Chordoma of skull base presenting as nasopharyngeal mass
A 28 year-old female sought medical attention for pain in throat and difficulty in deglutition for past 2 months. On anterior rhinoscopy, a pale mass was seen occupying right nasal cavity. The left nasal cavity was normal. Oral cavity examination revealed a smooth bulge on right-sided soft palate and anterior pillar of right tonsil, because of which the right tonsil could not be visualized. Uvula was in the midline. Indirect laryngoscopy could not be done. On central nervous system (CNS) examination, bilateral occulomotor and right hypoglossal nerves were involved. Fibreoptic nasopharyngoscopy was done under local anesthesia. A mass was seen in superior part of nasopharynx. Other sites of nasopharynx including fossa of Rosenmuller, eustacian tube opening, and torus tubarius were unremarkable.\nComputed tomography (CT) scan of head and neck [Figure and ] showed that base of skull was eroded with extracranial extension of bilateral temporal lobes and occipital lobe. The mass was compressing and pushing brainstem and extending into orbit and bilateral pterygopalatine and infratemporal fossae. Biopsy of the mass was performed.\nHistological examination revealed round to oval cells with central nuclei and a vacuolated cytoplasm (physaliphorous cells) []. The cells stained positive with Periodic acid-Schiff (PAS) [] and monoclonal staining for epithelial membrane antigen (EMA) []. A histopathological diagnosis of chordoma was made.\nThe patient was advised RT but the patient did not comply and became lost to follow up.