Metastatic sacral chordoma presenting as a cecal polyp: a case report

Chordoma is a rare malignant tumor arising from notochordal remnants, typically occurring along the axial skeleton between the skull base and sacrum. Although chordomas are locally aggressive, they can metastasize-most commonly to the lungs, followed by bone, lymph nodes, and liver. We report an unusual case of metastatic chordoma presenting as a pedunculated cecal polyp. A 67-year-old male with a history of sacral chordoma and prior metastases to lung and bone, under treatment with proton beam radiation, presented with intermittent lower gastrointestinal bleeding. Colonoscopy revealed a 1-cm pedunculated polyp in the cecum, which was completely resected by snare polypectomy. Histopathology demonstrated chondroid material with atypical cell clusters within colonic mucosa. Immunohistochemistry was strongly positive for pancytokeratin and brachyury, confirming the diagnosis of metastatic chordoma. While pulmonary metastasis is the most common presentation of disseminated chordoma, this case highlights an unusual site of metastatic spread to a colonic polyp, underscoring the importance of thorough histopathological and immunohistochemical evaluation of polyps in patients with a history of chordoma.