Giant skull base periosteal chondroma treated with endonasal endoscopic surgery: illustrative case

BACKGROUND

Intracranial chondroma is an extremely rare type of tumor composed of mature hyaline cartilaginous tissues. No previous cases of skull base periosteal chondroma have been presented.

OBSERVATIONS

A 31-year-old male had progressive memory loss and diminished motivation for the previous 1.5 years. Magnetic resonance imaging revealed a giant tumor with partial calcification arising from the upper clivus and extending to the prepontine cistern. Compression of the brainstem and hypothalamus was significant. Surgery was performed and intentionally limited to an intracapsular resection with endoscopic endonasal surgery (EES), and the brainstem and hypothalamus were successfully decompressed. Pathological examination findings showed a composition of hyaline cartilage with chondrocyte clusters. Genetic testing with next-generation sequencing indicated alternations in IDH1 R132C, KDR Q472H, IDH2 I142L, and TP53 P72R. On the basis of these findings, a diagnosis of periosteal chondroma was made. Postoperatively, complete relief from all symptoms was noted, and MRI one year later showed no evidence of tumor regrowth.

LESSONS

This is the first known report of skull base periosteal chondroma. Genetic testing was useful for confirming the diagnosis, and EES was effective for treatment. Should such a tumor show adhesion to an important structure, an intracapsular excision can be beneficial for avoiding complications.

Periosteal Chondroma of the Pelvis: An Uncommon Tumor in an Unusual Location

Periosteal chondromas (PCs) are rare tumors composed of hyaline cartilage that are typically present in long bones and tubular bones of the hand. These lesions are easily mistaken for other, more common tumors. This study reports a case of PC located in the posterior pelvis of a 24-year-old female. The patient initially presented with a four-month history of pelvic pain with a presumptive diagnosis of endometriosis. However, when an MRI was performed, a 6.0 cm x 5.6 cm x 4.5 cm mass was found along the right posterior ilium extending to the ipsilateral sacroiliac joint. The patient underwent intralesional excision and curettage of the mass. Histologic analysis of the excised lesion revealed a proliferation of chondrocytes and abundant hyaline cartilage without chondroblasts, further suggesting the diagnosis of PC. The current study highlights the unusual location of this rare tumor and alerts the physician of the clinical presentation and differential diagnosis.

Periosteal chondroma of the femur: A case report and review of the literature

Periosteal chondroma is a rare benign cartilage tumor located on the cortical bone, which may be mistaken clinically and histologically for other and more common tumors in this location. The current study reports the case of periosteal chondroma located in the distal femur of a 14-year-old female. A non-tender swelling, 5×4 cm in diameter, was identified on computed tomography, a radiological study of which revealed an overhanging edge and a radiolucent shadow with stippled calcification in radiographs and a lobular heterogeneous mass in magnetic resonance imaging. Cytological examination of the excision biopsy revealed cellular pleomorphism and binucleate cells. The patient underwent en bloc resection of the tumor and covering periosteum, and the histological diagnosis was subsequently determined to be periosteal chondroma. The present study also reviews nine previously reported cases of periosteal chondroma in the femur, with a discussion of the demographic characteristics, imaging features, differential diagnosis and treatment of bone tumors in this location. This study aims to inform clincians that periosteal chondromas may occur in the distal femur although osteochondromas are more common and to discuss making a differential diagnosis between periosteal chondroma and other bone tumors.

Periosteal chondroma of the distal tibia: Computed tomography and magnetic resonance imaging characteristics and correlation with histological findings

Periosteal chondroma is a rare benign hyaline cartilage neoplasm situated on the bone surface. This is the presentation of a unique case of periosteal chondroma arising in the left distal tibial metaphysis of a 25-year-old female patient with a history of antecedent trauma. The physical examination revealed swelling and tenderness in the anterolateral aspect of the left distal lower limb. Plain radiographs revealed a discernible soft tissue lesion with peripheral foci of mineralization. Computed tomography scans confirmed the presence of a surface-based mass with peripheral ossification and a thin rim of calcification. On magnetic resonance imaging, the well-circumscribed mass exhibited intermediate signal intensity on T1-weighted sequences and high signal intensity with foci of decreased signal intensity on T2-weighted sequences. Contrast-enhanced T1-weighted sequences revealed predominantly peripheral enhancement without intramedullary involvement. Following an open biopsy, marginal excision with curettage of the underlying bone cortex was performed. Histologically, the tumor consisted of mature hyaline cartilage arranged in distinct lobules. Foci of ossification with mature bone trabeculae forming a thin shell-like structure were identified in the periphery of the tumor. The mindbomb E3 ubiquitin protein ligase 1 labeling index was <1%. Based on these findings, the tumor was diagnosed as periosteal chondroma. There has been no evidence of local recurrence at 4 months following surgery. Despite its rarity, periosteal chondroma must be considered as a possible diagnosis when confronted with a surface-based, mineralized lesion in the metaphysis of long bones.