case_images: PMC11573806_01
case_images: Baseline (a) and follow-up (b) axial non-contrast T1-weighted images. a Presacral soft tissue component with a native hyperintense signal centrally (*) and a thick hypointense rim on the anterior side (white arrows). The lesion causes a mild mass effect over the rectum with a preserved fat plane in between the tumor and the rectum (arrowheads). b Note the marked decrease in size occurring in 4 weeks time. The signal intensity in the soft tissue mass has not changed (*)
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case_images: PMC11573806_01_256_2024_4700_Fig1_HTML.jpg
case_images: Fig1
case_images: T1-weighted images, the lesion showed a native hyperintense signal centrally, which may be due to previous hemorrhage (Fig. 1a). The lesion had mass effect over the rectum without invading it (Fig. 1a). The lesion was heterogeneously hyperintense on T2-weighted images with a thick hypointense rim around the presacral soft tissue mass (Fig. 2a). A notable spontaneous decrease in tumor size was identified on the subsequent MRI (from 46 x 47 x 45 mm to 37 x 16 x 33 mm) (Figs. 1b and 2b).
case_images: Decrease in size of the tumor's presacral soft tissue component. a Baseline sagittal T2-weighted MR image shows a focus of hyperintense signal intensity within the marrow of S4 (arrowhead). This finding, alongside the anterior soft-tissue component of the mass, points towards the osseous origin of the tumor. On the baseline MRI, the anteroposterior diameter of the soft tissue mass is 47 mm (double arrow). b Follow-up sagittal contrast-enhanced T1-weighted fat-saturated MR image shows a decrease in size of the anterior soft tissue component (anteroposterior diameter is 16 mm) with rim enhancement and heterogeneous enhancement of intraosseous component
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case_images: PMC11573806_01_256_2024_4700_Fig2_HTML.jpg
case_images: Fig2
case_images: The lesion had mass effect over the rectum without invading it (Fig. 1a). The lesion was heterogeneously hyperintense on T2-weighted images with a thick hypointense rim around the presacral soft tissue mass (Fig. 2a). A notable spontaneous decrease in tumor size was identified on the subsequent MRI (from 46 x 47 x 45 mm to 37 x 16 x 33 mm) (Figs. 1b and 2b).
case_images: Fused 18F-FDG PET-CT images of the sacrococcygeal tumor at baseline. a Axial image shows a peripheral rim of FDG uptake in the soft tissue mass. b Sagittal image shows an osteolytic tumor with moderately increased metabolic activity in the rim of the soft tissue component. There is discrete cortical destruction at level S4 with a focus of high FDG uptake within the marrow
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case_images: PMC11573806_01_256_2024_4700_Fig3_HTML.jpg
case_images: Fig3
case_images: There was mild FDG uptake peripherally in the tumor (Fig. 3 a and b).
case_images: Axial image of the CT-guided biopsy (with the patient in a prone position). The biopsy was taken from the bone (see the needle tip) to prevent a false negative biopsy result from the presacral soft tissue mass which had spontaneously decreased in size (arrows)
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case_images: PMC11573806_01_256_2024_4700_Fig4_HTML.jpg
case_images: Fig4
case_images: The biopsy was taken from the bone (see the needle tip) to prevent a false negative biopsy result from the presacral soft tissue mass which had spontaneously decreased in size (Fig. 4).
case_images: Preoperative and postoperative images. a Preoperative photograph during the soft tissue reconstruction using a partially de-epithelialized superior gluteal artery perforator (SGAP) flap. b Postoperative sagittal non-contrast T1-weighted image shows sacrectomy below the S2 level and soft tissue reconstruction using the SGAP flap (arrowheads). c Clinical image 6 weeks postoperatively showing uneventful healing of the SGAP flap
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case_images: Fig5
case_images: A soft tissue reconstruction was performed using a partially de-epithelialized superior gluteal artery perforator (SGAP) flap to fill the void and provide primary wound healing (Fig. 5a). Wound healing was uneventful, and postoperative MRI showed no complications regarding the flap (Fig. 5 b and c).
case_images: Pathology images after sacrectomy. a Sagittal section of the sacrectomy specimen shows a poorly demarcated glassy tumor in the sacral bone and in the soft tissue (*). A presacral area with hemorrhage is noticeable (arrowheads) and corresponds to the MR image of Fig. 2b. b On the H&E section, this hemorrhagic area is composed of fibrine and iron-laden macrophages (arrowhead). Tumoral cells adjacent to this area showed abundant eosinophilic cytoplasm with intracytoplasmic vacuoles with nuclei varying in shape and size (*). c Brachyury staining was positive in the tumoral cells, confirming the diagnosis of chordoma
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case_images: PMC11573806_01_256_2024_4700_Fig6_HTML.jpg
case_images: Fig6
case_images: Between the tumor process, a sharply defined area is noticed with a striking yellow color, suspicious for post-hemorrhagic changes (Fig. 6a). On the H&E section, this area was composed of fibrine and iron-laden macrophages, with the tumor cells adjacent to this area showed similar morphology as was seen on the pre-operative biopsy (Fig. 6b). Additional brachyury staining was positive in the tumoral cells and negative in the area with bleeding (Fig. 6c).