A case report of chordoid meningioma with contiguous extracranial invasion

Tumors of the rhinopharynx or cavum are rare, with an incidence of 0.5 to 2 cases per 100,000 inhabitants. Are more common in males, and the mean peak age is between 40 and 50 years old. They are very aggressivewith a tendency to earlymetastasis. The authors describe the case of a male patient, 47 years old, ex-smoker, presents with backache, fever (37.5 °C–38 °C), irritative cough and asthenia, for nearly two months. These complaints were initially interpreted as mechanical or degenerative back pain and tracheobronchitis. Medicated by the attending physician with antibiotics without improvement, was asked complementary exams: chest radiograph had no changes and simplify blood tests:without anemia or leukocytosis, c-reactive protein: 18 mg/dl, velocity sedimentation—70ms, ferritin—817 ng/ml. He was admitted in Internal Medicine for study. As first diagnosis most likely was spondylodiscitis we order other tests, including culture and serology tests, which proved negative. The CT of the lumbar spine revealed lytic lesions in the vertebral bodies, sacrum and iliac bone suggestive of secondary deposits. After this, was asked thoracoabdominal-pelvic CT that revealed two hepatic nodules and a 9 mm nodular thickening of the wall of the rectum. Colonoscopy revealed no changes and biopsies of the rectum were made. Anatomopathologic results were inconclusive. Other tests without significant changes. Meanwhile he is re-hospitalized for pneumonia and cervical pain. CT of the cervical spine showed an osteolytic lesion of C7 and C3–C4 tissue mass. For suspected neoplasm of nasopharynxwas asked soft tissues CT of the head and neckwith identification of amass at the cavum left side, and a nodule in left pulmonary apex. Spine MRI with multiple changes. Requested the collaboration of Otorhinolaringology for excisional surgical biopsy and histological study revealed the presence of squamous cell carcinoma (WHO type 1). Was diagnosed a nasopharyngeal carcinoma with bone, liver and lung metastasis. Without surgery indication, he was proposed to chemotherapy (cisplatin e paclitaxel), however died in 3 months after first hospitalization, 1 month after chemotherapy. We believe that this is an important case, not only for being uncommon, but also for not having manifested the most common form which is usually local manifestations, but with a back pain that is a much common complaint, which made the diagnosis much more difficult. In addition, alerts us to the aggressiveness of this tumor and the need for the rapid diagnosis and aggressive treatment.