Distinguishing Falcine Chondrosarcomas from Their Mimics and Management

SKK, B. JP, Bahuleyan A, P. RC, Varghese T, Pillai MA. Primary Extraskeletal Falcine Myxoid Chondrosarcoma-A Case Report and Review of Literature

Intracranial chondrosarcomas are rare malignant lesions. Both skull base and dural-based extraosseous chondrosarcomas have been reported to occur intracranially. Dural-based chondrosarcomas arising from the falx cerebri are rare lesions with only 19 cases reported till date. Although conventional, mesenchymal, and myxoid variants of chondrosarcomas have been reported intracranially, myxoid variant are the rarest with only 17 cases reported till date, among which only 2 were falcine. We are reporting the third case of falcine myxoid chondrosarcoma in a 32-year-old man who presented with seizures and subtle lower limb weakness. Radiological findings were suggestive of an atypical meningioma in the falcine region. Macroscopically total resection of the tumor was done. Histopathological examination confirmed myxoid chondrosarcoma, grade 1. Postoperative period was uneventful, and the patient remains asymptomatic 34 months after the surgery without the application of any adjuvant therapy. Falcine myxoid chondrosarcomas are extremely rare lesions with variable aggressiveness as suggested by the three cases reported till now including the present case.

Surgical Strategies and Outcomes for Intracranial Chondromas: A Retrospective Study of 17 Cases and Systematic Review

Objective

To improve the diagnosis and treatment of intracranial chondromas (ICDs) by discussing the clinical manifestations and imaging characteristics of ICDs, as well as surgical methods and treatment strategies.

Methods

We retrospectively analyzed 17 patients diagnosed with ICDs who underwent microsurgery or endoscopic transsphenoidal surgery at the Tangdu Hospital of Air Force Military Medical University and the Mianyang Central Hospital from January 2010 to November 2021. Clinical manifestations, imaging examinations, surgical treatments, and prognosis of these patients were analyzed.

Results

ICDs had often been misdiagnosed as craniopharyngioma, chordoma, schwannoma, cavernous hemangioma, pituitary adenoma, and meningioma before surgery. Of the 17 cases, gross total resection (GTR) was performed in 10 cases, subtotal resection (STR) in 5, and partial resection in 2. GTR of tumor was achieved in eight cases via the endoscopic endonasal transsphenoidal approach (EETA) or the extended endoscopic endonasal transsphenoidal approach (EEETA), and the remaining patients underwent craniotomies. Clinical symptoms were assessed 1 week after surgery, 10 cases were relieved at varying degrees, and four cases had no improvement. Postoperative complications included right-limb hemiparesis, diplopia, eyelid ptosis, pulmonary infection, subcutaneous hydrops, cerebrospinal-fluid leakage (CSFL), and intracranial infection (ICI). One patient received gamma knife treatment at 3 months after surgery, two patients died due to tumor progression, and the remaining patients had no tumor recurrence.

Conclusions

ICDs lack typical imaging features and are often misdiagnosed. The EETA or EEETA helps improve the surgical outcomes and GTR rates of ICDs at different sites.

Primary extraosseous dural chondrosarcoma: a case report

BACKGROUND

Dural chondrosarcoma is a very rare intracranial tumor, given that meninges do not normally contain cartilaginous tissue from which it can originate. We present a case of primary extraosseous dural chondrosarcoma.

CASE PRESENTATION

A 48-year-old woman presented to our tertiary center neurosurgery consultation with progressive headache, vomiting, vertigo, and gait instability of 5 months' duration. An initial brain CT revealed a large parietal mass with gross calcifications and subtle hyperostosis of the inner table. Subsequent brain MRI showed a heterogeneous expansive lesion with a honey-comb enhancement. Discussion of intra- or extra-axial location was warranted, and finally, initial presurgical suspicion of meningioma arose although some atypical imaging features were detected. The differential diagnosis included solitary fibrous tumor-hemangiopericytoma and dural metastasis. Total resection of the lesion was performed, extra-axial origin was confirmed, and pathology resulted in a primary dural chondrosarcoma.

CONCLUSION

The importance of this case presentation lies in the unusual nature of the final diagnosis, the brief literature review and differential diagnosis with emphasis on imaging pearls, as well as the useful reminder for physicians to consider less frequent diseases when key findings do not unambiguously lead to the usual suspects.

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.

Giant chondrosarcoma of the falx in an adolescent: A case report

Background:

Intracranial chondrosarcomas are slowly growing malignant cartilaginous tumors that are especially rare in adolescents.

Case Description:

A 19-year-old woman with no medical history presented with symptoms of intermittent facial twitching and progressive generalized weakness for 6 months. The patient’s physical examination was unremarkable. Imaging revealed a large bifrontal mass arising from the falx cerebri, with significant compression of both cerebral hemispheres and downward displacement of the corpus callosum. The patient underwent a bifrontal craniotomy for gross total resection of tumor. Neuropathologic examination revealed a bland cartilaginous lesion most consistent with low-grade chondrosarcoma. Her postoperative course was uneventful, and she was discharged to home on postoperative day 3.

Conclusion:

This is an unusual case of an extra-axial, non-skull base, low-grade chondrosarcoma presenting as facial spasm in an adolescent patient.

[Falcine chondrosarcoma (case report and literature review)]

Chondrosarcoma is a rare malignancy composed of transformed cells of cartilage. This cancer is characterized by slow growth. Almost 75% of intracranial chondrosarcomas are observed on the skull base and grow from bone synchondrosis. Other rarer localizations of tumor are cerebral falx, tentorium cerebelli, vascular plexuses of the ventricles, fourth ventricle, convexital surface of the brain, etc. In this manuscript, we report treatment of patient with falcine chondrosarcoma.