[A case of primary posterior mediastinal chordoma].

A 49-year-old man, with a tumor shadow overlapping the heart on chest X-ray film was followed for 5 years. He was admitted because the tumor shadow enlarged. Chest CT scan showed a 6 x 7 cm in diameter extrapulmonary tumor at the Th8 and Th9 level, and a defect of the anterior margin of the thoracic vertebra is observed. Because thoracic CT-guided needle biopsy was not successful, total resection combined with thoracic vertebrae was performed. The tumor was under the parietal pleura and did not involve into the intrathoracic organs. Histological examination showed small round cells arranged in sheets and cord-like fashion in a mucinous stroma. On immunohistochemistry, the tumor cells were positive for S-100 protein, vimentin, AE1/3. CAM5.2, EMA and Alcian blue staining. Thus, we confirmed the diagnosis of chordoma. Chordoma is a rare malignant bone tumor that originates from notochordal remnants and accounts for about 1-4% of all malignant bone tumors. Intrathoracic mediastinal chordomas is extremely rare, representing only 3% of all chordomas.

[Decerebrate rigidity after bilateral carotid arteries occlusion].

We reported a 77-year-old woman with atrial fibrillation. She was admitted to our hospital because of bradycardia and disturbance of consciousness. She regained consciousness soon after the admission, however on the 3rd day of admission, she abruptly fell into a coma. Neurological examination revealed decerebrate rigidity, conjugate eye deviation to the right, and bilateral Babinski signs, but remaining oculocephalic reflex in both vertical and horizontal directions. Diffusion-weighed MR image of the brain on the same day demonstrated extensive hyperintense lesions in the bilateral hemispheres, sparing the brainstem. On the duplex carotid ultrasonography just after the MR study, oscillating intraluminal thrombi occluded the right common carotid and the left internal carotid artery. We diagnosed the patient as having bilateral carotid occlusions by cardioembolic mechanism.