Chondromas of the falx cerebri and dural convexity: report of two cases and review of the literature

Dural Convexity Chondroma Mimicking Meningioma in a Young Female

Intracranial meningeal convexity chondroma is a rare benign lesion hypothesized to stem from remnant chondrocyte precursors of embryonic origin. This lesion often masquerades as meningioma given the similar dural-based attachment and pattern of calcification. We describe the case of a 26-year-old female with incidentally discovered convexity meningeal chondroma, originally presumed to be a meningioma. In this case, we share our diagnostic and operative intervention and outcome and discuss the unique pathologic findings in this lesion that differentiate it from similar appearing lesions. To the authors’ knowledge, there are fewer than 20 cases of convexity meningeal chondroma in the literature; thus, we also provide a brief review of the literature regarding this rare pathology.

Case report: Rare convexity meningeal chondroma mimicking a meningioma

Background:

Intracranial chondromas account for 0.2–0.3% of all intracranial neoplastic lesions and less than a quarter arise in the convexity or falx. Despite its benign nature, exceedingly rare malignant transformations exist. The misdiagnosis with meningiomas is frequent and may be related with chondromas’ similar insidious clinical presentation and imaging features. Standalone surgery is advised and complete resection provides the definitive treatment.

Case Description:

A 44-year-old female presents with insidious headache, visual disturbances, and papilledema. The imaging studies were compatible with frontal parasagittal meningioma. Surgery revealed a meningeal based mass, mostly avascular and with a well-demarked surgical plane from the brain parenchyma. Complete resection with meningeal margins was achieved and the histopathologic examination revealed a chondroma. The patient symptoms subsided and no surgical complications existed.

Conclusion:

Intracranial convexity chondromas constitute a rare differential diagnosis for meningiomas. The present case reinforces the current scarce data and serves as reminder for clinicians diagnosing and treating intracranial tumors.

Calcified Pseudoneoplasm of the Neuraxis

Calcified pseudoneoplasms of the neuraxis are extremely rare non-neoplastic lesions that can exist anywhere in the CNS. Although benign, the lesions can cause substantial neurologic symptoms, typically related to mass effect on adjacent structures. Calcified pseudoneoplasms of the neuraxis can also mimic other entities such as calcified oligodendrogliomas and meningiomas. Nevertheless, the lesions can usually be strongly suggested at the time of imaging due to a number of fairly unique imaging characteristics. Here, the clinical presentation of a patient with a posterior fossa calcified pseudoneoplasm of the neuraxis is described, along with its imaging and pathologic features.

Clinical and Radiologic Characteristics, Surgical Outcomes, and Its Possible Origins of Chondroma of the Dural Convexity

Chondroma of the dural convexity (CDC) is a benign and extremely rare type of intracranial chondroma. In this study, we reported five CDCs in a single center and reviewed the available literature to determine the clinical characteristics and surgical outcomes and possible origins of the disease. The clinical data of five patients (4 females) who confirmed to be CDC between 2000 and 2019 in our single center was collected together with 22 cases from literatures. The clinical characteristics and surgical outcomes were reviewed and analyzed. Among all the available CDC cases, the mean age was 31 ± 13.7 years; the mean tumor volume was 42.3 ± 40.9 cm³, showing a female predominance (63% vs. 37%). The tumors showed calcification in 88.2% cases (15/17) on CT scans and hypointense on T1WI (15/19, 78.9%), mixed intense on T2WI (10/18, 55.6%), and inhomogeneous enhancement without dural tail sign after administration of gadolinium (20/21, 95.2%). Almost all the tumors were misdiagnosed as meningiomas preoperatively. In addition, almost all image available CDC lesions (24/25, 96%) located across the cranial sutures indicating that the tumor originated from ectopic chondrocytes from adjacent skull sutures. No tumors recurred after total resection in follow-up. CDCs are characterized with female predominance and may originate from ectopic chondrocytes from adjacent skull sutures. The lesion with inhomogeneous contrast enhancement without dural tail sign and avascular in cerebral angiography are key points to be differentiated from meningioma. The most effective treatment is total resection.

Chondroma of the falx cerebri: A case report and review of literature

Chondroma is a benign cartilage-forming tumor which usually occurs in small bones of extremities but occasionally occurs in the brain. Usually, intracranial chondromas originate from skull base; however, chondroma of the falx cerebri is a very rare condition. We here report a rare case of falcine chondroma in a 19-year-old man who had normal physical examination without signs of any syndromic disorder. The neuroimaging findings were inconclusive, and the diagnosis was based on histopathological examination. The purpose of this paper is to raise attention about intracranial chondromas and suggest that chondroma must be ruled out in any patient presenting with masses arising from the falx.

Chondroma of the Falx Cerebri with Central Cystic Degeneration and Hemorrhage: A Case Report

Patient: Male, 44

Final Diagnosis: Falx cerberi chondroma

Symptoms: Headache

Medication: —

Clinical Procedure: Resection of the tumor

Specialty: Neurosurgery

Intracranial Chondroma of the Falx Cerebri: A Rare Case Report with Review of Literature

Intracranial chondromas are extremely rare, benign slow-growing cartilaginous tumors mostly originating from embryonic rests at sphenoethmoidal region and sometimes can originate from the falx, convexity dura, the tentorium, the choroid plexus, or the brain parenchyma. In this article, we present a 22-year-old woman with a chondroma of dural origin. The clinical, radiological, and histopathological findings along with the operative findings and postoperative course are described as well as the pertinent literature regarding intracranial chondromas is reviewed.

Giant convexity chondroma with meningeal attachment

OBJECTIVE

Intracranial chondroma is a rare and benign tumor with usual onset in young adulthood. The skull base is the most common site of occurrence although, less often, the tumors can appear at the falx cerebri or at the dural convexity. The differentiation of these lesions from meningiomas through imaging is generally difficult.

PATIENT AND METHODS

Clinical case presentation and review of the current literature.

RESULTS / CASE PRESENTATION

We report a case of a 25-year-old male patient with a giant convexity chondroma with meningeal attachment in the right frontal lobe that was detected after a first generalized seizure. Based on the putative diagnosis of meningioma, the tumor was completely resected via an osteoplastic parasagittal craniotomy. The postoperative MRI confirmed the complete tumor resection. Histopathological analysis revealed the presence of a chondroma.

CONCLUSION

Intracranial chondromas are a rarity and their preoperative diagnosis based on neuroimaging is difficult. In young patients and those with skeletal disease, the differential diagnosis of a chondroma should be considered. In symptomatic patients, operative resection is sensible. In most cases total removal of the tumor is possible and leads to full recovery. When the finding is merely incidental in older patients, a watchful waiting approach is acceptable, given the benign and slow-growing nature of the lesion.

Intracranial dural chondroma in a child-conventional and advanced neuroimaging characteristics and differential diagnosis

Intracranial chondromas are rare tumors, especially in the pediatric population. We describe the conventional and advanced neuroimaging characteristics of this rare convexity dura-based chondroma in a young adolescent. In particular we demonstrate that diffusion-weighted imaging (DWI) facilitates differentiation between a dura-based chondroma and the more frequent classical meningioma. Chondromas are typically DWI hypointense with high apparent diffusion coefficient (ADC) values while meningiomas are typically DWI hyperintense with low ADC values. We also discuss the relevant additional differential diagnoses of dura based focal lesions for the pediatric population as well as the diagnostic significance of additional imaging modalities, including computed tomography, magnetic resonance imaging and cerebral angiography.

Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself

Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.

Intracranial extra-axial chondroma: a case report

Intracranial chondroma is a rare benign neoplasm that occurs most often at the skull base. In extremely rare instances, it arises from the dura mater of the convexity or from the falx cerebri. The tumor cells are thought to originate from meningeal fibroblasts, perivascular mesenchymal tissue, or ectopic chondrocytes. Because the clinical presentation of such cases is nonspecific and because neuroimaging findings are not pathognomonic, intracranial chondromas mimic other intracranial tumors. Herein, we report a chondroma originating from the dura mater in the frontal region. The patient had been followed-up radiologically for 3 years after a preliminary diagnosis of meningioma until the correct diagnosis of chondroma was established with postoperative histological examination.

Intracranial cystic chondroma: a case report

INTRODUCTION

Intracranial chondromas are rare benign tumors with an incidence of 0.2% to 0.3% of all intracranial tumors. This is the first case of an intracranial chondroma reported from Pakistan.

CASE PRESENTATION

We report a case of a 23-year-old Asian man presenting with intracerebral chondroma of the left frontal lobe, which was eroding the dura matter. The intracranial chondroma was completely removed by surgery.

CONCLUSION

Intracranial chondromas are rare benign cartilaginous tumors. Through this case presentation we have discussed the diagnostic procedures, radiological and pathological findings. The purpose of presenting such a rare case is to develop awareness among clinicians and medical students and to highlight the requirement of immediate actions to ensure proper management of such cases.

18-year-old woman with a dural mass

We report a case of a dural-based chondroma in the right frontal extra-axial region. Chondromas are benign cartilaginous tumors which are uncommon intracranially. Their diagnosis should be predicated on the exclusion of a chondrosarcoma and clinical studies should be performed to rule out any underlying tumor predisposition syndromes.

Characteristic CT and MRI findings of intracranial chondroma

BACKGROUND

Intracranial chondromas are rare benign tumors. To date, few data are available on their neuroradiological features.

PURPOSE

To describe a series of patients with intracranial chondroma and to analyze and discuss the computed tomography (CT) and magnetic resonance imaging (MRI) features that may distinguish chondromas from other intracranial neoplasms.

MATERIAL AND METHODS

We retrospectively analyzed clinical and medical imaging data of six patients who had pathologically confirmed intracranial chondromas in our two institutions between July 2006 and September 2011. Both CT and MRI scanning were performed in all six cases.

RESULTS

Five tumors were located at the skull base and one originated from the falx. CT images revealed well-demarcated, irregular lobulated and variable density masses with obvious calcification (6/6), no or slight enhancement, without peritumoral edema, and frequently accompanied by erosion and destruction of surrounding bone (5/6). Tumor parenchyma appeared heterogeneously hypointense on T1WI, and hyperintense or mixed hyperintense and hypointense on T2WI, while the calcification appeared hypointense on T1WI and T2WI in five cases, demonstrating significant inhomogeneous enhancement on postcontrast MRI, which revealed the typical "punica granatum seeds" sign. Only one case showed homogeneous low signal intensity on T1WI and high signal intensity on T2WI, and relatively uniform obvious enhancement on postcontrast scans.

CONCLUSION

These characteristic CT and MR findings, combined with the location of the lesions and the history of a long duration of clinical symptoms, may prove helpful in differentiating intracranial chondromas from other more common tumors.

Intracranial parafalcine chondroma in a pregnant patient

Background:

Intracranial chondromas are rare benign neoplasms. We report a patient incidentally diagnosed with an intracranial chondroma during her second trimester.

Case Description:

A 22-year-old Caucasian was diagnosed with an incidental parafalcine lesion found during admission due to a motor vehicle accident. Prior to the admission, the patient did not present with any neurological symptom. Magnetic resonance spectroscopy (MRS) suggested this intracranial lesion to be benign. A decision was made to delay the tumor excision until after delivery. Special anesthesia considerations were made to maintain stable blood pressure and euvolemia during the Cesarean section. The patient underwent a successful gross total removal of the intracranial tumor two months postpartum without any post-operative deficit.

Conclusion:

This is the first case report of an intracranial parafalcine chondroma in pregnancy. This report highlights the disease course of this rare type of tumor during pregnancy. This case illustrates relevant aspects of the management of a neurologically asymptomatic patient with an incidentally discovered intracranial tumor of which MRS suggested a benign nature.

Chondroma of the dural convexity: a case report and literature review

Chondromas are unusual tumors that arise from the base of the skull and have a predilection for the spheno-ethmoidal region. Chondromas represent less than 0.5% of all intracranial tumors. In rare instances, these tumors originate from the dura mater of the convexity. Fewer than 30 cases of dural chondromas arising from the convexity or the falx are reported in the literature. In this study, we describe a new case of convexity chondroma. We discuss the radiological and histological features of this case and also review the literature.

Solitary intracerebral chondroma without meningeal attachment: a case report with review of the literature

Intracranial chondromas are rare, benign cartilaginous tumours that account for < 0.3% of primary intracranial tumours. They usually originate from the basal synchondrosis and are extradural though, extremely rarely, they can be intracerebral. Here the case of a 45-year old female is presented with a solitary intracerebral chondroma located in the right frontal lobe with no meningeal attachment. The epidemiology, aetiology, clinical behaviour, radiological features, histological features and treatment of the case are discussed with a review of previous cases reported in the literature.

A Solitary Convexity Dural Chondroma: the Proposed Role of Diffusion-Weighted MR Imaging in the Differential Diagnosis of Intracranial Chondroma and Meningioma. A Case Report

Chondromas arising from the dura mater are rare intracranial tumors. We describe a case of intracranial chondroma originating from the durra mater of the convexity, mimicking a meningioma. The neuroradiological and surgical findings are described. The diagnostic clues for the differential diagnosis between chondromas and meningiomas are discussed and reviewed.

Osteochondroma of the convexity: pathologic-neuroimaging correlates of a lesion that mimics high-grade meningioma

Intracranial chondromas are uncommon benign lesions usually attached to dura and located over the convexity of the skull. Osteochondromas are even rarer and additionally contain a benign bony component. Both lesions are reportedly difficult to distinguish from meningiomas on pre-operative neuroimaging studies, although few detailed pathologic-neuroimaging correlation studies have appeared in the literature, particularly for intracranial osteochondromas. A 33-year-old woman with a 4-year history of headaches presented with recent onset of left-sided muscle spasms and weakness. Two days prior to admission to our hospital, neuroimaging studies had shown a large right convexity mass with unusual multifocal bright signal intensities throughout an otherwise isointense mass. The bright signals were interpreted as showing multifocal hemorrhage and the mass was felt to be a convexity meningioma. However, subsequent catheter angiography characterized the lesion as being avascular. The mass was resected en bloc. Extensive histological sectioning revealed a benign osteochondroma predominantly composed of lobules of hypocellular cartilage. Microdissection of the different components revealed that the multifocal, spicule-like bright foci interpreted as hemorrhage on neuroimaging studies were instead foci of benign bone containing metaplastic bone marrow with trilineage hematopoietic cell populations and adipose tissue. Centrally, the hilum of the lesion contained avascular loose connective tissue. No recent or remote hemorrhage was identified anywhere in the lesion. Rare convexity osteochondromas may be mistaken for high-grade meningiomas on neuroimaging studies; their avascular nature, coupled with their complex signal pattern can serve as clues to the correct pre-operative diagnosis.

Intratentorial osteochondrolipoma in a 9-year-old boy

Intracranial osteolipomas and chondromas are rare benign tumors. Forty-five chondromas, mostly supratentorial, have been reported in the literature since 1981, with origins most commonly in the sellar regions. Twenty-one osteolipomas have been described to date, usually located near the tuber cinereum or the corpus callosum. The authors present a case of an osteochondrolipoma arising from the tentorium diagnosed in a pediatric patient at the age of 9 years. The case and treatment are discussed, and a review of the literature is provided.

Intracranial falx chondroma: Literature review and a case report

Intracranial chondromas are benign tumors that represent approximately 0.5% of all intracranial tumors. They usually occur at the base of the skull but on rare occasions might present as intra-parenchymal or intra-ventricular space-occupying lesions, most likely originating from heterotopic chondrocytes or metaplastic fibroblasts of the falx, the convexity dura, or the ventricular ependyma. Chondromas are slow-growing tumors, which remain clinically silent for a prolonged period of time in the majority of cases. Their clinical presentation is non-specific and their radiographic appearance usually does not differentiate them from their more common counterparts, such as meningiomas and glial tumors. As a result, their diagnosis has remained a histopathologic one. In our current study, we present a case of a falcine intracranial chondroma. This case provided the opportunity to extensively review the pertinent literature.

[Cranial vault chondroma: a case report and literature review]

Intracranial chondromas are unusual tumors, which most commonly arise from cartilage rets in the synchondrosis at the base of the skull. They are most likely found in the sellar and parasellar regions, usually located extradurally. In rare instances, these tumors originate from the dura mater of the convexity. In these cases their neuroradiological features may mimic other intracranial tumors. We present the case of a 50-year-old male presenting a large parasagittal tumor originating in the frontal convexity. MRI-scans revealed a cavitated tumor strongly enhanced after gadolinium infusion mimicking a parasagittal meningioma. There was no obstruction of the superior sagittal sinus as shown by cerebral angiogram. Total excision was achieved and the postoperative course was uneventful. No complementary treatment was therefore considered. The histological examination diagnosis was chondroma. Radiological workup performed at four years follow-up did not reveal any recurrence of the lesion. Pathogenic, clinico-radiological and therapeutic issues are discussed and the literature reviewed.