PMC3783480_01
The sagittal T2 weighted MRI image of sacrococcygeal region, shows a small high signal lesion in the previous surgical site in the lower coccyx (arrow) consistent with recurrent chordoma.
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Lumbosacral MRI was performed and showed a 0.5x0.8x1.0 cm, T2 hyper intense lesion, located in sacrococcygeal region, which was consistent with recurrent chordoma (Figure 1).
Axial FDG-PET/CT images of patient demonstrates high FDG uptake lymph nodes in the left iliac chain(SUV: 2.9) (A), the left femoral chain(SUV: 2.7) (B), and the right femoral chain (SUV: 2.9) (C).
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On PET-CT scan FDG avid lymph nodes in the left external iliac and bilateral femoral chains were detected (Figure 2).This raised the suspicions for a tumor metastasis to adjacent lymph nodes.
Sagittal FDG-PET/CT (A, B), and PET (C) images of the patient illustrate high FDG-uptake lymph nodes in the iliac and femoral chain of patient.
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The patient underwent open lymph node biopsy with pathology that unexpectedly revealed noncaseating epithelioid granuloma without evidence for malignant cells (Figure 3).
Photomicrographs of H&E staining images show: Astroid cells (arrow), and epithelioid granuloma (arrowhead) in the bone marrow (A), tumoral cells in the resected cocygeal bone (C), and epithelioid granuloma (arrow)in the resected lymph node (B).
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The surgical specimen pathology showed chordoma cells in the bone and further non-caseating epithelioid granulomas in the bone marrow consistent with diffuse sarcoidosis (Figure 4).