1
|
Bosman EM, Keizer ME, van Aalst J, Broen MP, Postma AA, Vernemmen AI, Kunst HP, Temel Y. Spontaneous Shrinking and Growing Skull Base Chordoma. J Neurol Surg Rep 2025; 86:e107-e111. [PMID: 40352577 PMCID: PMC12064314 DOI: 10.1055/a-2587-6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 04/09/2025] [Indexed: 05/14/2025] Open
Abstract
Background Chordomas are rare slow-growing tumors occurring in the axial skeleton and can demonstrate local aggressive behavior, typically extending from the median axis, compressing surrounding tissue. Complete surgical resection and adjuvant radiotherapy are the preferred treatments. We present an unusual case of a spontaneously shrinking and growing off-midline petroclival chordoma. Case Description A 23-year-old woman presented with right abducens nerve palsy. Computed tomography and magnetic resonance imaging (MRI) revealed an off-midline petroclival lesion compressing the abducens nerve with characteristics of a chondrosarcoma. Preoperative MRI indicated spontaneous lesion regression, and the abducens nerve showed clinical improvement. Hence, the planned surgery was canceled. During the wait-and-scan period, abducens nerve palsy recurred. MRI confirmed lesion growth and showed an intratumoral linear structure indicative of blood. Even though preoperative MRI again demonstrated shrinkage, the lesion was surgically removed. Despite the unusual presentation, histopathological examination diagnosed a conventional chordoma. A second surgery was required to remove the residual tumor, after which the patient received high-dose photon beam therapy. Conclusion This article discusses the uncommon presentation and behavior of a petroclival chordoma, showing fluctuating cycles of off-midline growth and spontaneous regression. While intratumoral hemorrhage is hypothesized to explain this tumor behavior, the exact etiology needs further investigation. The case presented here emphasizes the importance of considering chordoma in the differential diagnosis despite an atypical disease course.
Collapse
Affiliation(s)
- Esmée M. Bosman
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
| | - Max E. Keizer
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Jasper van Aalst
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
| | - Martinus P.G. Broen
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Alida A. Postma
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
- Department of Radiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Astrid I.P. Vernemmen
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henricus P.M. Kunst
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Otorhinolaryngology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, The Netherlands
- Dutch Academic Alliance Skull Base Pathology, Maastricht University Medical Center+ and Radboud University Medical Center, Maastricht and Nijmegen, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
- Istanbul Atlas University, Faculty of Medicine, Istanbul, Türkiye
| |
Collapse
|
2
|
Krishnamoorthy A, Bailey DS, Specht C, Zacharia BE. Preoperative Diagnosis of a Central Skull Base Giant Schwannoma From Tumoral Microhemorrhages Visualized on Susceptibility-Weighted Imaging. Cureus 2024; 16:e70182. [PMID: 39463506 PMCID: PMC11506372 DOI: 10.7759/cureus.70182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/29/2024] Open
Abstract
A 64-year-old female presented with extensive osseous erosion of the central skull base from a large tumor, which was evaluated with a combination of CT and MRI. Susceptibility-weighted imaging (SWI) aided the correct preoperative diagnosis of giant skull base schwannoma by demonstrating intratumoral microhemorrhages, later confirmed on histology. Other imaging features on CT and MRI were not helpful to identify the schwannoma in this case.
Collapse
Affiliation(s)
| | - David S Bailey
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Charles Specht
- Neuropathology, Penn State College of Medicine, Hershey, USA
| | - Brad E Zacharia
- Neurosurgery/Brain Surgery, Penn State College of Medicine, Hershey, USA
| |
Collapse
|
3
|
Lewis D, Li KL, Waqar M, Coope DJ, Pathmanaban ON, King AT, Djoukhadar I, Zhao S, Cootes TF, Jackson A, Zhu X. Low-dose GBCA administration for brain tumour dynamic contrast enhanced MRI: a feasibility study. Sci Rep 2024; 14:4905. [PMID: 38418818 PMCID: PMC10902320 DOI: 10.1038/s41598-024-53871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
A key limitation of current dynamic contrast enhanced (DCE) MRI techniques is the requirement for full-dose gadolinium-based contrast agent (GBCA) administration. The purpose of this feasibility study was to develop and assess a new low GBCA dose protocol for deriving high-spatial resolution kinetic parameters from brain DCE-MRI. Nineteen patients with intracranial skull base tumours were prospectively imaged at 1.5 T using a single-injection, fixed-volume low GBCA dose, dual temporal resolution interleaved DCE-MRI acquisition. The accuracy of kinetic parameters (ve, Ktrans, vp) derived using this new low GBCA dose technique was evaluated through both Monte-Carlo simulations (mean percent deviation, PD, of measured from true values) and an in vivo study incorporating comparison with a conventional full-dose GBCA protocol and correlation with histopathological data. The mean PD of data from the interleaved high-temporal-high-spatial resolution approach outperformed use of high-spatial, low temporal resolution datasets alone (p < 0.0001, t-test). Kinetic parameters derived using the low-dose interleaved protocol correlated significantly with parameters derived from a full-dose acquisition (p < 0.001) and demonstrated a significant association with tissue markers of microvessel density (p < 0.05). Our results suggest accurate high-spatial resolution kinetic parameter mapping is feasible with significantly reduced GBCA dose.
Collapse
Affiliation(s)
- Daniel Lewis
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK.
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Stott Lane, Salford, Greater Manchester, M6 8HD, UK.
| | - Ka-Loh Li
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mueez Waqar
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - David J Coope
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Omar N Pathmanaban
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Ibrahim Djoukhadar
- Department of Neuroradiology, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sha Zhao
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Timothy F Cootes
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alan Jackson
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Xiaoping Zhu
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Ota Y, Liao E, Capizzano AA, Baba A, Kurokawa R, Kurokawa M, Srinivasan A. Differentiation of Skull Base Chondrosarcomas, Chordomas, and Metastases: Utility of DWI and Dynamic Contrast-Enhanced Perfusion MR Imaging. AJNR Am J Neuroradiol 2022; 43:1325-1332. [PMID: 35953276 PMCID: PMC9451640 DOI: 10.3174/ajnr.a7607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Differentiation of skull base tumors, including chondrosarcomas, chordomas, and metastases, on conventional imaging remains a challenge. We aimed to test the utility of DWI and dynamic contrast-enhanced MR imaging for skull base tumors. MATERIALS AND METHODS Fifty-nine patients with chondrosarcomas, chordomas, or metastases between January 2015 and October 2021 were included in this retrospective study. Pretreatment normalized mean ADC and dynamic contrast-enhanced MR imaging parameters were calculated. The Kruskal-Wallis H test for all tumor types and the Mann-Whitney U test for each pair of tumors were used. RESULTS Fifteen chondrosarcomas (9 men; median age, 62 years), 14 chordomas (6 men; median age, 47 years), and 30 metastases (11 men; median age, 61 years) were included in this study. Fractional plasma volume helped distinguish all 3 tumor types (P = .003, <.001, and <.001, respectively), whereas the normalized mean ADC was useful in distinguishing chondrosarcomas from chordomas and metastases (P < .001 and P < .001, respectively); fractional volume of extracellular space, in distinguishing chondrosarcomas from metastases (P = .02); and forward volume transfer constant, in distinguishing metastases from chondrosarcomas/chondroma (P = .002 and .002, respectively) using the Kruskal-Wallis H test. The diagnostic performances of fractional plasma volume for each pair of tumors showed areas under curve of 0.86-0.99 (95% CI, 0.70-1.0); the forward volume transfer constant differentiated metastases from chondrosarcomas/chordomas with areas under curve of 0.82 and 0.82 (95% CI, 0.67-0.98), respectively; and the normalized mean ADC distinguished chondrosarcomas from chordomas/metastases with areas under curve of 0.96 and 0.95 (95% CI, 0.88-1.0), respectively. CONCLUSIONS DWI and dynamic contrast-enhanced MR imaging sequences can be beneficial for differentiating the 3 common skull base tumors.
Collapse
Affiliation(s)
- Y Ota
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - E Liao
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A A Capizzano
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Baba
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (A.B.), Jikei University School of Medicine Ringgold standard institution, Tokyo, Japan
| | - R Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (R.K.), The University of Tokyo Hospital, Tokyo, Japan
| | - M Kurokawa
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (M.K.), Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Ringgold standard institution, Bunkyo-ku, Japan
| | - A Srinivasan
- From the Division of Neuroradiology (Y.O., E.L., A.A.C., A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
5
|
Rao D, Stein R, Jenson M, Patel J, Fiester P. Imaging Review of the Endoscopic Operative Corridor for Clivus Lesions. Curr Probl Diagn Radiol 2022; 52:66-76. [DOI: 10.1067/j.cpradiol.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
|
6
|
Mark IT, Van Gompel JJ, Inwards CY, Ball MK, Morris JM, Carr CM. MRI enhancement patterns in 28 cases of clival chordomas. J Clin Neurosci 2022; 99:117-122. [PMID: 35278932 DOI: 10.1016/j.jocn.2022.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/09/2022] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Clival chordomas are classically thought of as locally aggressive tumors of the skull base and differentiate themselves from their benign counterparts by demonstrating moderate to marked contrast enhancement, reported as 95-100% in prior studies. The purpose of this review was to evaluate the imaging characteristics of lesions from a single institution classified as clival chordomas with an emphasis of highlighting lesions that do not follow the prevalent current description for chordoma. We searched our institutional databases for all patients with pathologically proven clival chordomas from 1997 to 2017 who had pre-operative imaging available. The images were evaluated for degree of contrast enhancement, MRI signal characteristics, osseous involvement, location, aggressiveness of appearance, and presence of calcifications. 28 cases were identified that had preoperative imaging available for review. Over half of the patients demonstrated either no/minimal (11/28, 39%) or mild enhancement (7/28, 25%). The remaining cases demonstrated moderate (4/28, 14%) and marked enhancement (6/28, 21%). The 4 lesions measuring less than 20 mm all had mild to minimal/no enhancement and lacked aggressive features on CT. Our experience finds that over half (64%) of clival chordomas will demonstrate mild or no enhancement at all. These findings suggest that the lack of MRI contrast enhancement should not be synonymous with a benign clival mass.
Collapse
Affiliation(s)
- Ian T Mark
- Mayo Clinic, Department of Radiology. Rochester, MN, USA.
| | | | | | | | | | - Carrie M Carr
- Mayo Clinic, Department of Radiology. Rochester, MN, USA
| |
Collapse
|
7
|
Gupta N, Hiremath S, Martinez-Rios C, Chakraborty S, Miller E. Pediatric Petrous Apex Lesions: A Radiological Classification and Diagnostic Algorithm. Can Assoc Radiol J 2022; 73:655-671. [PMID: 35253470 DOI: 10.1177/08465371221074880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The petrous apex (PA) is involved in a myriad of pathological conditions, some of which are exclusive in children. Diagnosis may be difficult due to vague clinical presentation, and local examination is challenging owing to its inaccessible location. This is further complicated by multiple unfused sutures and ongoing PA pneumatization in children. Cross-sectional imaging is vital for the evaluation of the PA lesions, due to their precarious location and proximity to the major neurovascular structures. Several classification systems have been proposed for these lesions based on their site of origin, solid or cystic appearance, surgical or non-surgical (no touch lesions) management, and benign or malignant nature. In this article, we emphasize the distinctive role of different cross-sectional imaging modalities in the diagnosis of pediatric PA lesions, with special attention to normal variants that should not be mistaken for pathology. We also propose a radiological classification and algorithmic approach to aid in the precise diagnosis and facilitate appropriate management of the various PA lesions in children.
Collapse
Affiliation(s)
- Neetika Gupta
- Medical Imaging Department, 27338Children's Hospital of Eastern Ontario (CHEO), Department of Radiology-University of Ottawa, Ottawa, ON, Canada
| | - Shivaprakash Hiremath
- Division of Neuroradiology, Department of Radiology, 6363The Ottawa Hospital Civic and General Campus, Ottawa, ON, Canada
| | - Claudia Martinez-Rios
- Medical Imaging Department, 27338Children's Hospital of Eastern Ontario (CHEO), Department of Radiology-University of Ottawa, Ottawa, ON, Canada.,Division of Neuroradiology, Department of Radiology, 6363The Ottawa Hospital Civic and General Campus, Ottawa, ON, Canada
| | - Santanu Chakraborty
- Division of Neuroradiology, Department of Radiology, 6363The Ottawa Hospital Civic and General Campus, Ottawa, ON, Canada
| | - Elka Miller
- Medical Imaging Department, 27338Children's Hospital of Eastern Ontario (CHEO), Department of Radiology-University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
8
|
Zhao K, Nimchinsky E, Agarwalla PK. Differential Diagnosis and Radiographic Imaging of Pituitary Lesions. Otolaryngol Clin North Am 2022; 55:247-264. [DOI: 10.1016/j.otc.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
9
|
Bashari WA, Gillett D, MacFarlane J, Scoffings D, Gurnell M. Pituitary Imaging. THE PITUITARY 2022:677-721. [DOI: 10.1016/b978-0-323-99899-4.00022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
|
10
|
Soule E, Baig S, Fiester P, Holtzman A, Rutenberg M, Tavanaiepour D, Rao D. Current Management and Image Review of Skull Base Chordoma: What the Radiologist Needs to Know. J Clin Imaging Sci 2021; 11:46. [PMID: 34513210 PMCID: PMC8422542 DOI: 10.25259/jcis_139_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
Chordomas of the skull-base are typically slow-growing, notochord-derived tumors that most commonly originate along the clivus. Skull base chordoma is treated with surgery and radiotherapy. Local recurrence approaches 50% at 10 years. Radiologists play a critical role in diagnosis, treatment planning, and follow-up. Surgeons and radiation oncologists rely on radiologists for pre-operative delineation of tumor and adjacent anatomy, identification of post-treatment changes and disease recurrence, and radiation treatment effects. This review provides an overview of clinical characteristics, surgical anatomy, indications for radiotherapy, identification of treatment complications, and patterns of disease recurrence for radiologists to provide value in the management of these lesions.
Collapse
Affiliation(s)
- Erik Soule
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Saif Baig
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Peter Fiester
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Adam Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Michael Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daryoush Tavanaiepour
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| |
Collapse
|
11
|
La Corte E, Broggi M, Raggi A, Schiavolin S, Acerbi F, Danesi G, Farinotti M, Felisati G, Maccari A, Pollo B, Saini M, Toppo C, Valvo F, Ghidoni R, Bruzzone MG, DiMeco F, Ferroli P. Peri-operative prognostic factors for primary skull base chordomas: results from a single-center cohort. Acta Neurochir (Wien) 2021; 163:689-697. [PMID: 31950268 DOI: 10.1007/s00701-020-04219-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS Fifty-nine primary chordoma patients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
Collapse
|
12
|
Palmer JD, Gamez ME, Ranta K, Ruiz-Garcia H, Peterson JL, Blakaj DM, Prevedello D, Carrau R, Mahajan A, Chaichana KL, Trifiletti DM. Radiation therapy strategies for skull-base malignancies. J Neurooncol 2020; 150:445-462. [PMID: 32785868 DOI: 10.1007/s11060-020-03569-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The management of skull base malignancies continues to evolve with improvements in surgical technique, advances in radiation delivery and novel systemic agents. METHODS In this review, we aim to discuss in detail the management of common skull base pathologies which typically require multimodality therapy, focusing on the radiotherapeutic aspects of care. RESULTS Technological advances in the administration of radiation therapy have led to a wide variety of different treatment strategies for the treatment of skull base malignances, with outcomes summarized herein. CONCLUSION Radiation treatment plays a key and critical role in the management of patients with skull base tumors. Recent advancements continue to improve the risk/benefit ratio for radiotherapy in this setting.
Collapse
Affiliation(s)
- J D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M E Gamez
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - K Ranta
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA
| | - J L Peterson
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Blakaj
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - D Prevedello
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - R Carrau
- Department of Neurosurgery, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Otolaryngology - Head and Neck Surgery at the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - K L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
| |
Collapse
|
13
|
Yaniv D, Soudry E, Strenov Y, Cohen MA, Mizrachi A. Skull base chordomas review of current treatment paradigms. World J Otorhinolaryngol Head Neck Surg 2020; 6:125-131. [PMID: 32596658 PMCID: PMC7296475 DOI: 10.1016/j.wjorl.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation. Methods Literature review of current treatment strategies for chordomas of the skull base. Results Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis. When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging. Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy. There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness. Conclusion Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.
Collapse
Affiliation(s)
- Dan Yaniv
- Department of Otolaryngology- Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ethan Soudry
- Department of Otolaryngology- Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Strenov
- Department of Pathology, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Aviram Mizrachi
- Department of Otolaryngology- Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Abstract
Clinically, radiologically, and pathologically, chondroid neoplasms of the skull can be diagnostically challenging due to overlapping features in each of these domains. Compounding the problem for the pathologist, there is also significant morphologic, immunophenotypic, and molecular genetic overlap between benign and malignant cartilaginous lesions, and the majority of these lesions are encountered quite rarely in routine surgical pathology practice. Each of these factors contribute to the diagnostic difficulty posed by these lesions, highlighting the importance of radiologic-pathologic correlation in the diagnosis. This review is intended to provide an update for surgical pathologists on some of the most commonly encountered chondroid neoplasms in the skull, and includes the following lesions: chondromyxoid fibroma, synovial chondromatosis, chondrosarcoma and variants, and chordoma and variants. For each of these lesions, the differential diagnosis and useful ancillary tests will be discussed in the context of a broad range of additional primary and secondary lesions.
Collapse
|
15
|
La Corte E, Dei Cas M, Raggi A, Patanè M, Broggi M, Schiavolin S, Calatozzolo C, Pollo B, Pipolo C, Bruzzone MG, Campisi G, Paroni R, Ghidoni R, Ferroli P. Long and Very-Long-Chain Ceramides Correlate with A More Aggressive Behavior in Skull Base Chordoma Patients. Int J Mol Sci 2019; 20:E4480. [PMID: 31514293 PMCID: PMC6769603 DOI: 10.3390/ijms20184480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Skull base chordomas are rare tumors arising from notochord. Sphingolipids analysis is a promising approach in molecular oncology, and it has never been applied in chordomas. Our aim is to investigate chordoma behavior and the role of ceramides. METHODS Ceramides were extracted and evaluated by liquid chromatography and mass spectrometry in a cohort of patients with a skull base chordoma. Clinical data were also collected and correlated with ceramide levels. Linear regression and correlation analyses were conducted. RESULTS Analyzing the association between ceramides level and MIB-1, total ceramides and dihydroceramides showed a strong association (r = 0.7257 and r = 0.6733, respectively) with MIB-1 staining (p = 0.0033 and p = 0.0083, respectively). Among the single ceramide species, Cer C24:1 (r = 0.8814, p ≤ 0.0001), DHCer C24:1 (r = 0.8429, p = 0.0002) and DHCer C18:0 (r = 0.9426, p ≤ 0.0001) showed a significant correlation with MIB-1. CONCLUSION Our lipid analysis showed ceramides to be promising tumoral biomarkers in skull base chordomas. Long- and very-long-chain ceramides, such as Cer C24:1 and DHCer C24:1, may be related to a prolonged tumor survival and aggressiveness, and the understanding of their effective biological role will hopefully shed light on the mechanisms of chordoma radio-resistance, tendency to recur, and use of agents targeting ceramide metabolism.
Collapse
Affiliation(s)
- Emanuele La Corte
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Michele Dei Cas
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Monica Patanè
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Chiara Calatozzolo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Giuseppe Campisi
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Rita Paroni
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Riccardo Ghidoni
- PhD School in Molecular and Translational Medicine, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, University of Milan, 20142 Milan, Italy.
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| |
Collapse
|
16
|
Li L, Wang K, Ma X, Liu Z, Wang S, Du J, Tian K, Zhou X, Wei W, Sun K, Lin Y, Wu Z, Tian J. Radiomic analysis of multiparametric magnetic resonance imaging for differentiating skull base chordoma and chondrosarcoma. Eur J Radiol 2019; 118:81-87. [PMID: 31439263 DOI: 10.1016/j.ejrad.2019.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/25/2019] [Accepted: 07/04/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Patients with skull base chordoma and chondrosarcoma have different prognoses and are not readily differentiated preoperatively on imaging. Multiparametric magnetic resonance imaging (MRI) is a routine diagnostic tool that can noninvasively characterize the salient characteristics of tumors. In the present study, we developed and validated a preoperative multiparametric MRI-based radiomic signature for differentiating these tumors. METHOD This retrospective study enrolled 210 patients and consecutively divided them into the primary and validation cohorts. A total of 1941 radiomic features were acquired from preoperative T1-weighted imaging, T2-weighted imaging and contrast-enhanced T1-weighted imaging for each patient. The most discriminative features were selected by minimum-redundancy maximum-relevancy and recursive feature elimination algorithms in the primary cohort. The multiparametric and single-sequence MRI signatures were constructed with the selected features using a support vector machine model in the primary cohort. The ability of the novel radiomic signatures to differentiate chordoma from chondrosarcoma were assessed using receiver operating characteristic curve analysis in the validation cohort. RESULTS The multiparametric radiomic signature, which consisted of 11 selected features, reached an area under the receiver operating characteristic curve of 0.9745 and 0.8720 in the primary and validation cohorts, respectively. Moreover, compared with each single-sequence MRI signature, the multiparametric radiomic signature exhibited better classification performance with significant improvement (p < 0.05, Delong's test) in the primary cohorts. CONCLUSION By combining features from three MRI sequences, the multiparametric radiomics signature can accurately and robustly differentiate skull base chordoma from chondrosarcoma.
Collapse
Affiliation(s)
- Longfei Li
- Collaborative Innovation Center for Internet Healthcare, Zhengzhou University, Zhengzhou, Henan, 450052, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Ke Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Xiujian Ma
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jiang Du
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, Dongcheng Distract, 100050, China
| | - Kaibing Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China
| | - Xuezhi Zhou
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Wei Wei
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Kai Sun
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China
| | - Yusong Lin
- Collaborative Innovation Center for Internet Healthcare, Zhengzhou University, Zhengzhou, Henan, 450052, China; School of Software, Zhengzhou University, Zhengzhou, Henan, 450003, China.
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; University of Chinese Academy of Sciences, Beijing, 100080, China; School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710071, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China.
| |
Collapse
|
17
|
Abstract
RATIONALE Chordomas are rare malignant neoplasms arised from residual embryonic notochordal tissue, mostly located in the axial midline. Tumors along extra-axial locations in the head and neck are rare. Chordomas located in the jugular foramen are extremely rare, with a low incidence of 0.2%. PATIENT CONCERNS A 64-year-old male with 20 years of dizziness history complaining of 6 months of severe dizziness: significant with the changing of the body posture, vertigo which can be self-remissioned within 1 minute and hearing loss of both ears, without headache, nausea, dysphagia, or otalgia. Computed tomography and magnetic resonance imaging (MRI) were performed before surgery which suggests various possibilities. Immunohistochemistry helped to confirm the final diagnosis. DIAGNOSES Immunohistochemistry demonstrated diffuse positivity for S100 (+++), positivity for D2-40 (focal +), EMA (+), and PR (+). Ki-67 labeling index was estimated at 2% focally. The final diagnosis was chordoma. INTERVENTIONS The tumor was excised via retro-sigmoid approach without postoperative radiotherapy. OUTCOMES Facial paralysis occurred in this case. House-Brackmann facial nerve grading system was used to evaluate the facial paralysis of this patient. It is considered as H-B grade IV. The patient was followed up regularly every month after operation, totally for 9 months. An MRI of the brain was performed 6 months after surgery which shows a small range of abnormal signals similar to the previous MRI in the jugular foramen, suggesting that there may be residual or recurrent tumor. And facial paralysis stays at H-B grade IV without any recovery. LESSONS It is a big challenge for us to remove giant tumors located in the jugular foramen because of its unique anatomy. Access should be combined with retro-sigmoid or infra-temporal fossa approach to remove such tumors. Chordomas is a malignant neoplasm which may need radiotherapy after surgery, particularly those with subtotal and partial resection.
Collapse
Affiliation(s)
| | - Ya Liu
- Department of Otorhinolaryngology Head and Neck Surgery
| | - Cheng Dong Chang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ya Ping Xu
- Department of Otorhinolaryngology Head and Neck Surgery
| |
Collapse
|
18
|
|
19
|
Ear and Temporal Bone: Cartilaginous and Osseous Pathologies. Head Neck Pathol 2018; 12:378-391. [PMID: 30069840 PMCID: PMC6081291 DOI: 10.1007/s12105-018-0949-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/29/2022]
Abstract
Although the majority of conditions involving the ear and temporal bone are inflammatory or epithelial based, cartilage and osseous entities will also be encountered. The pathologic examination of these underlying cartilaginous and osseous structures and their histologic findings and associated differential diagnoses will be discussed. Correlation with clinical and imaging findings are also critical for accurate determination of the pathologic entity.
Collapse
|
20
|
Lin E, Scognamiglio T, Zhao Y, Schwartz TH, Phillips CD. Prognostic Implications of Gadolinium Enhancement of Skull Base Chordomas. AJNR Am J Neuroradiol 2018; 39:1509-1514. [PMID: 29903925 DOI: 10.3174/ajnr.a5714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Skull base chordomas often demonstrate variable MR imaging characteristics, and there has been limited prior research investigating the potential clinical relevance of this variability. The purpose of this retrospective study was to assess the prognostic implications of signal intensity on standard imaging techniques for the biologic behavior of skull base chordomas. MATERIALS AND METHODS Medical records were retrospectively reviewed for 22 patients with pathologically confirmed skull base chordomas. Clinical data were recorded, including the degree of surgical resection, the presence or absence of radiation therapy, and time to progression/recurrence of the tumor or time without progression/recurrence of the tumor following initial treatment. Pretreatment imaging was reviewed for the presence or absence of enhancement and the T2 signal characteristics. Tumor-to-brain stem signal intensity ratios on T2, precontrast T1, and postcontrast T1 spin-echo sequences were also calculated. Statistical analysis was then performed to assess correlations between imaging characteristics and tumor progression/recurrence. RESULTS Progression/recurrence of skull base chordomas was seen following surgical resection in 11 of 14 (78.6%) patients with enhancing tumors and in zero of 8 patients with nonenhancing tumors. There was a statistically significant correlation between skull base chordoma enhancement and subsequent tumor progression/recurrence (P < .001), which remained significant after controlling for differences in treatment strategy (P < .001). There was also a correlation between postcontrast T1 signal intensity (as measured by postcontrast T1 tumor-to-brain stem signal intensity ratios) and recurrence/progression (P = .02). While T2 signal intensity was higher in patients without tumor progression (median tumor-to-brain stem signal intensity ratios on T2 = 2.27) than in those with progression (median tumor-to-brain stem signal intensity ratios on T2 = 1.78), this association was not significant (P = .12). CONCLUSIONS Enhancement of skull base chordomas is a risk factor for tumor progression/recurrence following surgical resection.
Collapse
Affiliation(s)
- E Lin
- From the Departments of Radiology (E.L., C.D.P.)
| | | | - Y Zhao
- Healthcare Policy and Research (Y.Z.)
| | - T H Schwartz
- Neurological Surgery (T.H.S.), New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - C D Phillips
- From the Departments of Radiology (E.L., C.D.P.)
| |
Collapse
|
21
|
Batista KP, Gómez GL, Quintana EM, Astudillo A, Fernandez-Vega I, Fernandez BA, Cuellar-Martínez A, Llorente-Pendás J, Rovira-Pereira V, Alvarez-Reyes K. Giant cranionasal epithelioid haemangioendothelioma with invasive growth pattern mimicking a skull base chondrosarcoma. Contemp Oncol (Pozn) 2018; 22:118-123. [PMID: 30150890 PMCID: PMC6103236 DOI: 10.5114/wo.2018.76235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/21/2018] [Indexed: 11/17/2022] Open
Abstract
Epithelioid haemangioendothelioma (EHE) is a rare low-grade vascular neoplasm that is composed of mostly epithelioid cells. EHE may arise as a solitary tumour or in the form of multiple body lesions, and commonly occurs in soft tissues, liver, pleura, lung, peritoneum, lymph nodes, breast, and many other sites. EHE in the cranionasal region is extremely rare. There are very few reports of cases of skull-base EHE. We discuss an extremely rare presentation of an aggressive EHE that originated from the sellar region. Based on literature review, our patient is the first reported case of a giant solitary EHE with prepontine cistern invasion and abducens nerve encroachment mimicking a chondrosarcoma. We treated this rare tumour by near subtotal surgical excision with subsequent radiotherapy, considering that complete tumour resection with free margins in both cavernous sinus and clival region avoiding neural and vascular structure encroachment becomes technically difficult.
Collapse
|
22
|
Diagnostic accuracy of DW MR imaging in the differentiation of chordomas and chondrosarcomas of the skull base: A 3.0-T MRI study of 105 cases. Eur J Radiol 2018; 105:119-124. [PMID: 30017267 DOI: 10.1016/j.ejrad.2018.05.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of DW MR imaging with apparent diffusion coefficient (ADC) mapping for the distinction of skull base chordoma from skull base chondrosarcoma. PATIENTS AND METHODS From October 2009 to April 2014, 105 consecutive patients (chordomas (n = 70), and chondrosarcomas (n = 35) who were planned to receive proton or heavy-ion beam therapy underwent DW MR imaging on a 3.0 T. MR images were assessed by means of consensus of three experienced radiologists who were blinded to pathologic and clinical information. ADC values (mean, minimum, maximum, and normalized) of the solid tumor component were evaluated. Group means and cut-off points were established to separate skull base chordoma from skull base chondrosarcoma, and statistical significances were calculated by Student's t or Mann-Whitney-U tests, and receiver operating characteristic (ROC) curve analyses. The prospective study was approved by the institutional ethics committee. RESULTS For solid tumor component, there were higher mean, minimum, maximum, and normalized ADC values in chondrosarcomas compared with those in chordomas (all p < 0.001). ROC analysis revealed areas under the curve for mean, minimum, maximum, and normalized ADC values between 0.79 and 0.93. The mean ADC value of the solid tumor components had the best AUC, with a cut-off point of 1585 × 10(-6) mm (2)/s and sensitivity and specificity of 94.3% and 98.6%, respectively. CONCLUSION Skull base Chondrosarcomas generally have higher mean, minimum, maximum, and normalized ADC values than skull base chordomas, with the mean ADC value of the solid tumor component offering the highest accuracy for characterization.
Collapse
|
23
|
Abstract
Purpose of Review Chordoma are rare tumours of the axial skeleton which occur most often at the base of the skull and in the sacrum. Although chordoma are generally slow-growing lesions, the recurrence rate is high and the location makes it often difficult to treat. Both computed tomography (CT) and magnetic resonance imaging (MRI) are crucial in the initial diagnosis, treatment planning and post-treatment follow-up. Recent Findings Basic MRI and CT characteristics of chordoma were described in the late 1980s and early 1990s. Since then, imaging techniques have evolved with increased resolution and new molecular imaging tools are rapidly evolving. New imaging tools have been developed not only to study anatomy, but also physiologic changes and characterization of tissue and assessment of tumour biology. Recent studies show the uptake of multiple PET tracers in chordoma, which may become an important aspect in the diagnosis, follow-up and personalized therapy. Summary This review gives an overview of skull base chordoma histopathology, classic imaging characteristics, radiomics and state-of-the-art imaging techniques that are now emerging in diagnosis, treatment planning and disease monitoring of skull base chordoma.
Collapse
|
24
|
Immunophenotypic features of dedifferentiated skull base chordoma: An insight into the intratumoural heterogeneity. Contemp Oncol (Pozn) 2018; 21:267-273. [PMID: 29416431 PMCID: PMC5798418 DOI: 10.5114/wo.2017.72385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/26/2017] [Indexed: 01/05/2023] Open
Abstract
Chordomas are rare and low-grade malignant solid tumours, despite their histologically benign appearance, that arise in the bone from embryonic notochordal vestiges of the axial skeleton, a mesoderm-derived structure that is involved in the process of neurulation and embryonic development. Chordomas occurring in the skull base tend to arise in the basiocciput along the clivus. Three major morphological variants have been described (classical, chondroid, and atypical/dedifferentiated). The pathogenesis and molecular mechanisms involved in chordoma development remain uncertain. From a pathological standpoint, the microenvironment of a chordoma is heterogeneous, showing a dual epithelial-mesenchymal differentiation. These tumours are characterised by slow modality of biologic growth, local recurrence, low incidence of metastasis rates, and cancer stem cell (CSC) phenotype. The main molecular findings are connected with brachyury immunoexpression and activation of the downstream Akt and mTOR signalling pathways. The differentiation between typical and atypical chordomas is relevant because the tumoural microenvironment and prognosis are partially different. This review provides an insight into the recent and relevant concepts and histochemical markers expressed in chordomas, with special emphasis on dedifferentiated chordomas and their prognostic implications.
Collapse
|
25
|
Hudgins PA, Baugnon KL. Head and Neck: Skull Base Imaging. Neurosurgery 2017; 82:255-267. [DOI: 10.1093/neuros/nyx492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 09/07/2017] [Indexed: 12/20/2022] Open
Abstract
Abstract
There are a myriad of head and neck pathologies that extend from the extracranial to the intracranial compartment, traversing the skull base, and knowledge of the imaging appearance of this pathology is critical to practicing neurosurgeons. This article reviews some of the important inflammatory or acquired head and neck pathology along the skull base, neoplastic skull base lesions, and the intracranial extension of head and neck malignancy. Focus will be on the relevant anatomy, appropriate imaging protocols to evaluate these processes, as well as the differentiating imaging findings on computed tomography and magnetic resonance imaging.
Collapse
Affiliation(s)
- Patricia A Hudgins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
26
|
Abstract
Chordoma is a rare malignant bone tumor that can arise anywhere along the central neural axis and many involve head and neck sites, most commonly the skull base. The relative rarity of these tumors, combined with the complex anatomy of the head and neck, pose diagnostic challenges to pathologists. This article describes the pertinent clinical, pathologic, and molecular features of chordomas and describes how these features can be used to aid in formulating a differential diagnosis. Emphasis is placed on key diagnostic pitfalls and the importance of incorporating immunohistochemical information into the diagnosis.
Collapse
|
27
|
Müller U, Kubik-Huch RA, Ares C, Hug EB, Löw R, Valavanis A, Ahlhelm FJ. Is there a role for conventional MRI and MR diffusion-weighted imaging for distinction of skull base chordoma and chondrosarcoma? Acta Radiol 2016; 57:225-32. [PMID: 25722460 DOI: 10.1177/0284185115574156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chordoma and chondrosarcoma are locally invasive skull base tumors with similar clinical symptoms and anatomic imaging features as reported in the literature. PURPOSE To determine differentiation of chordoma and chondrosarcoma of the skull base with conventional magnetic resonance imaging (cMRI) and diffusion-weighted MR imaging (DWI) in comparison to histopathological diagnosis. MATERIAL AND METHODS This retrospective study comprised 96 (chordoma, n = 64; chondrosarcoma, n = 32) patients with skull base tumors referred to the Paul Scherrer Institute (PSI) for proton therapy. cMRI signal intensities of all tumors were investigated. In addition, median apparent diffusion coefficient (ADC) values were measured in a subgroup of 19 patients (chordoma, n = 11; chondrosarcoma, n = 8). RESULTS The majority 81.2% (26/32) of chondrosarcomas displayed an off-midline growth pattern, 18.8% (6/32) showed clival invasion, 18.8% (6/32) were located more centrally. Only 4.7% (3/64) of chordomas revealed a lateral clival origin. Using cMRI no significant differences in MR signal intensities were observed in contrast to significantly different ADC values (subgroup of 19/96 patients examined by DWI), with the highest mean value of 2017.2 × 10(-6 )mm(2)/s (SD, 139.9( )mm(2)/s) for chondrosarcoma and significantly lower value of 1263.5 × 10(-6 )mm(2)/s (SD, 100.2 × 10(-6 )mm(2)/s) for chordoma (P = 0.001/median test). CONCLUSION An off-midline growth pattern can differentiate chondrosarcoma from chordoma on cMRI in a majority of patients. Additional DWI is a promising tool for the differentiation of these skull base tumors.
Collapse
Affiliation(s)
- Uta Müller
- Department of Radiology, Kantonsspital Baden AG, Switzerland
| | | | - Carmen Ares
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Eugen B Hug
- Princton Radiation Oncology Center, Monroe Township, NJ, USA
| | - Roland Löw
- Department of Radiology, Kantonsspital Baden AG, Switzerland
| | | | - Frank J Ahlhelm
- Department of Radiology, Kantonsspital Baden AG, Switzerland
| |
Collapse
|
28
|
Faje A, Tritos NA, Swearingen B, Klibanski A. Neuroendocrine disorders: pituitary imaging. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:873-885. [PMID: 27430447 DOI: 10.1016/b978-0-444-53486-6.00044-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Significant advances in pituitary imaging have taken place in the past several decades, including the introduction of magnetic resonance imaging (MRI). This imaging modality has vastly improved our ability to detect and characterize sellar masses and more accurately characterize the extent and spread of lesions in and around the sella. Intraoperative MRI may help improve the completeness of resection of sellar masses. Other imaging modalities, including magnetic resonance angiography, computed tomography (CT), and CT angiography, have an important role in specific cases. Interventional methods, including bilateral inferior petrosal sinus sampling, may establish the pituitary origin of corticotropin (ACTH) excess in patients with ACTH-dependent Cushing's syndrome. Pituitary imaging should be obtained in patients with pituitary hormone excess, hypopituitarism, or mass effect in the sella. Despite rapid advances in pituitary imaging, there are several diagnostic challenges remaining. Future research may help improve the radiographic detection of small sellar lesions, such as ACTH-secreting adenomas causing Cushing's disease, accurately characterize the type and extent of sellar pathologies, and provide prognostic information regarding their growth potential.
Collapse
Affiliation(s)
- Alexander Faje
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brooke Swearingen
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
29
|
Abstract
Extra-axial brain tumors are the most common adult intracranial neoplasms and encompass a broad spectrum of pathologic subtypes. Meningiomas are the most common extra-axial brain tumor (approximately one-third of all intracranial neoplasms) and typically present as slowly growing dural-based masses. Benign meningiomas are very common, and may occasionally be difficult to differentiate from more aggressive subtypes (i.e., atypical or malignant varieties) or other dural-based masses with more aggressive biologic behavior (e.g., hemangiopericytoma or dural-based metastases). Many neoplasms that typically affect the brain parenchyma (intra-axial), such as gliomas, may also present with primary or secondary extra-axial involvement. This chapter provides a general and concise overview of the common types of extra-axial tumors and their typical imaging features.
Collapse
Affiliation(s)
- Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - James G Smirniotopoulos
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
30
|
Abstract
We present the case of a 62-year-old woman with chondromyxoid fibroma of the sphenoid sinus. Chondromyxoid fibroma is a rare bone tumor found most prevalently in long bones, so its presence at the cranial base is especially uncommon. The presence of a monoclonal gammopathy of undermined significance (MGUS) prompted consideration and investigation of a plasma cell disorder; however, CT and MRI findings followed by biopsy led to the correct diagnosis of chondromyxoid fibroma.
Collapse
|
31
|
Kim JH, Jung HH, Chang JH, Chang JW, Park YG, Chang WS. Gamma Knife surgery for intracranial chordoma and chondrosarcoma: radiosurgical perspectives and treatment outcomes. J Neurosurg 2015; 121 Suppl:188-97. [PMID: 25434952 DOI: 10.3171/2014.7.gks141213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracranial chordomas and chondrosarcomas are histologically low-grade, locally invasive tumors that are reported to be similar in terms of anatomical location, clinical presentation, and radiological findings but different in terms of behavior and outcomes. The purpose of this study was to investigate and compare clinical outcomes after Gamma Knife surgery (GKS) for the treatment of intracranial chordoma and chondrosarcoma. METHODS The authors conducted a retrospective review of the results of radiosurgical treatment of intracranial chordomas and chondrosarcomas. They enrolled patients who had undergone GKS for intracranial chordoma or chondrosarcoma at the Yonsei Gamma Knife Center, Yonsei University College of Medicine, from October 2000 through June 2007. Analyses included only patients for whom the disease was pathologically diagnosed before GKS and for whom more than 5 years of follow-up data after GKS were available. Rates of progression-free survival and overall survival were analyzed and compared according to tumor pathology. Moreover, the association between tumor control and the margin radiation dose to the tumor was analyzed, and the rate of tumor volume change after GKS was quantified. RESULTS A total of 10 patients were enrolled in this study. Of these, 5 patients underwent a total of 8 sessions of GKS for chordoma, and the other 5 patients underwent a total of 7 sessions of GKS for chondrosarcoma. The 2- and 5-year progression-free survival rates for patients in the chordoma group were 70% and 35%, respectively, and rates for patients in the chondrosarcoma group were 100% and 80%, respectively (log-rank test, p = 0.04). The 2- and 5-year overall survival rates after GKS for patients in the chordoma group were 87.5% and 72.9%, respectively, and rates for patients in the chondrosarcoma group were 100% and 100%, respectively (log-rank test, p = 0.03). The mean rates of tumor volume change 2 years after radiosurgery were 79.64% and 39.91% for chordoma and chondrosarcoma, respectively (p = 0.05). No tumor progression was observed when margin doses greater than 16 Gy for chordoma and 14 Gy for chondrosarcoma were prescribed. CONCLUSIONS Outcomes after GKS were more favorable for patients with chondrosarcoma than for those with chordoma. The data also indicated that at 2 years after GKS, the rate of volume change is significantly higher for chordomas than for chondrosarcomas. The authors conclude that radiosurgery with a margin dose of more than 16 Gy for chordomas and more than 14 Gy for chondrosarcomas seems to enhance local tumor control with relatively few complications. Further studies are needed to determine the optimal dose of GKS for patients with intracranial chordoma or chondrosarcoma.
Collapse
Affiliation(s)
- Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do; and
| | | | | | | | | | | |
Collapse
|
32
|
Rombi B, Timmermann B. Proton Beam Therapy for Pediatric Chordomas: State of the Art. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13.00008.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
33
|
Hu H, Xu X, Zeng W, Deng H, Yun D, Li G. Low- to moderate-grade myxoid chondrosarcoma in the craniofacial region: CT and MRI findings in 13 cases. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0184-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Kaloostian PE, Gokaslan ZL. Understanding the cell cycle in the pathophysiology of chordomas: a molecular look. World Neurosurg 2013; 82:e135-7. [PMID: 23380279 DOI: 10.1016/j.wneu.2013.01.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Paul E Kaloostian
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
| |
Collapse
|
35
|
Yeom KW, Lober RM, Mobley BC, Harsh G, Vogel H, Allagio R, Pearson M, Edwards MSB, Fischbein NJ. Diffusion-weighted MRI: distinction of skull base chordoma from chondrosarcoma. AJNR Am J Neuroradiol 2012; 34:1056-61, S1. [PMID: 23124635 DOI: 10.3174/ajnr.a3333] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chordoma and chondrosarcoma of the skull base are rare tumors with overlapping presentations and anatomic imaging features but different prognoses. We hypothesized that these tumors might be distinguished by using diffusion-weighted MR imaging. MATERIALS AND METHODS We retrospectively reviewed 19 patients with pathologically confirmed chordoma or chondrosarcoma who underwent both conventional and diffusion-weighted MR imaging. Differences in distributions of ADC were assessed by the Kruskal-Wallis test. Associations between histopathologic diagnosis and conventional MR imaging features (T2 signal intensity, contrast enhancement, and tumor location) were assessed with the Fisher exact test. RESULTS Chondrosarcoma was associated with the highest mean ADC value (2051 ± 261 × 10(-6) mm(2)/s) and was significantly different from classic chordoma (1474 ± 117 × 10(-6) mm(2)/s) and poorly differentiated chordoma (875 ± 100 × 10(-6) mm(2)/s) (P < .001). Poorly differentiated chordoma was characterized by low T2 signal intensity (P = .001), but other conventional MR imaging features of enhancement and/or lesion location did not reliably distinguish these tumor types. CONCLUSIONS Diffusion-weighted MR imaging may be useful in assessing clival tumors, particularly in differentiating chordoma from chondrosarcoma. A prospective study of a larger cohort will be required to determine the value of ADC in predicting histopathologic diagnosis.
Collapse
Affiliation(s)
- K W Yeom
- Department of Radiology, Stanford University, Palo Alto, California 94304, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Arai M, Nobusawa S, Ikota H, Takemura S, Nakazato Y. Frequent IDH1/2 mutations in intracranial chondrosarcoma: a possible diagnostic clue for its differentiation from chordoma. Brain Tumor Pathol 2012; 29:201-6. [PMID: 22323113 DOI: 10.1007/s10014-012-0085-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/06/2012] [Indexed: 11/30/2022]
Abstract
Mutations in the genes encoding isocitrate dehydrogenase (IDH) 1/2 have been detected in a significant proportion of diffuse gliomas and in a small fraction of acute myeloid leukemia (AML) cases. Recently, in an examination of various types of mesenchymal tumor, IDH1/2 mutations were only found in cartilaginous tumors including central conventional and periosteal enchondromas/chondrosarcomas. The frequency of IDH1/2 mutations was 56%, and the IDH1 R132C mutation, which is not common in diffuse gliomas or AML, accounted for 40% of these mutations. In this study, we investigated the IDH1/2 mutation status of intracranial chondrosarcomas and chordomas, which are morphologically similar and affect similar regions of the cranial cavity. Of the 13 chondrosarcomas analyzed, six (46.1%) displayed IDH1/2 mutations (the predominant type was IDH1 R132C). Also, an IDH2 mutation (R172S) was observed in one case. Conversely, none of the ten chordomas analyzed displayed any IDH1 or IDH2 mutations. Our data suggest that the IDH1/2 mutation status could be valuable for distinguishing intracranial chondrosarcomas from chordomas.
Collapse
Affiliation(s)
- Motohiro Arai
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Abstract
The central skull base (CSB) constitutes a frontier between the extracranial head and neck and the middle cranial fossa. The anatomy of this region is complex, containing most of the bony foramina and canals of the skull base traversed by several neurovascular structures that can act as routes of spread for pathologic processes. Lesions affecting the CSB can be intrinsic to its bony-cartilaginous components; can arise from above, within the intracranial compartment; or can arise from below, within the extracranial head and neck. Crosssectional imaging is indispensable in the diagnosis, treatment planning, and follow-up of patients with CSB lesions. This review focuses on a systematic approach to this region based on an anatomic division that takes into account the major tissue constituents of the CSB.
Collapse
Affiliation(s)
- Alexandra Borges
- Radiology Departement, Instituto Português de Oncologia de Francisco Gentil- Centro de Lisboa Rua Prof. Lima Basto, 1093, Lisboa, Portugal.
| |
Collapse
|
39
|
Pettorini BL, Novegno F, Cianfoni A, Massimi L, De Bonis P, Esposito G, Caldarelli M, Tamburrini G, Di Rocco C, Giangaspero F, Lauriola L. 5-year-old boy with a clival mass. Brain Pathol 2009; 19:523-6. [PMID: 19563544 DOI: 10.1111/j.1750-3639.2009.00299.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
40
|
|
41
|
Seizeur R, Forlodou P, Quintin-Roue I, Person H, Besson G. [Chondrosarcomas of skull base treatment]. Rev Neurol (Paris) 2009; 166:305-13. [PMID: 19592057 DOI: 10.1016/j.neurol.2009.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 05/12/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases. METHODS Retrospective study of five cases treated in 13 years and study of the literature. RESULTS Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2]. DISCUSSION The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.
Collapse
Affiliation(s)
- R Seizeur
- Service de neurochirurgie, pôle neurolocomoteur, hôpital Cavale-Blanche, CHU de Brest, avenue Foch, 29609 Brest cedex, France.
| | | | | | | | | |
Collapse
|
42
|
Borges A. Skull base tumours Part II. Central skull base tumours and intrinsic tumours of the bony skull base. Eur J Radiol 2008; 66:348-62. [PMID: 18472241 DOI: 10.1016/j.ejrad.2008.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 12/18/2022]
Abstract
With the advances of cross-sectional imaging radiologists gained an increasing responsibility in the management of patients with skull base pathology. As this anatomic area is hidden to clinical exam, surgeons and radiation oncologists have to rely on imaging studies to plan the most adequate treatment. To fulfil these endeavour radiologists need to be knowledgeable about skull base anatomy, about the main treatment options available, their indications and contra-indications and needs to be aware of the wide gamut of pathologies seen in this anatomic region. This article will provide a radiologists' friendly approach to the central skull base and will review the most common central skull base tumours and tumours intrinsic to the bony skull base.
Collapse
Affiliation(s)
- Alexandra Borges
- Instituto Português de Oncologia Francisco Gentil, Serviço de Radiologia, Rua Professor Lima Basto, 1093 Lisboa Codex, Portugal.
| |
Collapse
|
43
|
Abstract
Chordomas are rare, slow growing tumors of the axial skeleton, which derive from the remnants of the fetal notochord. They can be encountered anywhere along the axial skeleton, most commonly in the sacral area, skull base and less commonly in the spine. Chordomas have a benign histopathology but exhibit malignant clinical behavior with invasive, destructive and metastatic potential. Genetic and molecular pathology studies on oncogenesis of chordomas are very limited and there is little known on mechanisms governing the disease. Chordomas most commonly present with headaches and diplopia and can be readily diagnosed by current neuroradiological methods. There are 3 pathological subtypes of chordomas: classic, chondroid and dedifferentiated chordomas. Differential diagnosis from chondrosarcomas by radiology or pathology may at times be difficult. Skull base chordomas are very challenging to treat. Clinically there are at least two subsets of chordoma patients with distinct behaviors: some with a benign course and another group with an aggressive and rapidly progressive disease. There is no standard treatment for chordomas. Surgical resection and high dose radiation treatment are the mainstays of current treatment. Nevertheless, a significant percentage of skull base chordomas recur despite treatment. The outcome is dictated primarily by the intrinsic biology of the tumor and treatment seems only to have a secondary impact. To date we only have a limited understanding this biology; however better understanding is likely to improve treatment outcome. Hereby we present a review of the current knowledge and experience on the tumor biology, diagnosis and treatment of chordomas.
Collapse
|
44
|
Jinhu Y, Jianping D, Xin L, Yuanli Z. Dynamic enhancement features of cavernous sinus cavernous hemangiomas on conventional contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2007; 29:577-81. [PMID: 18065511 DOI: 10.3174/ajnr.a0845] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE The reported MR imaging characteristics of cavernous sinus cavernous hemangiomas (CSCHs) in the literature are nonspecific. The purpose of our study was to explore dynamic enhancement features of CSCHs on conventional contrast-enhanced MR imaging and to correlate these features with histopathologic subtypes. MATERIALS AND METHODS Twenty-one patients (8 male and 13 female; age range, 13-63 years; average age, 42.6 years) with surgically confirmed CSCHs were retrospectively investigated. Preoperative MR study was performed in all cases, consisting of T1-weighted axial imaging, T2-weighted axial imaging, T1-weighted sagittal imaging, and contrast-enhanced T1-weighted axial, sagittal, and coronal images. RESULTS There were 4.8% (1/21) that showed homogeneous enhancement on all 3 contrast-enhanced sequences, whereas 95.2% (20/21) demonstrated heterogeneous enhancement on the first contrast-enhanced sequence. Among the 20 lesions, on subsequent contrast-enhanced sequences, 55.0% (11/20) showed homogeneous enhancement, whereas 35.0% (7/20) of lesions showed progressive contrast "filling in." The remaining 10% (2/20) exhibited no apparent enhancement changes. The 95.2% (20/21) of lesions with heterogeneous enhancement on the first contrast-enhanced sequence correlated with type B or type C pathologic findings, whereas 4.8% (1/21) with homogeneous enhancement correlated with type A pathologic findings. Among the 20 type B or type C lesions, 80% (16/20) achieved total or near-total resection. CONCLUSION Progressive contrast "filling in" in the tumors on conventional contrast-enhanced MR images can aid in differentiating between cavernous sinus lesions and suggest the diagnosis of cavernous hemangiomas.
Collapse
Affiliation(s)
- Y Jinhu
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | | |
Collapse
|
45
|
Bonneville F, Savatovsky J, Chiras J. Imaging of cerebellopontine angle lesions: an update. Part 2: intra-axial lesions, skull base lesions that may invade the CPA region, and non-enhancing extra-axial lesions. Eur Radiol 2007; 17:2908-20. [PMID: 17569053 DOI: 10.1007/s00330-007-0680-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 03/11/2007] [Accepted: 04/27/2007] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging reliably demonstrate typical features of vestibular schwannomas or meningiomas in the vast majority of mass lesions responsible for cerebellopontine angle (CPA) syndrome. However, a large variety of unusual lesions can also be encountered in the CPA. Covering the entire spectrum of lesions potentially found in the CPA, these articles explain the pertinent neuroimaging features that radiologists need to know to make clinically relevant diagnoses in these cases, including data from diffusion- and perfusion-weighted imaging or MR spectroscopy, when available. A diagnostic algorithm based on the lesion's site of origin, shape and margins, density, signal intensity and contrast material uptake is also proposed. Non-enhancing extra-axial CPA masses are cystic (epidermoid cyst, arachnoid cyst, neurenteric cyst) or contain fat (dermoid cyst, lipoma). Tumours can also extend into the CPA by extension from the skull base (paraganglioma, chondromatous tumours, chordoma, cholesterol granuloma, endolymphatic sac tumour). Finally, brain stem or ventricular tumours can present with a significant exophytic component in the CPA that may be difficult to differentiate from an extra-axial lesion (lymphoma, hemangioblastoma, choroid plexus papilloma, ependymoma, glioma, medulloblastoma, dysembryoplastic neuroepithelial tumour).
Collapse
Affiliation(s)
- Fabrice Bonneville
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
| | | | | |
Collapse
|
46
|
Bayrakli F, Guney I, Kilic T, Ozek M, Pamir MN. New candidate chromosomal regions for chordoma development. ACTA ACUST UNITED AC 2007; 68:425-30; discussion 430. [PMID: 17714767 DOI: 10.1016/j.surneu.2006.11.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 11/01/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chordomas are rare, slow growing, infiltrative tumors thought to arise from vestigial or ectopic notochord. Chordoma can occur along the axial skeleton, predominantly in the sphenooccipital, vertebral, and sacrococcygeal regions. Although most chordomas are sporadic, familial cases have also been reported. The most common molecular cytogenetic abnormalities in these tumors are monosomy of chromosome 1 and gain of chromosome 7. In addition, a variety of other chromosomal changes, which are associated with losses and gains of different chromosomes, have also been described in chordomas, such as 1q, 2p, 3p, 5q, 9p, 10, 12q, 13q, 17, and 20q. METHODS In this study, using molecular cytogenetics (iFISH), we have studied 1p36, 1q25, 3p13-p14, 7q33, 17p13.1 (p53 gene locus), 2p13 (TGF-alpha locus), 6p12 (VEGF locus), and 4q26-q27 (bFGF/FGF2 locus) loci in chordoma tissues from seven patients with 7 primary tumors and 11 recurrences. RESULTS We found that chromosomes 1p36, 1q25, 2p13, and 7q33 are affected in primary chordomas, and these aberrations persist in recurrences. However, the chromosome 6p12 aberration was seen only in primary chordomas, but not in recurrences, indicating that this locus may be associated with chordoma genesis. CONCLUSIONS Our descriptive data from interphase FISH analyses suggest that future studies should incorporate a larger number of patients and should focus on identifying the candidate genes in chordoma pathogenesis. Such studies may use a whole-genomic approach, in addition to the regions identified in this study and others.
Collapse
Affiliation(s)
- Fatih Bayrakli
- Department of Neurosurgery and Institute of Neurological Sciences, Istanbul 81326, Turkey.
| | | | | | | | | |
Collapse
|
47
|
Grunwald IQ, Veith C, Backens M, Roth C, Papanagiotou P, Reith W. Infratentorielle Tumoren. Radiologe 2007; 47:486-91. [PMID: 17534591 DOI: 10.1007/s00117-007-1515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article gives an overview concerning the typical infratentorial tumors of adults.
Collapse
Affiliation(s)
- I Q Grunwald
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Homburg
| | | | | | | | | | | |
Collapse
|