A rare case of surgical pathway implantation of clival chordoma presenting as a neck mass

Chordomas are rare, locally-aggressive tumours with a high rate of local recurrence. Recurrence along the route of surgical entry is an uncommon form of treatment failure. We report a case of a 59-year-old female who presented with a 3 cm neck mass in the left mid-sternocleidomastoid region. She had a history of a large clival chordoma resected via a transcervical, transparotid and transoral approach along with endoscopic intranasal exposure and a palatal split 4.5 years previously, followed by radiation to the primary site. Biopsy of the neck mass confirmed the diagnosis of chordoma recurrence following implantation in the surgical pathway. This case illustrates that while surgical pathway recurrence is a rare entity, it requires a high index of suspicion and should be considered in the differential diagnosis of a patient with a history of chordoma resection presenting with a mass more than two years after undergoing initial treatment.