Intended for healthcare professionals


How a rare diagnosis caused me to sprain my ankle

BMJ 2002; 325 doi: (Published 02 November 2002) Cite this as: BMJ 2002;325:1016
  1. John Williams, retired general practitioner

    My brain is the sort that is much better at retaining esoteric facts than more useful information. As a first year clinical student, I had been reading up tumour pathology and was fascinated by a description of chordomata, rare tumours that occur anywhere in the spinal tract from the midbrain to the cauda equina and that retain the cellular characteristics of the primitive notochord. Commonest at the lower end of the spinal tract, they were said to feel like a cricket ball attached to the front of the sacrum.

    The next day, on a surgical ward round, my consultant asked me to examine an elderly man rectally. I did so and felt a cricket ball attached to the front of the sacrum. “What is the diagnosis?” I was asked.

    “Chordoma, Sir,” I replied.

    “Nonsense,” he said, “it's a carcinoma of rectum.” I am not sure whether he had heard of the condition.

    At surgery the next day the tumour was removed, and it did indeed prove to be a chordoma. I decided to write it up for the surgical prize and, reviewing the hospital records, discovered that there had only been one other case, some 30 years earlier. It had occurred in the midbrain, and the patient had been a distinguished scientist and FRS. Six months later, I was about to hand in my study when I heard that my original patient had been admitted in extremis. Sadly he died, but his autopsy report and cellular photographs did much to enhance my report.

    A week later, tired by my exertions, I was walking with a friend along the South Downs when we noticed a typical downland church nestling in the valley and decided to visit it. We climbed down to the flint walled graveyard, and my friend walked round to the lychgate while I decided to climb over the wall. As I landed, I twisted my ankle on a grave kerbstone; it bore the name and epitaph of the distinguished scientist.


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