A surgical case of posterior mediastinum chordoma requiring differentiation from neurogenic tumor

Chordoma is a malignant bone and soft tissue tumor derived from remnants of the embryonic notochord. It accounts for 1–4% of all malignant bone tumors and most commonly arises in the sacrum and skull base. Mediastinal chordomas are extremely rare, comprising only 1–3% of all chordomas. A 46-year-old male patient presented to the clinic for a routine check-up and was referred to our hospital after an abnormal chest shadow was detected during a routine physical examination. A contrast-enhanced computed tomography scan revealed a spindle-shaped lesion with an extrapleural sign adjacent to the vertebral body at the Th2-3 level. The lesion was predominantly cystic with no contrast enhancement. There was no evidence of surrounding invasion, bone destruction, or extension into the intervertebral foramen. We suspected a neurogenic tumor with cystic degeneration. Complete resection was considered feasible, and we performed a robot-assisted mediastinal tumor resection. The lesion was cystic, soft, and showed no apparent connection to the nerves. It was excised through total circumferential dissection, with no evident invasion into the surrounding tissue. Complete resection was successfully achieved, and the patient was discharged without complications during the postoperative course. Pathological examination confirmed the diagnosis of chordoma. Two years post-surgery, the patient remains alive without recurrence. We report a case of a primary posterior mediastinal chordoma that was successfully resected using robot-assisted surgery.