Intracranial chondroma. Case report

Intra-cranial Chondroma: A Case Report and Problematic Diagnosis

Introduction:

Chondroma is a benign cartilaginous tumor. It is found very rarely in the head and neck.

Case presentation:

This report describes a 25-year-old woman who presented with generalized headache from 4 months ago. The patient underwent excisional surgery. The histological examinations revealed benign cartilage forming tumor, compatible with chondroma. The radiologic and histologic correlation confirmed the diagnosis. Based on the diagnosis, the patient received no more treatment.

Conclusion:

We concluded that intracranial chondroma should be included in the differential diagnosis of a calcified mass on skull imaging. Proper diagnosis is necessary for further patient management.

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.

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.

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.

Intracranial falcine and convexity chondromas: two case reports

Intracranial chondromas are uncommon intracranial tumours that most frequently arise from the skull base. They can, however, arise from the calvarium or the meninges. In these cases their neuroradiological features may mimic other intracranial tumours. We present two cases of intracranial chondroma, one that originated from the convexity and the other from the falx. Total excision was achieved in both cases. The literature on intracranial chondromas is reviewed.

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.

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

Intracranial chondromas usually arise from the base of the skull. They rarely originate from the convexity dura and falx. Here we describe two cases of intracranial chondroma located at the convexity dura and falx, discuss the genesis, radiologic, histologic features and review the literature.

Intracranial chondrosarcoma: a case report and review of the literature

OBJECTIVE AND IMPORTANCE

Chondrosarcomas rarely occur intracranially away from the skull base. We present a case of a supratentorial dural-based, low-grade classic chondrosarcoma and emphasize salient imaging findings that assist in its diagnosis.

CLINICAL PRESENTATION

A 23-year-old female presented with new onset seizures. Multiple radiographic imaging studies identified a large left frontal mass with radiological findings that suggested the correct diagnosis.

INTERVENTION

The patient underwent a left frontal craniotomy and gross total resection of the lesion and associated dura.

CONCLUSION

Intracranial chondrosarcomas away from the skull based are extremely rare malignancies. As with other extra-axial masses, they often grow to a relatively large size before generating symptoms. Careful analysis of CT, MR, and angiographic imaging characteristics should suggest the correct diagnosis.

Convexity dural chondroma: a case report and review of the literature

The majority of intracranial chondromas arise from cartilage rests in the synchondrosis at the base of the skull. Chondromas are most commonly found in the sellar and parasellar regions, usually located extradurally. In rare instances, these tumours originate from the dura mater of the convexity. We report a rare case of a chondroma arising from the convexity dura mater. The origin of this tumour is analysed and the literature reviewed.

Giant chondroma arising from the dura mater of the convexity. Case report and review of the literature

Chondromas arising from the dura mater are rare intracranial tumors. The authors present a case of intracranial giant chondroma originating from the dura mater of the convexity. Neuroimaging and surgical findings are described. The diagnostic clues are discussed and similar cases from the literature are reviewed.

Intracranial low-grade chondrosarcoma with hyperostosis of the skull: a case report

We describe a case of intracranial chondrosarcoma in a 46-year-old woman. The preoperative diagnosis was meningioma as plain radiography and computed tomography of the head revealed a tumor with discrete calcifications predominantly in the right frontoparietal region and hyperostosis of the inner table of the skull overlying the tumor. However, the tumor was histologically composed of cartilaginous tissue without meningiomatous differentiation and the final diagnosis was a low-grade chondrosarcoma based on its histological appearance and size, together with the radiologic images. Intracranial chondrosarcoma occurring above the skull base is extremely rare and 19 cases were found in our literature review. Intracranial chondrosarcoma showing hyperostosis of the skull has not been reported in the cases. The discussion includes its differential diagnosis, origin, and clinical behavior.

Preoperative PET activation for assessment of motor cortex area in precentral chondroma

BACKGROUND

A main problem in the preoperative planning for precentral tumors is the exact assessment of the spatial relationship between the tumor and the functionally relevant brain areas, which may be difficult using only morphologically oriented imaging (CT, MRI). Therefore, we applied motor activation PET and PET/MRI overlay in a patient with a precentral tumor.

DESCRIPTION

We report the case of a 21-year-old woman suffering from progressive right-sided headache and intermittent dysesthesia of the left leg. MRI showed a hypointense tumor with inhomogenous contrast enhancement in the right precentral area. For preoperative assessment of the spatial relationship between the tumor and the motor cortex area, the patient underwent two F-18-fluorodeoxyglucose positron emission tomography (PET) scans (1. resting condition and 2. motor activation of the left leg) and subsequent calculation of subtraction images of activation minus rest. Fusion of PET and MRI data (PET/MRI overlay) was performed for bimodal function and morphology presentation. PET revealed an activation pattern behind and below the tumor, indicating that the motor cortex area was shifted to the back. PET findings were confirmed by intraoperative electrophysiology. Cortical stimulation combined with intraoperative neuronavigation localized the motor area of the left foot and leg exactly at the dorsal border, below and lateral to the lesion. After complete resection of the solid tumor, histopathological examination revealed a chondroma. The postoperative course was uneventful, and the patient was discharged without neurological deficits.

CONCLUSIONS

This case shows that biomodal imaging (PET/MRI) provides a noninvasive exact assessment of functionally important cortex areas for preoperative planning in patients with cerebral lesions.

Chondroma of the cerebellopontine angle. Case report

A patient is reported who had a solitary chondroma of the cerebellopontine angle. The tumor was totally removed. The diagnostic value of CT-scanning and MRI in this rare pathological condition are discussed.

[Falx osteochondroma: case report and review of the literature]

One case of an intracranial osteochondroma originating from the falx is described. The tumor was partially removed. Surgical aspects and etiopathogenesis of falx chondromas are discussed. The values of computerized tomography and magnetic resonance are emphasized.

Giant chondroma of the falx. Case report and review of the literature

The authors describe the radiological and pathological features in a patient with an intracranial chondroma originating in the falx cerebri. Diagnostic procedures and management in treatment are discussed, and a review of the literature is presented.

Intracranial chondroma arising from the cranial vault: CT and MR appearance

A case of intracranial chondroma arising from the right parietal bone in a 37-year-old woman is presented. CT and MRI findings as well as the differential diagnosis of the lesion are discussed.

Intracranial chondroma. Report of two cases and review of the literature

INTRODUCTION

Chondromas are rare intracranial tumors. The authors present two cases of intracranial intradural chondroma, one originating from the falx cerebri and the other from the dura mater of the convexity.

METHOD AND RESULTS

Diagnostic procedures, including magnetic resonance imaging, and surgical findings are described. In both cases, pre-operative diagnosis could have been at least suspected, and the tumor was completely removed, without recurrence after a follow-up of many years. The pathogenesis and pathological findings are discussed, and cases from the literature are reviewed.

CONCLUSION

Benign intradural chondroma has a good prognosis, with no recurrence after surgical excision in most cases.