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Spontaneous Regression Of A Clival Chordoma: An Unusual Case Report

Bander, E. D. 2020Other/Unknown

Bander, E. D., Kocharian, G., Liechty, B., Tsiouris, A. J., & Schwartz, T. H. (2020). Spontaneous regression of a clival chordoma. Case report. Acta neurochirurgica, 162(2), 433–436. https://doi.org/10.1007/s00701-019-04107-9

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Abstract

In this case report, we present a rare and previously unreported case of spontaneous regression of a histologically consistent clival chordoma. At the time of diagnosis, imaging demonstrated a T2 hyperintense and T1 isointense midline skull base mass, centered in the nasopharynx, with scalloping of the ventral clivus consistent with a chordoma measuring 3.1 × 1.9 × 3.0 cm (8.84 cm3). On pre-operative imaging 2 months later, with no intervening therapy, the mass had regressed by 61.7% to a size of 2.3 × 2.1 × 1.4 cm (3.38 cm3). The patient self-administered several herbal supplements and animal oils which may have contributed to tumor regression. The purpose of this report is to document this rare occurrence and provide a comprehensive description of the case details and list of the various medications, herbs, and supplements used prior to this rare event.

Case Details

Disease Location

Skull

Personal Characteristics

75-year-old woman. History of hypertension, mitral valve prolapse, history of head trauma with a seizure disorder (controlled on medications), and a contrast allergy. She was taking multiple medications for her chronic medical conditions, including gabapentin, famotidine, loratadine, hydralazine, atenolol, a nitroglycerin patch, and vitamins b2, b6, and b12. Also, intermittently and inconsistently been taking a number of alternative supplements since diagnosis, including “healthy aging anti-oxidant complex” (containing resevatrol, r-alpha lipoic acid, hyaluronic acid, astaxanthin, acai), echinacea, and russian supplements including badger (meles meles linnaeus) fat/oil tablets and sea buckhorn (hippophae rhamnoides) oil.

Clinical Characteristics

Diagnosed after presenting to an emergency room with severe, constant, and stabbing headaches. Magnetic resonance imaging (MRI) of the brain demonstrated a t2 hyperintense and t1 isointense midline skull base mass, centered in the nasopharynx, with scalloping of the ventral clivus consistent with a possible chordoma the patient presented 1 month later for surgery. She underwent endoscopic endonasal resection of the skull base tumor without complication

Remission Characteristics

On repeat pre-operative MRI without contrast, she was found to have had 61.7% regression of her skull base mass.

Treatment & Mechanisms

Proposed Remission Mechanisms

The chordoma may have regressed from an autoimmune reaction

Clinical Treatment

Gabapentin, famotidine, loratadine, hydralazine, atenolol, a nitroglycerin patch, and vitamins b2, b6, and b12.

Non-Clinical Treatment

Resevatrol, r-alpha lipoic acid, hyaluronic acid, astaxanthin, acai, echinacea, and russian supplements including badger (meles meles linnaeus) fat/oil tablets and sea buckhorn (hippophae rhamnoides) oil.