Spinal chondroma of the lumbar tract: case report

Chondromas of the Lumbar Spine: A Systematic Review

STUDY DESIGN

Systematic review and illustrative case.

OBJECTIVES

Lumbar spinal chondromas (LSCs) are rare spine tumors. The characteristics of these intraspinal lesions are not well described in the literature. The goal of this article is to describe the features of this rare spinal tumor.

METHODS

A PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with LSCs. The data gathered from this review was analyzed to characterize LSCs.

RESULTS

The search yielded 14 cases of patients with LSCs. All studies were case reports (Level V of evidence). Different characteristics of LSCs are described, including demographics, clinical findings, imaging, and treatment.

CONCLUSIONS

The results of this review show that LSCs are almost exclusively seen in the extradural space and may adopt a dumbbell shape. LSCs frequently manifest in a very similar way to lumbar disc herniations; therefore, they should be considered in the differential diagnosis of sciatica, especially if magnetic resonance imaging with gadolinium shows peripheral rim enhancement of the lesion. Different degrees of improvement are usually observed after surgical treatment of these patients.

Large enchondroma of the thoracic spine: a rare case report and review of the literature

Background

Enchondroma, a subtype of chondroma, originates from the medullary cavity of the bone and produces an expansile growth pattern. Enchondroma located in the spine is rare and a few cases of large thoracic enchondroma have been reported. The authors document a rare case of large enchondroma in the thoracic spine of a 49-year-old woman, and discuss its clinical, radiological and histopathological characteristics.

Case presentation

The patient presented with rapidly progressive and severe pain on her upper back. Magnetic resonance imaging revealed an expansile lesion at the posterior elements of T3 that was hypointense on T1-weighted images and mixed iso- to hyperintense on T2-weighted images. Administration of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) resulted in heterogeneous enhancement. During surgery, a large tumor of 4.2cm × 4.7cm × 2.1cm was resected along with the lamina and spinous process. Histological examination revealed that the tumor consisted of mature hyaline cartilage with typical chondrocytes, indicating that it was an enchondroma.

Conclusions

Despite its benign-growing nature, enchondroma should be examined closely for signs of enchondromatosis and enchondrosarcoma. Complete surgical resection is the treatment of choice for immediate relief of symptoms and avoidance of recurrence.

Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

Periosteal chondroma with spinal cord compression in the thoracic spinal canal: a case report

Periosteal chondroma is a very unusual cartilaginous neoplasm of the spinal canal. We herein report a case of periosteal chondroma in a 41-year-old male who presented with gait disturbance and paresthesia of both lower extremities. Magnetic resonance (MR) images showed an extradural mass which caused compression of the spinal cord at the T5/6 level. The mass showed iso-signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and nodular and peripheral rim enhancement on post-contrast T1-weighted images. Computed tomography (CT) images showed a mass with punctate calcifications and extension into the left T5/6 neural foramen. MR and CT images showed extrinsic cortical bone erosion of the posterior inferior body of T5 and superior pedicle of T6, bone remodeling with overhanging margins, and sclerosis adjacent to the tumor. The patient underwent a complete excision of the mass by left T5/6 hemi-laminectomy and exhibited complete resolution of his symptoms. Histopathologic examination revealed periosteal chondroma. Tumor recurrence was not recorded during the 18-month follow-up period.

Extradural chondroma presenting as lumbar mass with compressive neuropathy

The identification of a soft tissue chondroma within the spine represents a rarity and is typically not included within the differential diagnosis for patients with sensory complaints of the leg. The authors describe 46-year-old female presenting with 3-week history of decreased sensation and paresthesias of the left leg. Magnetic resonance imaging of the lumbar spine demonstrated an L3 extradural soft tissue mass. She underwent an uncomplicated excision through an L3 laminectomy and exhibited complete resolution of symptoms. Pathologic examination revealed benign cartilaginous tissue; however, the authors recommend long-term follow-up for such lesions as the potential for malignant transformation is unknown.

Lumbar spinal chondroma presenting with acute sciatica

A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

Soft tissue chondroma mimicking "dumbbell" neurogenic tumour: a rare cause of lumbar radiculopathy

Soft tissue chondromas are rare, benign extra-skeletal tumours of cartilaginous origin, which may rarely occur within the spinal canal. We report a patient who presented with left lumbar radiculopathy, and a peripherally-enhancing dumbbell shaped soft tissue mass involving both the intraspinal and extraspinal compartments on MRI. This was misdiagnosed as a neurogenic tumour and the patient underwent surgical removal. Histological examination revealed cartilaginous tissue. Although rare, soft tissue chondromas should be considered in the differential diagnosis of spinal dumbbell shaped tumours, especially if MRI shows peripheral contrast enhancement.

Primary vertebral tumors: a review of epidemiologic, histological, and imaging findings, Part I: benign tumors

Primary vertebral tumors, although less common than metastases to the spine, make up a heterogeneous group of neoplasms that can pose diagnostic and treatment challenges. They affect both the adult and the pediatric population and may be benign, locally aggressive, or malignant. An understanding of typical imaging findings will aid in accurate diagnosis and help neurosurgeons appreciate anatomic subtleties that may increase their effective resection. An understanding of the histological similarities and differences between these tumors is imperative for all members of the clinical team caring for these patients. In this first review of 2 parts, we discuss the epidemiological, histological, and imaging features of the most common benign primary vertebral tumors-aneurysmal bone cyst, chondroma and enchondroma, hemangioma, osteoid osteoma, and osteoblastoma-and lesions related to eosinophilic granuloma and fibrous dysplasia. In addition, we discuss the basic management paradigms for each of these diagnoses. In combination with part II of the review, which focuses on locally aggressive and malignant tumors, this article provides a comprehensive review of primary vertebral tumors.

Lumbar osteochondroma arising from spondylolytic l3 lamina

Osteochondromas are common, benign tumors in the long bones, but osteochondromas are rare in the vertebrae. Most vertebral osteochondromas arise from the cervical or upper thoracic spine. However, lumbar osteochondromas have rarely been reported. In this report, a rare case of a lumbar osteochondroma arising from the spondylolytic L3 lamina in a 57-year-old woman is presented. She also had a ruptured disc and lumbar canal stenosis at L4-5-S1. The osteochondroma was completely removed and a posterior lumbar interbody fusion and instrumentation were performed. Considering the rarity of osteochondromas in the lumbar vertebrae, especially the L3 vertebra, it is possible that the pre-existing lumbar spondylolysis or spondylolisthesis was one of the factors affecting the occurrence or progression of the osteochondroma.

Periosteal chondroma of the pediatric cervical spine

Periosteal chondromas located in the spine are rare. The authors document an even more infrequent occurrence of a recurrent periosteal chondroma in the cervical spine of a 6-year-old boy. During the operation, a giant (>7 cm in diameter) periosteal chondroma with involvement of the C-5 and C-6 vertebral bodies was resected. The vertebral column was reconstructed with anterior-posterior instrumentation. The pathological examination revealed that the tumor consisted of chondroid tissue with typical chondrocytes, confirming the diagnosis of periosteal chondroma.

Synovial chondromatosis of the lumbar spine with compressive myelopathy: a case report with review of the literature

Synovial chondromatosis has been rarely reported to occur in the spine with only one case found in the lumbar spine. We describe another case of synovial chondromatosis in the lumbar spine in a 41-year-old man who presented with compressive myelopathy. The tumor was located in the left ventrolateral corner of the epidural space just below the L(4)-L(5) intervertebral space. Besides being extremely rare, our case was unusual in that the juxtaposed facet joint was radiologically normal.

A periosteal chondroma in the lumbar spinal canal. Case report

Periosteal chondromas located in the spine are rare. The authors document a case of periosteal chondroma in the lumbar spinal canal of a 77-year-old man. The patient had severe pain in his right leg and used a wheelchair because of weakness in both legs. Magnetic resonance imaging revealed a round tumor that was hypo- or isointense on T1-weighted images and uniformly hyperintense on T2-weighted images. Administration of gadolinium-diethylenetriamine pentaacetic acid resulted in margin enhancement on T1-weighted images. During the operation, a round tumor 1.5 cm in diameter was found on the surface of the anterior wall of the L-3 lamina. Histological examination revealed that the tumor consisted of chondroid tissue with typical chondrocytes, indicating that it was a periosteal chondroma.

Spinal osteochondromas in middle-aged to elderly patients

STUDY DESIGN

Three case reports of solitary spinal osteochondromas in middle-aged and elderly patients.

OBJECTIVES

To describe the treatment of three rare cases of spinal osteochondromas in patients significantly older than the cases previously reported in the literature.

SUMMARY OF BACKGROUND DATA

Osteochondromas arising in the vertebral column are considered rare. The mean age of clinical appearance is said to be in the second or third decade of life.

METHODS

Clinical history, physical examinations, plain radiographs, magnetic resonance imaging, myelography, computed tomographic myelography, and histopathologic findings for each case were reviewed in conjunction with previous cases reported in the literature.

RESULTS

Total removal of the tumor was effective in causing the symptoms to disappear.

CONCLUSIONS

Spinal osteochondromas are rare and tend to appear in young adults. Three cases of spinal osteochondromas that were unusual in terms of age at clinical presentation and localization were reported, suggesting a continuous growth of the tumor beyond skeletal maturity.

Osteochondroma of the thoracic spine and scoliosis

STUDY DESIGN

The case of a 16-year-old patient with an osteochondroma in T11 and scoliosis is reported.

OBJECTIVE

To describe the treatment of an osteochondroma with scoliotic deformity and the imaging methods used for the diagnosis.

SUMMARY OF BACKGROUND DATA

Osteochondromas arising in the vertebral column are rare. However, spinal involvement is found with some regularity because osteochondromas are among the most common benign tumors of bone.

METHODS

The clinical history, plain radiographs, computed tomography, and magnetic resonance imaging, and pathologic findings of the reported patient were reviewed. The medical literature also was reviewed.

RESULTS

The patient was treated with surgery in an attempt to remove the tumor and correct the aesthetic deformity. The results were satisfactory, with an improvement of the thoracolumbar scoliosis from 45 degrees to 18 degrees.

CONCLUSIONS

Osteochondromas of the vertebral column may cause scoliosis. Computed tomography and magnetic resonance imaging are necessary for evaluating the origin, size, and characteristics of the tumor. In this case, surgical management involved resection of the tumor and correction of the scoliotic deformity.