, Chen YJ, Huang J. Extraosseous chordoma of the retropharyngeal space. Otolaryngol Head Neck Surg. 2004;130(3): 383-85.

6. Hart ES. Cervical spine chordoma. Orthopaedic Nursing 2012:31(6):355-56.

7. Koybasioglu F, Simsek GG, Onal BU, Han U, Adabag A. Oropharyngeal chordoma diagnosed by fine needle aspiration: a case report. Acta Cytol 2005;49:173–6.

8. Forsyth PA, Cascino TL, Shaw EG, Scheithauer BW, O’Fallon JR, Dozier JC, et al. Intracranial chordomas:a clinicopathological and prognostic study of 51 cases. J Neurosurg. 1993;78:741-7.

9. Barrenechea IJ, Perin NI, Triana A, Lesser J, Costantino P, Sen C: Surgical management of chordomas of the cervical spine. J Neurosurg Spine 2007;6:398–406.

10. Orecchia R, Vitolo V, Fiore MR, Fossati P, Iannalfi A, Vischioni B, et al. Proton beam radiotherapy: report of the first ten patients treated at the “Centro Nazionale di Adroterapia Oncologica (CNAO)” for skull base and spine tumours. Radiol Med 2014;119:277–82.

11.Casali PG, Stacchiotti S, Sangalli C, Olmi P, Gronchi A: Chordoma. Curr Opin Oncol 2007;19(4):367-70.