Conventional Skull Base Chordoma in a Ugandan Adult Male, Presenting with Prolonged Headache: A Case Report.
Malcom Mark Okello, Male Mutumba, Sam Kalungi et al.
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Case in brief
A 49-year-old man had more than a year of intermittent, progressively worsening headache and reported an episode of facial numbness, although facial sensation and the remainder of his neurological examination were preserved. CT showed an expansile, destructive midline skull-base mass involving the sphenoid sinus and extending into the ethmoid. Biopsy showed morphology consistent with chordoma; immunohistochemistry was positive for EMA, pan-cytokeratin, and S100, with a Ki-67 index below 5%. Brachyury testing was unavailable. He was clinically stable at last review, with surgery planned, but was subsequently lost to follow-up.
What made this case unusual
The diagnostic work-up identified a destructive skull-base chordoma after prolonged headache despite no objective focal neurological deficit; the reported facial numbness was not confirmed on examination.
Diagnostic / clinical pearl
A destructive midline skull-base mass with compatible morphology and EMA, pan-cytokeratin, and S100 positivity supports chordoma. When brachyury testing is unavailable, acknowledge that limitation in the diagnostic assessment.
Why it matters
The case highlights the need to investigate progressive headache, particularly when a new focal symptom is reported, rather than relying on prolonged symptomatic management.