• Qiang Xu, Houyun Gu, Xuqiang Liu, Hucheng Liu, Yibiao Zhou, Guiping Chen, Min Dai, and Bin Zhang.
• Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang.
• Medicine (Baltimore). 2018 Dec 1; 97 (51): e13748.

RationaleChordoma is a relatively rare tumor that accounts for 1% to 4% of all malignant bone tumors, with an annual incidence of <0.1 per 100,000 people. Although chordoma is aligned with the axis of the spine and most commonly develops in the sacrum, to the best of our knowledge, giant sacrococcygeal chordoma is extremely rare.Patient ConcernsA 61-year-old Chinese man presented with a massive dorsal sacral mass. The patient's primary complaint was that, during the last two months, the mass had been increasing in size and his right lower extremity was uncomfortable while he was sitting, although the discomfort was relieved when he was standing.DiagnosesBased on the imaging findings, we suspected that the sacrococcygeal mass was a chordoma, and a postoperative pathological examination confirmed the diagnosis of a sacral chordoma.InterventionThe patient underwent extensive open surgery to achieve complete resection of the sacrococcygeal mass. An occlusion balloon catheter was used in the abdominal aorta to minimize intraoperative bleeding and maintain a clear surgical field.OutcomesThe patient was discharged without complications at 27 days after surgery. The 3-month follow-up revealed that the patient had recovered well, the discomfort in his right lower extremity while standing had completely resolved and that there was no evidence of recurrence.LessonsThe development of chordoma is not associated with clear symptoms, although early diagnosis and treatment are needed to prevent invasion of the nearby tissues and organs. Therefore, we believe that surgical treatment of sacral chordoma is effective, although care must be taken to completely remove all residual tumor tissue and reduce the risk of recurrence. Besides, This report adds to our limited understanding of the rare giant sacrococcygeal chordoma.

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