Surgical seeding of chordomas

Object. Chordomas have a high propensity for local recurrence and progressi on, as well as for systemic and cerebrospinal fluid metastasis. The authors identified and analyzed a series of patients with chordomas, focusing on a n underrecognized pathological entity-surgical seeding of tumor cells. Methods. In a retrospective analysis of 82 patients with chordomas treated over a 10-year period (1990-2000), the authors found six patients (7.3%) in whom surgical seeding had occurred. In five (83%) of these patients the pr imary tumor was located at the clivus. In one (17%), the tumor was present at the cervical spine. There were two male (33%) and four female patients ( 67%) whose mean age was 34 years. The seeding sites, which were separate fr om the primary tumor, were located along the operative route or in the abdo men where fat was removed. The seeding was diagnosed 5 to 15 months (mean 1 2 months) after surgery. One seeding site was present in five patients, and 17 seeding sites were present in one patient. The involved tissues include d mucosa, bone, dura, muscle, and fat. After resection, all seedings were c onfirmed histologically. Conclusions. Seeding of chordomas occurs along the operative route and at d istant locations where tissue is bar-vested. Early diagnosis and aggressive surgery are recommended. Based on the results of this study, the authors s uggest that surgical techniques, postoperative radiotherapy, neuroradiologi cal follow-up protocol, and even research on chordomas should be reevaluate d.