Case Report
Chondroid Chordoma in an Atypical Location
Cordoma condroide de localización atípica
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"identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan José" "apellidos" => "Rivas de Andrés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Raúl" "apellidos" => "Embún Flor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Severiano" "apellidos" => "Cortés Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cordoma condroide de localización atípica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 843 "Ancho" => 950 "Tamanyo" => 90032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Computed tomography. Note the increased size of the mass in relation to the magnetic resonance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chordoma is a slow-growing malignant tumour originating from remnants of the notochord.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It accounts for 1%–4% of malignant primary bone tumours, 50% of which are located in the sacrococcygeal region.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its annual incidence is 0.1/100<span class="elsevierStyleHsp" style=""></span>000 population, and thoracic involvement may be observed in 2%–5% of cases.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is the only neoplasm of embryogenic origin that presents in the later decades of life. In the case of the vertebrae, it usually appears in young individuals and is much more aggressive.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It occurs predominantly in males (2.7/1–1.6/1).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>Chordomas have a great capacity for recurrence and malignant transformation, despite their slow-growing nature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Observation</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 52-year-old man, with no medical history of interest, presented with a 6-month history of dorsal thoracic pain. As the patient's symptoms did not improve, it was decided to perform magnetic resonance imaging (MRI), following a normal chest radiograph. The diagnosis was costal hydatidosis with intraspinal extension (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Due to questions about the nature of this process, a thoracoabdominal computed tomography (CT) scan was requested, in which an 88<span class="elsevierStyleHsp" style=""></span>mm×60<span class="elsevierStyleHsp" style=""></span>mm×95<span class="elsevierStyleHsp" style=""></span>mm right paravertebral mass was found. It was predominantly cystic with lobulated contours, extrapleural morphology and protruded through the right foramen between the sixth and seventh costal arches towards the spinal canal, extending paravertebrally from the fourth to the seventh right posterior costal arches, involving the extrapleural fat and extending towards the dorsal muscles through the intercostal spaces, with no costal involvement. As a result, the new suspected diagnosis was soft tissue sarcoma (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Fine needle aspiration was carried out (non-diagnostic). Given the intraspinal finding of the mass, it was decided to use a combined neurosurgical and thoracic approach.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Resection and excision of the extradural intraspinal tumour was performed with a D5–D6 laminectomy and en bloc excision of a large tumour attached to the parietal pleura, together with atypical resection of segment 6 and posterior segment of the right upper lobe, adding costal resection of the sixth and seventh ribs and their respective intercostal spaces, as well as the fifth intercostal space. Other lesions contiguous with the large tumour were observed, which required extrapleural resection. Curettage of vertebral zone D6–D7 was performed. Once the whole specimen had been resected en bloc, disseminated lesions could be observed in the diaphragmatic and parietal pleura, suspicious of implants that were shown to be secondary to the lesion. The defect was reconstructed using prosthetic material covered by the trapezius muscle. The patient was discharged on the seventh day post-operatively with satisfactory clinical process and no neurological involvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Pathological examination revealed the presence of a 12.8<span class="elsevierStyleHsp" style=""></span>cm×7.3<span class="elsevierStyleHsp" style=""></span>cm chondroid chordoma, which respected the underlying skeletal muscle and resected lung parenchyma.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After treatment with adjuvant radiotherapy and EGFR inhibitors, the disease is currently stable and the patient remains free of neurological symptoms.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The presence of chordomas at the level of the thoracic vertebrae is a rare entity (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Their main symptom is mechanical pain, but they progress with the onset of neurological symptoms due to their growth.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">CT scans are used to characterise the involvement of the vertebral bodies, presence of a paravertebral tumour, and intraspinal and disc space involvement.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> MRI helps to clarify the epidural extension, spinal cord compression or the presence of epidural metastases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> The use of positron emission tomography (PET) or PET-CT, where the chordoma behaves like a lesion with increased glucose uptake, is very discreetly referenced in the literature, both for the initial diagnosis and for follow-up.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Depending on its histopathology,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> it can be classified into: classic, chondroid, undifferentiated, sarcomatoid, intradural and intraspinal (mediastinal).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Its diagnosis is confirmed by cytokeratin-positive staining<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and expression of the <span class="elsevierStyleItalic">brachyury</span> gene.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This gene is a specific biomarker that enables differentiation between chordomas and chondrosarcomas,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,10</span></a> and is the object of gene therapy studies. Other alternatives are being investigated along the same line, such as the use of EGFR inhibitors (erlotinib and combined gefitinib-cetuximab), with promising results.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The ideal treatment is through an aggressive surgical approach, attempting to achieve en bloc resection with the widest free surgical margins possible, otherwise recurrence generally occurs,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> although this is not always possible given the extension of the lesion and/or structures affected.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Without adequate margins, adjuvant radiotherapy must be administered to try to increase the hypothetical disease-free survival.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The local recurrence rate is around 26%–68%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Chordomas can metastasise in 20%–60% of cases<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> (skin, lung, lymphatic system, etc.). The 5-year survival for this tumour is generally between 10% and 70%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,8</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres287814" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec271301" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres287813" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec271302" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Observation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-11-30" "fechaAceptado" => "2013-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec271301" "palabras" => array:4 [ 0 => "Chondroid chordoma" 1 => "Vertebral tumour" 2 => "Classification" 3 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec271302" "palabras" => array:4 [ 0 => "Cordoma condroide" 1 => "Tumor vertebral" 2 => "Clasificación" 3 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chondroid chordoma is an extremely rare tumour with an annual incidence of around 0.1 cases per 100<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>population. Involvement of the thoracic vertebrae may be present in 2%–5% of cases.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Definitive diagnosis usually requires a suitable distinction between this and other mesenchymal tumours such as chondrosarcomas, so immunohistochemical analysis is virtually mandatory.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In spite of its slow-growing nature, chondroid chordoma tends to relapse, and it may eventually become malignant, often jeopardising the patient's prognosis. Although surgery remains the main therapeutic approach, research into the molecular and genetic aspects of this tumour is ongoing. These new advances are likely to improve future oncology therapies by complementing surgery and radiotherapy, changing the currently poor prognosis.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We report the case of a patient with a chondroid chordoma involving the thoracic vertebrae and pleural cavity, and the treatment performed.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El cordoma condroide de localización vertebral torácica es un tipo de tumor que constituye una auténtica rareza. La incidencia anual del cordoma condroide se cifra en 0,1/100.000<span class="elsevierStyleHsp" style=""></span>habitantes, y la afectación torácica se aprecia en el 2 al 5% de los casos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Su diagnóstico definitivo se ve complicado por su semejanza con otros tumores como los condrosarcomas, por lo que es preciso acudir al estudio inmunohistoquímico.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Su capacidad de recidiva y la tendencia a la malignización a pesar de su naturaleza de lento crecimiento provocan que su tratamiento, predominantemente quirúrgico, sea de una complejidad nada desdeñable. Su comportamiento evolutivo tan agresivo está siendo motivo de estudio a nivel molecular y genético para la elaboración de nuevas terapias oncológicas médicas con el fin de complementar la cirugía y la radioterapia, cuando estas sean aplicables.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso de localización torácica vertebral e intrapleural, así como el tratamiento practicado.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Royo Crespo I, Rivas de Andrés JJ, Embún Flor R, Cortés Franco S. Cordoma condroide de localización atípica. Arch Bronconeumol. 2013;49:491–493.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 945 "Ancho" => 950 "Tamanyo" => 97983 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging: mass with intraspinal involvement (red arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 843 "Ancho" => 950 "Tamanyo" => 90032 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Computed tomography. Note the increased size of the mass in relation to the magnetic resonance.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vertebral/Total Chordomas \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Utne and Pugh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1955 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higinbothan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1967 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cummings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1983 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Volpe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1983 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rich \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1985 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">O’Neill \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1985 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amendola \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azzarelli \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1988 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coffin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/12 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab419691.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Vertebral Chordomas/Spinal Chordomas \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sundaresan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1979 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Meyer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1984 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bjornsson \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Boriani \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/52 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab419692.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Chordoma Series With Vertebral Involvement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chordoma of the thoracic spine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. 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Tirabosco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/path.1969" "Revista" => array:6 [ "tituloSerie" => "J Pathol" "fecha" => "2006" "volumen" => "209" "paginaInicial" => "157" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16538613" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of epidermal growth factor receptor targeting in advanced chordoma: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.G. Launay" 1 => "B. Chetaille" 2 => "F. Medina" 3 => "D. Perrot" 4 => "S. Nazarian" 5 => "J. 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Davis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "1995" "volumen" => "103" "paginaInicial" => "271" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7532910" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000011/v1_201310300902/S1579212913001602/v1_201310300902/en/main.assets" "Apartado" => array:4 [ "identificador" => "9347" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000011/v1_201310300902/S1579212913001602/v1_201310300902/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001602?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 42 | 18 | 60 |
| 2024 September | 40 | 15 | 55 |
| 2024 August | 63 | 36 | 99 |
| 2024 July | 46 | 25 | 71 |
| 2024 June | 58 | 27 | 85 |
| 2024 May | 59 | 26 | 85 |
| 2024 April | 43 | 30 | 73 |
| 2024 March | 55 | 15 | 70 |
| 2024 February | 33 | 20 | 53 |
| 2023 March | 9 | 2 | 11 |
| 2023 February | 61 | 17 | 78 |
| 2023 January | 44 | 29 | 73 |
| 2022 December | 63 | 27 | 90 |
| 2022 November | 61 | 27 | 88 |
| 2022 October | 73 | 44 | 117 |
| 2022 September | 42 | 25 | 67 |
| 2022 August | 64 | 33 | 97 |
| 2022 July | 49 | 54 | 103 |
| 2022 June | 44 | 37 | 81 |
| 2022 May | 46 | 37 | 83 |
| 2022 April | 47 | 36 | 83 |
| 2022 March | 51 | 48 | 99 |
| 2022 February | 59 | 44 | 103 |
| 2022 January | 53 | 44 | 97 |
| 2021 December | 52 | 49 | 101 |
| 2021 November | 58 | 51 | 109 |
| 2021 October | 129 | 41 | 170 |
| 2021 September | 75 | 46 | 121 |
| 2021 August | 55 | 40 | 95 |
| 2021 July | 57 | 31 | 88 |
| 2021 June | 89 | 36 | 125 |
| 2021 May | 59 | 41 | 100 |
| 2021 April | 133 | 95 | 228 |
| 2021 March | 61 | 27 | 88 |
| 2021 February | 43 | 37 | 80 |
| 2021 January | 47 | 15 | 62 |
| 2020 December | 54 | 25 | 79 |
| 2020 November | 67 | 21 | 88 |
| 2020 October | 122 | 15 | 137 |
| 2020 September | 125 | 16 | 141 |
| 2020 August | 86 | 12 | 98 |
| 2020 July | 57 | 19 | 76 |
| 2020 June | 36 | 13 | 49 |
| 2020 May | 51 | 13 | 64 |
| 2020 April | 41 | 20 | 61 |
| 2020 March | 40 | 16 | 56 |
| 2020 February | 33 | 27 | 60 |
| 2020 January | 33 | 14 | 47 |
| 2019 December | 48 | 26 | 74 |
| 2019 November | 30 | 23 | 53 |
| 2019 October | 60 | 10 | 70 |
| 2019 September | 38 | 9 | 47 |
| 2019 August | 29 | 14 | 43 |
| 2019 July | 26 | 13 | 39 |
| 2019 June | 29 | 15 | 44 |
| 2019 May | 57 | 27 | 84 |
| 2019 April | 66 | 22 | 88 |
| 2019 March | 50 | 18 | 68 |
| 2019 February | 47 | 21 | 68 |
| 2019 January | 36 | 21 | 57 |
| 2018 December | 50 | 29 | 79 |
| 2018 November | 105 | 22 | 127 |
| 2018 October | 182 | 32 | 214 |
| 2018 September | 72 | 12 | 84 |
| 2018 May | 60 | 0 | 60 |
| 2018 April | 32 | 10 | 42 |
| 2018 March | 94 | 5 | 99 |
| 2018 February | 40 | 6 | 46 |
| 2018 January | 48 | 8 | 56 |
| 2017 December | 46 | 6 | 52 |
| 2017 November | 38 | 6 | 44 |
| 2017 October | 31 | 9 | 40 |
| 2017 September | 39 | 22 | 61 |
| 2017 August | 50 | 12 | 62 |
| 2017 July | 53 | 19 | 72 |
| 2017 June | 54 | 13 | 67 |
| 2017 May | 52 | 4 | 56 |
| 2017 April | 37 | 18 | 55 |
| 2017 March | 51 | 10 | 61 |
| 2017 February | 29 | 8 | 37 |
| 2017 January | 22 | 7 | 29 |
| 2016 December | 43 | 7 | 50 |
| 2016 November | 56 | 9 | 65 |
| 2016 October | 52 | 9 | 61 |
| 2016 September | 60 | 16 | 76 |
| 2016 August | 43 | 9 | 52 |
| 2016 July | 48 | 12 | 60 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 60 | 3 | 63 |
| 2015 September | 48 | 24 | 72 |
| 2015 August | 46 | 14 | 60 |
| 2015 July | 35 | 15 | 50 |
| 2015 June | 54 | 12 | 66 |
| 2015 May | 59 | 26 | 85 |
| 2015 April | 56 | 34 | 90 |
| 2015 March | 53 | 17 | 70 |
| 2015 February | 41 | 12 | 53 |
| 2015 January | 33 | 17 | 50 |
| 2014 December | 41 | 13 | 54 |
| 2014 November | 35 | 11 | 46 |
| 2014 October | 44 | 12 | 56 |
| 2014 September | 33 | 15 | 48 |
| 2014 August | 39 | 16 | 55 |
| 2014 July | 45 | 17 | 62 |
| 2014 June | 65 | 14 | 79 |
| 2014 May | 47 | 17 | 64 |
| 2014 April | 65 | 22 | 87 |
| 2014 March | 77 | 12 | 89 |
| 2014 February | 51 | 13 | 64 |
| 2014 January | 0 | 1 | 1 |
| 2013 December | 0 | 2 | 2 |
| 2013 November | 1 | 1 | 2 |
| 2013 October | 0 | 1 | 1 |
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