Chordoma Spontaneous Regression After Covid-19
Silva Junior, L. F. M. D., Silva, G. E. B., Campos, M. A. G., Teixeira Júnior, A. A. L., Santos, R. M., Santos, O. J. D., & Salgado Filho, N. (2024). Chordoma Spontaneous Regression After COVID-19. Viruses, 17(1), 10. https://doi.org/10.3390/v17010010
View Original Source →Abstract
Chordomas are a low-to-intermediate-grade slow-growing subtype of sarcoma, but show propensity to grow and invade locally with recurrence and metastasis in 10-40% of cases. We describe the first case of spontaneous regression of a solid tumor (histologically and immunohistochemically proven chordoma) after COVID-19. A female patient with clival chordoma underwent occipitocervical fixation prior to tumor resection. In the early post-operative stage following the arthrodesis procedure, she was diagnosed with COVID-19. Six months after COVID-19, she finally came back for endoscopic endonasal resection of the tumor and pre-operative MRI surprisingly showed 98.9% regression of the tumor volume. Tumor resection was performed, and both histopathological and immunohistochemistry confirmed diagnosis of chordoma with positive brachyury levels. She showed improvement of right hemiparesis and left-sided tongue palsy. The tumor was comprised of tumor-infiltrating inflammatory cells. CD3 and CD68 were positive, suggesting the presence of T-lymphocytes and macrophages. CD20 and CD56 were negative, suggesting the absence of B-lymphocytes and NK-cells. The authors believe that the onset of COVID-19 exacerbated the patient's immune response and improved anti-tumor immunity. It was concluded that T-cells, which are involved in the COVID-19 immune response and were found infiltrating the tumor, acted as a critical pathway to this event. Further studies are encouraged in order to gain a better understanding of the SARS-CoV-2-chordoma interaction.
Case Details
Disease Location
Skull, spine
Personal Characteristics
35-year-old woman
Clinical Characteristics
She reported 9 months of recurrent headache and 1 month of right hemiparesis (grade iii) with a left-sided deviation of the tongue. Magnetic resonance imaging (MRI) showed a 6.1 cm × 4.7 cm × 3.7 cm heterogeneous lesion in the anterior aspect of the craniocervical junction eroding the clivus, a left lateral mass of c1, and the inferior portion of the odontoid process. It showed a huge extraosseous component protruding into the pre-pontine cistern, left cerebellum-medullary cistern, and foramen magnum after 6 months, she came back with the progression of symptoms. She had intense cervical pain, a headache, and was unable to walk. MRI was repeated with the same finding of a 6.5 cm × 4.5 cm × 3.5 cm heterogeneous lesion suggestive of chordoma with a mass effect over the adjacent structures and bone invasion. She underwent a spine procedure. Treatment was started with ceftriaxone, clindamycin, azithromycin, hydroxychloroquine, ivermectin, prednisone, zinc, and vitamin v. The patient had moderate symptoms with mild dyspnea requiring oxygen (o2). Even after the episode of covid-19, she continued to report a headache and neuropathic pain for 5 months whilst taking gabapentin and amitriptyline.
Remission Characteristics
5 months after the covid-19 infection, another MRI was performed to re-evaluate the tumor and define the surgical plan. A surprising regression of the tumor was noticed. A 1 cm × 0.6 cm × 0.5 cm lesion was restricted to the left side of the skull base, no extraosseous component was identified, and there was no mass effect over the brainstem, cervical spinal cord, or even longus colli muscles
Treatment & Mechanisms
Proposed Remission Mechanisms
The onset of covid-19 with exacerbated immune response and improvement in anti-tumor immunity (detection and elimination), by both direct and cross-reactions, had a fundamental role in this surprising chordoma regression
Clinical Treatment
Occipitocervical fixation ceftriaxone, clindamycin, azithromycin, hydroxychloroquine, ivermectin, prednisone, zinc, and vitamin v. O2. Gabapentin, amitriptyline