CHORDOMA m.b. (Cal.), m.r.c.p. (Lond.) By Professor o) Medicine, Medical College, Calcutta, and First Physician, Medical College Hospitals

M. N. DE,

and

(Cal.), d.b. (Lond.) Bacteriology, Medical of Pathology the to and Bacteriologist College, Calcutta, Government of Bengal (From the Department of Pathology and Bacteriology, Medical College, Calcutta) Chordoma is a tumour growth which arises from the remnants of the embryological notochord. Though its occurrence has been recorded in the past in considerable numbers, this type of neoplasm still remains rather a rare condition in the course of routine morbid histological diagnostic work. The notochord gives rise to a tissue which has often been called cartilage. The notochordal tissue however differs from the typical cartilage B. P. TRIBEDI,

Professor

m.b.

and

THE INDIAN MEDICAL GAZETTE

466

Williams (1908) described the principal stages in its development in the pig. The human notochord undergoes a development similar to that of the pig. After it has ceased to be an epithelioid rod of cells, its most characteristic feature is that it includes a portion of the nucleus pulposus. The notochordal tissue forms a vacuolized syncytium suspended in a gelatinous matrix, which, at the periphery of the nucleus pulposus, is bounded by a structureless membrane. The notochord is rarely a source of tumour formation, but, when it does give rise to one, this is composed of tissues similar to those normally found within the nucleus pulposus (Lewis and Bremer, 1927).

structure.

Stewart (1922), who described the first case in the British Isles and also gave an historical review dated from 1856 on the subject, recorded the published cases and discussed the morbid anatomy, histology and the clinical manifestations of this type of neoplasia. Coenen (1925) and Stewart and Morin (1926) recorded further cases of this type of neoplasia. Cappell (1928) while describing chordomas studied the embryology of the notochord in the human subject and observed certain aberrations of development of and this tissue. Machulko-Horbatzewitsch Rochlin (1930) described notochordal tumours and Mabrey (1935) recorded his observations on the study of 150 cases of this type of tumour. Dickson, Worster-Drought and McMenemey (1937) described a case of spheno-occipital chordoma and discussed its histology in detail. Considering the rarity of these tumours a case of chordoma that we have observed is recorded below :? K. F., male, aged 42 years, mason by occupation, to the hospital on 7th January, 1937, for a growth on the lower part of his buttock. Four years back a small swelling about the size of a bean appeared over the sacrum posteriorly. This was slightly painful and tender. The size increased slowly and a globular mass of 2 inches in diameter appeared. He carried on his job without any inconvenience but 15 days before his admission he was gored by a bull and injured at the site of the tumour. After this incident the tumour increased rapidly and began to

The histological picture of the tumour presented columns of cells, fibrous tissue strands and mucoid areas (plate XV, figure 2). On higher magnification most of the cells showed the typical cytoplasmic vacuolations (plate XV, figure 3). These physaliphorus cells were a marked feature in all the blocks that were studied. On still higher magnification the characteristic nuclear vacuolations, diffuse and circumscribed, could be seen clearly (plate XV, figure 4). At certain areas the cellular element was altogether deficient but extensive mucoid areas, as seen in plate XV, figure 2, were found. The patient made an uneventful recovery and after the wound healed up he was discharged from the hospital on 21st March, 1937. He was traced and examined on 15th February, 1939. As to the general condition he was fairly well and carrying on his work as usual. On examination of the site of the tumour s it was noticed that a globular mass, the size of a hen in?n an half and soft in had consistency, appeared egg below the scar mark of the last operation (figure ?)? For the last six months he noticed this swelling whicn

came

hang

as a

pendulous

mass.

On examination.?A swelling 4i inches in diameter and was noticed in the lower part of the sacrum coccyx. Skin over the swelling was tense, shining and hot. The mass was found to be fixed to the underlying structures. Rectal examination revealed no protruding mass. There was only slight tenderness over the posterior wall of the rectum in the lower part. X-ray examination showed complete destruction of the No bone reaction was seen and the lower coccyx. two-thirds of the sacrum were missing. The tumour was removed by operation on 25th January, 1937, and it was observed that though it was attached to the rectal wall it was completely separate from it. The mass as obtained from the operation showed the following: The tumour was a globular mass, oval in shape and measured 5| by 4 inches. The cut surface of the tumour mass was noticed to be partitioned into a number of areas of different sizes, sharply demarcated by bluish-white and grey strands. These circumscribed areas were composed of pale yellow, brown and red masses. At certain places, there were actual hemorrhages, recent and 'old. The whole of the cut surface presented a gelatinous mucoid appearance which was a very marked feature (plate XIV, figure 1).

1939

[Aug.,

showing the of the tumour in situ just below the old operation scar.

Fig.

5.?Photograph

recurrence

was very slowly increasing. He had plaints whatsoever and was inclined

no

local

to

ignore

c?.ue

recurrence.

Comments under review corresponds in m0,, points with the previously reported cases. ^ is interesting to note that the patient had complaint except that of a hanging mass, al? though the tumour was attached to the -1wall, it did not invade that structure. g i?a in of of this tumour greater incidence type brings up the question of trauma (Mabr^J' 1935). In the present case there is de association of trauma which at least aggrava the condition. Figure 5 clearly suggests a recurrence immediately below the old scar. 11 ^ prolonged course for over five years did produce any marked effect on the general condition which indicates the low gra of malignancy of this neoplasm. ^ Our thanks are due to Professor M. J. SteW Leeds, for confirming the histological diagn0" (Continued at foot of opposite page) The

case

^

j

re?,,'ie

sl?jlC

Pa^iellje

Fig.

the tumour tumour can be seen to divide the and grey strands strands can u removed tumour; bluish-white w hitP and erey can removed tumour; bluis are hsemorriages can colour different in in hemorrhages different areas; colour jn Note that their contents ,jgerenjcompartments. Note that be seen at certain places. plaCes.

1.?A drawing of the Fig. 1.?A ma*s drawing of the into compartments. mass into

?

their^con^entsjq

Plate XV.

Ik *'

.*?S3r

*

733ba.

showing Fig. view) showing (low power power view) Fig. 2.?Photomicrograph 2.?Photomicrograph (low the the strands and and the tissue strands the columns of cells, fibrous tissue columns of cells, fibrous mucoid mucoid

areas. areas.

Ocular Ocular (Zeiss-compens)?no. (Zeiss-compens)?no. 4.4. 10. Objective Objective (Zeiss-apochromatic)?no. (Zeiss-apochromatic)?no. 10.

# Fig. 4.?Photomicrograph (much higher magnification) the typical cytoplasmic and one circumscribed

showing

^

.

magnifi?^ magnify

Fig. 3.?Photomicrograph (higher showing characteristic physaliphorus Ocular (Leitz-periplan)?no. 8 X. X. Objective (Zeiss-apochromatic)?no.

nuclear vacuolation. Ocular (Reichert-compens)?no. (Reichert-compens)?110. 12. Objective (Zeiss)?no. 1/12" oil immersion.

ce eel

"a?

s.

\

(Continued from previous page) _nlrS two references and our j also due to Dr. B. N. Mukherjee, ^re Medical College Hospitals, ^ lng us in the collection of the to the Collegee Medical Superintendent, for supplying us with and

^

letting us have

.

pathologist,

.

'

*?d

Hospitals, records.

Calcutta,

References Journ.

Capped D F (1928). XXXI, p. 797. Coenen, H. (1925). V