In May 2009, a 62-year-old male patient was admitted with complaints of severe pain and edema in gluteal region. He had a history of cholecystectomy and pulmonary tuberculosis 3 years before. Pelvic computed tomography (CT) revealed a huge mass (15*13 cm) infiltrating the coccyx and most of the sacrum without any regional lymphadenopathies. Chordoma of the sacrococcygeal area was diagnosed by Tru-Cut biopsy under radiological evaluation. In June 2010, the chordoma in the sacral region was excised with tumor-free margins. Afterwards, adjuvant radiotherapy was applied for about 30 days; pelvic box tumor total dose: 50 gray in 25 fractions and boost tumor total dose: 10 gray in 5 fractions. After completion of the treatment, the patient was followed up 10 Gy boost dose was applied after 50 Gy to the total dose of 60 Gy in 30 fractions. 2 Gy was applied per fraction every weekdays.
A local tumor recurrence developed after about two years and required additional surgical procedures. The patient was reoperated for its tumor recurrence. Soon after the operation, during routine examination, liver function tests were found moderately high. Abdominal computerized tomography (CT) revealed multiple hypodense lesions in the liver: 17 cm mass in the right lobe, about 7 cm mass in the left lobe, and 3 cm mass in junction of the right and the left lobe of the liver (Figure 1). Therefore, we decided to proceed fine needle aspiration of the lesion under ultrasound guidance. A histological examination of the biopsy from the liver lesion showed a metastatic focus from the sacrococcygeal chordoma (Figures 2(a) and 2(b)). We then decided to treat our patient with imatinib mesylate. However, the patient died because of hepatic failure before starting the treatment.