Cytological detection of metastatic chordoma cells in pleural effusions: A case report

Abstract

Cytological detection of chordoma cells in the serosal cavity is challenging because of its rare presentation. Herein, we report a case of chordoma showing malignant pleural effusion accompanied by pleuropulmonary metastases in a 68-year-old woman.Cytological analysis was performed using pleural fluid obtained following thoracentesis. Conventional cytological staining demonstrated few clusters of large, atypical cells characterized by epithelial cell-like connectivity and rich cytoplasm with foamy and/or multivacuolar changes. The nuclei of these atypical cells were large and either round or oval with no conspicuous irregularities in the nuclear membrane.Periodic acid-Schiff staining of these atypical cells revealed fine granules in the cytoplasm. Giemsa staining showed foamy and/or multivacuolar cytoplasm in these cells, with metachromatic mucoid stroma in the surroundings. Immunocytochemistry analysis using cellblock showed these cells to be positive for broad cytokeratins, epithelial membrane antigen, S100 protein, vimentin, and Brachyury. To the best of our knowledge, this is the first case report in which chordoma cells were cytologically detected in pleural effusions. Our findings also suggest that conventional cytology combined with cellblock immunocytochemistry can increase the accuracy of chordoma cell detection in the serosal cavity.

Multifocal Ectopic Recurrence of a C2 Chordoma

“…31 While most chordomas have been found to metastasize to the lung, bone, lymph nodes, and liver, 3,8,14,17,20 chordomas have a diverse range of potential sites for metastatic growth with reports describing metastatic disease in the tongue, larynx, breast, mandible, pleural effusions, and skeletal muscle. 16,[33][34][35][36][37] Cutaneous metastatic cases, also known as chordoma cutis, are quite rare with less than 20 reported cases in the literature, most originating from sacral chordomas, though origins from cervical and skull base chordomas have been documented as well. 38 Cardiac metastases are even rarer, with only seven reported cases originating from primary sacral and clival chordomas.…”