Clival Chordoma Presenting as Nasopharyngeal Mass: A Case Report

Introduction: Skull base chordomas represent a challenge to the otolaryngologist because of its rarity, biological behavior, and resistance to treatment. Chordomas are known to originate from embryonic remnants of the notochord, presenting from the skull base to sacrum. Chordomas arising from skull base/clivus are typically locally aggressive with lytic bone destruction. The ideal treatment may be radiotherapy alone or combined with gross total resection, when feasible. Because of the risk of severe late complications, the radiotherapy dose is often limited and the probability of cure is low. Recently, the transnasal endoscopic approach has improved morbidity and mortality allowing also for excellent removal rates.

Objectives: The aim of this study is to describe the incidental finding of a clival chordoma in nasopharynx and to discuss its approach.

Resumed Report: A 19-year-old male patient sought medical attention because of ear fullness, nasal obstruction, and snoring, refractory to clinical treatment. Nasal endoscopy revealed septal deviation to the right (Cottle zones II and III) and tissue in adenoid topography occupying 80% of the cavum. Septoplasty and adenoidectomy were proposed to the patient, but during the procedure a nasopharyngeal mass was identified and biopsied. Tissue histology was compatible with chordoma. After workup performed, surgical approach was planned with neurosurgery.

Conclusion: Chordoma of skull base can sometimes present as nasopharyngeal mass that can be mistaken for primary nasopharyngeal mass. To avoid delay in diagnosis, nasopharyngeal extension of an intracranial chordoma should be considered in the differential diagnosis of any mass in nasopharynx.

Keywords: clival chordoma, nasopharyngeal.