T1 sagittal post gad w/ fat sat T1 axial post gad T2 axial

Diagnosis: Chordoma

Chordomas arise from embryonic notochordal elements and are seen in the clivus at the spheno-occipital synchondrosis as well as the sacrum. Chordomas may very rarely occur in the vertebral column. Sacrococcygeal chordomas make up 50 to 75% of all chordomas and are usually seen in older patients. 1/4 of chordomas arise in the clivus and tend to occur in younger patients presenting with progressive cranial nerve deficits.

Clival chordomas are enhancing, destructive masses which usually have calcification on CT. Plasmacytoma as well as metastases from lung, breast, or prostate are the main differential considerations. Metastasis is less likely if there are calcifications within the mass on non-enhanced CT. Meningiomas are typically not destructive but if they become large enough, they may mimic a chordoma. Related Cases

Adenoid cystic carcinoma Meningioma Clival chordoma