Extraskeletal myxoid chondrosarcoma of the cerebellopontine angle presenting during pregnancy

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.

Extraskeletal Myxoid Chondrosarcoma of the Jugular Foramen in a Pediatric Patient: A Case Report and Comprehensive Review of the Literature

INTRODUCTION

Extraskeletal myxoid chondrosarcoma of the jugular foramen is a rare clinical entity, especially in the pediatric population. Thus, it can be confused with other pathologies.

CASE PRESENTATION

We report an extremely rare case of a 14-year-old female patient with jugular foramen myxoid chondrosarcoma that was completely removed through microsurgical resection.

CONCLUSION

The primary purpose of the treatment is gross total resection of the chondrosarcomas. However, adjuvant methods such as radiotherapy should additionally be applied in patients who have high-grade diseases or cannot undergo gross total resection because of anatomic localization.

Primary intracranial extraskeletal myxoid chondrosarcoma: A case report and review of literature

BACKGROUND

Primary intracranial extraskeletal myxoid chondrosarcoma (EMC) is an extremely rare low- to intermediate-grade malignant soft tissue sarcoma, and only 15 cases have been reported in the literature. Due to its rarity, clinical data and research on this tumor type are extremely limited, the pathogenesis and histological origin are still unclear, and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.

CASE SUMMARY

We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo, and his health status deteriorated during the last week. CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus. Brain magnetic resonance imaging (MRI) showed a 3.4 cm × 3.0 cm sized, well-defined, round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus. The entire lesion was removed via supratentorial craniotomy and microsurgery. Postoperative pathological diagnosis indicated primary intracranial EMC. Subsequently, the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge. At present, it is 12 mo after surgery, with regular postoperative follow-up and regular MRI examinations, that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor, and the patient has returned to normal life.

CONCLUSION

Currently, the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy. Long-term follow-up is also necessary for patients.

Intracranial Extraskeletal Myxoid Chondrosarcoma in Fourth Ventricle

We present an extremely rare case of intracranial extraskeletal myxoid chondrosarcoma. A 36-year-old male presented with dizziness persisting for 2 weeks. MRI of the patient showed well-enhanced mass of fourth ventricle. The tumor was totally removed under telovelar approach. Pathology results confirmed an intracranial extraskeletal myxoid chondrosarcoma. Adjuvant radiotherapy was initiated one month after the surgery, and MRI followed 3 months after initial operation and showed no evidence of tumor recurrence.

Primary intracranial extra-skeletal myxoid chondrosarcoma of right lateral ventricle with EWSR1 gene fusion: a case report and review of literature

Background

Primary intracranial malignancies with extra-skeletal myxoid chondrosarcoma (EMC) features are extremely rare. EMC constitutes a distinct genomic entity characterised by reciprocal translocation of fusion genes, most commonly EWS RNA Binding Protein 1 (EWSR1) in 22q12 with Nuclear Receptor Subfamily 4 Group A Member 3 (NR4A3) in 9q2-q31.1. It is reported to have a high propensity for local recurrence and has potential for metastasis. So far in 28 years since its first description, only 17 cases of primary intracranial EMC were reported in literature. This would be the second case of intraventricular origin and first case from lateral ventricle.

Case presentation

A 27-year-old male presenting with complaints of headache, seizures and pain in neck was diagnosed to have a mass lesion in right lateral ventricle in Magnetic Resonance Imaging of brain. He underwent right parieto-occipital craniotomy with total excision of the lesion. Initial histopathological examination was reported as Ependymoma, WHO grade II. However, blocks and slides review with immunohistochemistry (IHC) markers revealed neoplastic aetiology with extensive myxoid changes. Hence, fluorescent in-situ hybridisation (FISH) testing was done with EWSR1 break apart probe, which demonstrated EWSR1 break apart signals. Therefore, correlating the clinical findings with morphology, IHC and FISH, the diagnosis of primary intracranial EMC was rendered. Patient received adjuvant external beam radiation of 54 Gy in 30 fractions to the post-op region. At 29-month follow-up, there was no evidence of disease recurrence.

Conclusions

Owing to the rarity of the condition, there are no standard treatment guidelines available for primary intracranial EMC. A combined treatment approach with surgery followed by adjuvant radiotherapy provides good local control with less morbidity.

Extraskeletal Myxoid Chondrosarcoma of the Parotid Gland

Extraskeletal myxoid chondrosarcoma (EMC) is a rare tumor with an estimated incidence of <3% among of all soft-tissue sarcomas. It is characterized by a multinodular architecture, abundant myxoid matrix, and malignant chondroblast-like cells arranged in cords. The tumor is an entity from chondrosarcomas of bones, commonly found in the soft tissues of the lower extremities at 80%. There are very limited reports of this tumor in the head and neck, especially in the parotid gland. The purpose of this paper is to describe an EMC located at an unusual site in the parotid gland, and briefly, the literature review with special reference to the clinicopathological features and the treatment approach was discussed.

Primary extraskeletal myxoid chondrosarcoma in cerebellum: A case report with literature review

RATIONALE

Extraskeletal myxoid chondrosarcoma (EMC) is a rare malignant neoplasm of which intracranial EMC is the rarest.

PATIENT CONCERNS

We present an unusual case report of a 41-year-old woman who was sent to the emergency department for a sudden headache and other symptoms related to increased intracranial pressure.

INTERVENTIONS

Emergent CT revealed an occupying lesion in the left cerebellum with surrounding edema. A complete surgical excision of the lesion through a transcortical approach was performed. After the operation, this patient received adjuvant radiotherapy and temozolomide treatment.

DIAGNOSES

Pathology diagnosis was an intracranial EMC.

OUTCOMES

The patient survives with no tumor recurrence as of the last follow-up. Progression-free survival exceeded 20 months.

LESSONS

We have reviewed the literature and here summarize the diagnosis and treatment options for intracranial EMC. Diagnosis and treatment options of this rare disease are discussed.

Extraskeletal myxoid chondrosarcoma of the masticator space in a pediatric patient

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft-tissue neoplasm rarely described in the head and neck region of children and adolescents. We describe a case of EMC affecting the masticator space and a literature review. A 13-year-old boy who presented a large painless, diffuse mass causing progressive midfacial asymmetry of 6 months duration. Histopathological evaluation revealed a multinodular lesion, containing scattered round vacuolated tumor cells dispersed in an abundant myxoid stroma, separated by fibrous septae. Immunohistochemical analysis revealed positivity for vimentin, neuron-specific enolase, and chromogranin. The Ki-67 labelling index was 42%. The patient was treated surgically with tumor resection followed by adjuvant local radiotherapy. The patient died 1 year after initial diagnosis due to locoregional tumor dissemination. EMC should be considered in the differential diagnosis of myxoid neoplasms in the head and neck region.

Key words:Extraskeletal myxoid chondrosarcoma, masticator space, parapharyngeal space, immunohistochemistry, children.

Chondrosarcoma of the tibial head during pregnancy: a challenging diagnosis

Chondrosarcoma is one of the most common malignant bone tumours in adults. However, it rarely occurs during pregnancy. Therefore, reports on surgical and medical management of this entity are hard to find. Different studies suggest a possible growth-enhancing effect of altered hormone levels on various bone tumours. The effect of pregnancy on growth characteristics of chondrosarcomas however remains unclear. We report a case of a 32-year-old pregnant woman with a newly occurred chondrosarcoma of the tibial head. Intense clinical monitoring and repeated MRI scans showed a tumour progression during pregnancy followed by the need of above-knee amputation after 30 weeks gestation. Spontaneous vaginal delivery after 38 weeks gestation was complicated by an amniotic infection syndrome and finally stopped, necessitating a caesarean section. Despite this there were no further complications to be mentioned. No local tumour recurrence or metastases could be detected in the staging CT scans following pregnancy.

Intracranial extraskeletal myxoid chondrosarcoma : case report and literature review

Intracranial extraskeletal myxoid chondrosarcoma is extremely rare, with only seven patients previously reported. We present a case report of a 21-year-old woman admitted for weakness in her right extremities and symptoms of increased intracranial pressure. Magnetic resonance imaging (MRI) revealed hydrocephalus and a well-enhanced large mass around her left thalamus. A left parietal craniotomy and a cortisectomy at the superior parietal lobule were performed. Total surgical resection was also performed, and pathology results confirmed an extraskeletal myxoid chondrosarcoma. Postoperative MRI showed no residual tumor, and the patient underwent radiotherapy. After six months of radiotherapy, the patient's headache and weakness had improved to grade IV. This malignant tumor showed high rates of recurrence in previous reports. We here report another occurrence of this highly malignant and rare tumor in a patient treated using total surgical excision and adjuvant radiotherapy.