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Chordoma is a rare malignant neoplasm. It is usually diagnosed at an advanced stage, which contributes for the poor prognosis and high mortality. In this article, we will consider three clinical cases with locally advanced chordomas in order to emphasize the importance of early diagnosis by MRI and the need for strict pathohistological and immunohistochemical analysis.  Our observations reported late diagnosis, slow tumor growth, and numerous partial tumor resections, enhancing the mitotic activity of chordoma tumor cells. After numerous operations, rapid local tumor progression with aggressive infiltration of adjacent healthy tissues was observed. Hematogenous dissemination is observed after the third year of primary diagnosis and repeated surgical interventions of locally advanced chordoma. The prognosis in locally advanced chordomas is extremely unfavorable.  Early diagnosis requires MRI and biopsy with exact pathomorphological and immunohistochemical analysis. To improve the treatment results, early diagnosis and complex treatment, including radical surgery and assessment of the need for high-tech postoperative radiotherapy are required.

Clinical observations in three clinical cases with locally advanced chordomas. What is needed for early diagnosis with improved survival?