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| CASE REPORT |
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| Year : 2020 | Volume
: 68
| Issue : 6 | Page : 1443-1444 |
Intracranial Dural-based Convexity Chondroma
Akshay V Kulkarni1, Nishant Sadashiv1, B Indira Devi1, Shilpa Rao2
1 Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka, India
2 Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India
| Date of Web Publication | 19-Dec-2020 |
Correspondence Address:
Dr. B Indira Devi
Department of Neurosurgery, NIMHANS, Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.304106
Intracranial chondromas arising from the convexity with dural attachments are extremely rare tumors with scarce reports in the literature. They have atypical radiological findings that can often preclude the preoperative diagnosis. Complete resection is treatment with a good prognosis.
Keywords: Chondroma, convexity chondroma, dural-based chondroma, intracranial chondroma
Key Messages: Atypical radiological features in a presumed case of meningioma should raise the suspicion for a rare differential diagnosis. Chondromas are rare lesion presenting with sequestered bony spicules or granular coarse lesion with punctate enhancement. Surgical excision is mainstay of the treatment.
How to cite this article:
Kulkarni AV, Sadashiv N, Devi B I, Rao S. Intracranial Dural-based Convexity Chondroma. Neurol India 2020;68:1443-4 |
A 19-year-old male presented with a 6-years history of right-sided focal intractable seizures and a 3-month history of double vision. CT scan showed hyperdense well defined lesion with sequestered bony spicules [Figure 1] Magnetic resonance imaging showed extra axial lesion which was isointense on T1 and Hypointense on T2 with minimal contrast enhancement [Figure 2] and [Figure 3]. It was diagnosed with a dural-based lesion with probable differential diagnosis of meningioma. Right frontal craniotomy and gross total resection of the tumor with its dural attachments were done. Macroscopically, it was a firm nodular cartilaginous gray-white mass. Microscopic examination was suggestive of chondroma. Postoperative scans documented the total excision of the tumor. Clinically, there was a resolution of diplopia. Hence, subsequent follow-up and imaging were done till three years post-op and there was no radiological or clinical recurrence [Figure 4] and [Figure 5]. | Figure 1: Preoperative CT - Hyperdense lesion with sequestered bone spicules within the lesion. Lytic changes in overlying bone. A well-defined lesion with moderate contrast enhancement and no perilesional edema
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 | Figure 2: Preoperative MRI images- T1 Axial Hypointense, T2 Sagittal and Axial showing heterogenous hyperintensity
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 | Figure 3: Preoperative MRI Axial and Sagittal contrast showing pomegranate seed appearance
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 | Figure 4: (a and b) H and E images showing tumor cells arranged in cords against a chondromyxoid background. Typical physaliferous cells seen (arrow, b). Tumorcells are diffusely positive for S100 (c) and cytokeratin (d)
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 | Figure 5: Three-years postoperative MRI T2 Axial, Sagittal, and Contrast showing no recurrence
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| » Conclusion and Discussion | |  |
Intracranial chondromas constitute less than 0.2–0.5% of all intracranial tumors with a preoperative diagnosis with neuroimaging being challenging.[1],[2] Intracranial chondromas have a predilection for skull base. Dural convexity chondromas are often misdiagnosed as meningiomas on radiology.[1] The closest differential diagnosis constitutes atypical meningiomas, dural-based nonenhancing metastases, and calcified extra-axial hematomas.[2] Computed Tomography (CT) appearance of chondroma is iso to the hyperdense lesion with overlying bone showing lytic changes. It has irregular intratumoral calcifications which are probably sequestrum of normal bone. There is no perilesional edema and relatively avascular with minimal contrast enhancement.[3] On magnetic resonance imaging (MRI) the lesion is heterogeneously hypointense on T1, unevenly hyperintense, or hyperintense with areas of hypointensity on T2. The lesion is usually surrounded by a T2 hypointense arc with minimal contrast enhancement. Contrast enhancement is referred to as “Punica granatum seeds”[3] or simply pomegranate seeds appearance. Histopathological examination shows mature appearing chondrocytes arranged in large lobules and sheets with focal irregular calcification, separated by variable amounts of fibrous connective tissue and without any atypia or overt mitotic activity. Complete resection with removal of dural attachments is advised to prevent recurrence and rare malignant transformation.[3] In the older age group, asymptomatic incidental chondromas can be advised as a watchful waiting approach given the slow growth.[4],[5] Recurrence is seen in less than 3% cases which can be attributed to incomplete resection. Chemotherapy and radiotherapy are usually not advised.[5] As per meta-analysis of 163 cases of intracranial chondromas, radiotherapy is advised only in case of partial resection (8% cases) and malignant transformation (2.3% cases). Generally, the cases have a good prognosis and progression-free survival.
Financial support and sponsorship
There was no financial support or sponsorship for this case report.
Conflicts of interest
There are no conflicts of interest.
| » References | | |
| 1. | Erdogan S, Zorludemir S, Erman T, Akgul E, Ergin M, Ildan F, et al. Chondromas of the falx cerebri and dural convexity: Report of two cases and review of the literature. J Neurooncol 2006;80:21-5.  |
| 2. | Shrot S, Cohen AR, Rodriguez FJ, Berkowitz F, Soares BP, Huisman TA. Intracranial dural chondroma in a child-conventional and advanced neuroimaging characteristics and differential diagnosis. Neuroradiol J 2018;31:386-9. |
| 3. | Duan F, Qiu S, Jiang J, Chang J, Liu Z, Lv X, et al. Characteristic CT and MRI findings of intracranial chondroma. Acta Radiol 2012;53:1146-54. |
| 4. | Fountas KN, Stamatiou S, Barbanis S, Kourtopoulos H. Intracranial falx chondroma: Literature review and a case report. Clin Neurol Neurosurg 2008;110:8-13. |
| 5. | Sullivan JC, Goldsmith J, Rojas R, Varma H, Kasper EM. Intracranial dural parafalcine chondroma: Case report and systematic review of the literature. World Neurosurg 2019;122:1-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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