Chondroma of the cervical spine. Case report

Subaxial cervical foraminal chondromas: case-based discussion on surgical management

Cervical foraminal chondromas are benign lesions that may require surgical resection when symptomatic due to radicular and/or spinal cord compression. The aim of surgery is to achieve gross tumor removal while preserving neurological function and spine stability. The authors describe a case of subaxial foraminal chondroma with a systematic review of the literature on patients with cervical chondromas. In the reported case, the authors used a retrojugular approach to remove a C6-C7 right chondroma without the need for spinal stabilization. Literature review identified a total of 11 patients who underwent surgery for subaxial foraminal chondroma. The mean age at diagnosis is 33.6 years (range: 10-73). Most patients report neurological symptoms at the time of diagnosis. The most frequently involved vertebral level is C4-C5 (54.6%, 6/11). Preoperative foraminal enlargement is present in 63.6% (7/11) of patients. Surgical resection is performed via an anterior approach in 18.2% (2/11) of patients, with vertebral body resection and concomitant cervical instrumentation. The anterolateral approach is selected in 27.2% (3/11) of patients, and the posterior approach in 54.6% (6/11) of patients, with only one patient requiring both anterior and posterior instrumentation. The choice of surgical access for subaxial foraminal chondroma can be challenging due to the anatomical location of the tumor in relation to the cervical nerve roots and spinal cord. Accurate approach selection is key to achieving complete tumor removal while preserving cervical spine stability.

Resection of Cervical Juxtacortical Chondroma and Circumferential Spinal Stabilization for Kyphotic Deformity

Chondromas are rare, benign tumors composed of cartilaginous tissue that mainly affect the metaphases of long tubular bones. Juxtacortical (periosteal) chondromas arise from the surface of periosteum and rarely affect the cervical spine. We present a patient with a spinal juxtacortical chondroma causing spinal cord compression and a cervical deformity treated with surgical resection and circumferential spinal fixation and stabilization.

A 55-year-old female with past medical history of Crohn’s disease with years of neck pain, balance issues, and left upper extremity radicular symptoms. Cervical spine x-rays show kyphosis with an apex at C5, degenerative changes of the endplates and facet joints, and grade 2 anterolisthesis C4 on C5 with no abnormal motion with flexion/extension. MRI showed a left sided C5-6 extramedullary mass measuring 11 x 11 x 15 mm causing spinal cord compression and neural foraminal narrowing. Her pain is worsening and refractory to physical therapy, gabapentin and methocarbamol.

A C4-5 & C5-6 anterior cervical discectomy and fusion, C4-5 & C5-6 laminectomy for tumor resection, and C4-5 & C5-6 posterior fusion with instrumentation was performed. The tumor was completely removed in piecemeal fashion. Microscopic findings showed bland well differentiated cartilaginous neoplasm consistent with juxtacortical chondroma. Postoperative X-rays show partial reduction of C4-5 anterolisthesis and partial reversal of cervical kyphosis. The patient’s radicular pain resolved and neck pain improved postoperatively but she still has some left sided neck pain and hand dysesthesias that are controlled with oral medication one year following surgery.

Cervical chondromas are rare, benign cartilaginous tumors that may present with spinal cord or nerve root compression. They are more complex when they present in patients with co-existing spinal deformities. Maximal safe resection followed by spinal re-alignment and fixation without adjuvant chemotherapy or radiation is recommended in most cases. Close follow-up is recommended to monitor for recurrence.

Isolated enchondroma of the atlas

Periosteal enchondromas located in the spine are rare. We reported an even more infrequent occurrence of a periosteal enchondroma in the cervical spine of a 19-year-old girl. During the operation, a giant (>8 cm × 5.5 cm × 5 cm) ossified periosteal enchondroma with involvement of posterior structures and muscles of the axis was resected. The pathological examination revealed that the tumor consisted of enchondroid tissue with typical chondrocytes, confirming the diagnosis of periosteal enchondroma. Early identification of the initial lesion should be coupled with total surgical resection, as a definitive treatment, to prevent malignant transformation. Enchondromas grow in an expanding manner which makes easy total resection.

Enchondroma Protuberans of the Transverse Process of D8 Vertebra Extending to the 7th and 8th Ribs: A Rare Case Report

Background

Enchondroma protuberans (EP) is rare, benign cartilaginous bone tumor arising from the intramedullary cavity of long bones and usually protrudes beyond the cortex with an exophytic growth pattern resembling osteochondroma. This study reports on a rare case of EP arising from the transverse process of the D8 vertebra and extending to the adjacent 7th and 8th ribs and the paraspinal tissues.

Methods

A 45-year-old female patient came in with complaints of upper back pain radiating up to the left costal margin for the past 6 months. There were no parasthesias, and there was no history of any sensory or motor symptoms. On physical examination there was midline and left paraspinal tenderness over the D6 to D8 region. Anteroposterior and lateral X-ray images revealed a well-defined oval ossific mass lesion over the lateral aspect of the D8 vertebra, extending to the 7th and 8th ribs on the left side, and multiple bridging osteophytes were noted. Computed tomography scan showed an ossific mass lesion arising from the D8 transverse process with extension to the adjacent 7th and 8th ribs; its margins were well defined, with no periosteal reaction. Magnetic resonance imaging showed a well-defined expansile mass lesion arising from the transverse process of the D8 vertebra matrix; it was was isointense with adjacent marrow and had no evidence of calcifications or vascular flow voids and no encroachment into the spinal canal.

Results

Complete resection of the mass lesion with the adjacent part of the 7th and 8th ribs and with intramedullary curettage was performed and sent for histopathologic examination. Histopathology showed bony trabeculae with normal mucosal elements, and a mild hypercellularity with binucleation. Chondrocytes in the myxoid matrix located in round lacunae were compatible with enchondroma, with no evidence of atypia. The postoperative period was uneventful, and after 12 months there were no signs of recurrence noted in computed tomography scan.

Conclusions

EP is a rare presentation in the dorsal spine; it should be considered in the differential diagnosis of osteochondroma, enchondroma, chondrosarcoma, and periosteal chondroid tumors.

Cervical Periosteal Chondroma Causing Spinal Cord or Nerve Compression: 2 Case Reports and Literature Review

BACKGROUND

Chondroma is a rare benign cartilaginous tumor that originates in chondrocytes and is commonly seen in the long bones; however, it infrequently occurs in the cervical spine.

CASE DESCRIPTIONS

We report 2 patients with cervical periosteal chondroma that originated in the C2 vertebral body and C1 lamina as extramedullary tumors. The first patient was a 28-year-old man who presented with right upper extremity weakness and numbness. Cervical radiography revealed a bony tumor with evidence of severe spinal cord compression. The second patient was a 26-year-old woman with left occipital neuralgia. Cervical radiography demonstrated a bony tumor arising from the left C1 lateral mass that compressed the C2 nerve root. Both patients underwent surgical removal of the bony tumors, which were diagnosed as periosteal chondroma.

CONCLUSIONS

The authors herein summarized 16 previous reports of cervical chondroma and compared the clinical courses and treatments. Recommended treatment included maximal surgical resection, especially when significant compression of the cervical cord and signal abnormality within the cord was observed. Annual postoperative follow-up is mandatory to ensure proper neurologic improvement.

Cervical Spine Chondroma Compressing Spinal Cord: A Case Report and Literature Review

Chondromas are benign tumor of cartilaginous tissue that is rarely found in spine. The authors document a rare case of a 72 year old male patient with a cervical spinal chondroma compressing the spinal cord. The patient had symptoms of motor and sensory deficits, dysphagia and dysarthria. C1 and C2 laminotomy was done and the spinal tumor was removed. The patient gradually recovered from his previous symptom after the surgery.

Enchondroma of the cervical spine in young woman: A rare case report

Enchondroma is a type of benign cartilaginous bone tumor. Enchondroma of the spine is very rare. There are only a few cases of enchondromas located in the lamina of the cervical spine have been reported. Therefore, we report a case of enchondroma in the cervical spine. A 24-year-old female patient presented with a history of neck pain, restriction of neck movement, pain and numbness along the right scapula, and weakness accompanied by wasting of the right hand. Presumptive diagnoses included bony tumors such as an aneurysmal bone cyst or a giant cell tumor. Radiologic examinations revealed a round tumor in the right lamina of C4 with extracortical extension and foramen of C4-5. C4 right hemilaminectomy and facetectomy were performed with near complete removal of the tumor. On histological examination, the tumor was confirmed to be an enchondroma. At the 6-month follow-up, a computed tomography scan showed no recurrence with good alignment.

Lumbar spinal chondroma presenting with acute sciatica

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

Cervical osteochondroma presenting with acute quadriplegia

Osteochondromas of the vertebral column are rare tumors and constitute about 3-4% of all primary vertebral column tumors. We report a case of osteochondroma arising from C3 lamina presenting with acute quadriplegia following a trivial fall. Computed Tomography (CT) and Magnetic Resonance imaging (MRI) showed bony lesion arising from C3 laminar arch compressing the cord with underlying spinal cord contusion. Emergency C3 laminectomy and complete enbloc excision of the lesion was performed, following which patient showed gradual recovery in neurological status. This acute presentation in this rare, slow growing, tumor has never been reported in literature till date.

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

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

Periosteal chondroma of the pediatric cervical spine

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

Spinal chondroma of the lumbar tract: case report

BACKGROUND

Cartilage-forming tumors are benign cartilaginous tumors that rarely affect the spinal canal: they account for 2% of all spinal tumors and 2.6% of all benign bone tumors. Pathologically, they may be classified as chondromas, osteochondromas, chondroblastomas, and chondromyxoid fibromas. This oncotype may remain asymptomatic (it is confined within the vertebral structure) or may present as a hard paravertebral swelling (it invades the paravertebral structures) or more rarely, with a slowly-developing neurologic syndrome (it extends into the vertebral canal).

METHODS

Thirty-one cases have been reported (including our case) of benign cartilage-forming tumors localized in the lumbar column. Only three cases of chondroma of the lumbar spine presented with lumbar radicular pain. We report a fourth case and review clinical and radiologic characteristics of these lesions.

RESULTS

Eleven out of the 31 cases were diagnosed as chondromas, 17 as osteochondromas, while in three cases the histopathologic diagnosis was not reported. Seventeen cases originated from the neural arch, seven from the vertebral body, two from the spinous process, and in five cases the exact localization was not reported. This tumor is more frequent in males (21 cases out of 31), than in females (five cases); in five cases the sex was not reported. Mean duration of symptoms was 23 +/- 5.1 months (range: 1-96); chondromas have a short clinical history before diagnosis (13.8 +/- 3.4 months) compared to osteochondromas (28.6 +/- 7.6). Clinical presentation with local swelling is reported in 10 cases, in 10 cases local pain without radicular irradiation, in six cases lumbar pain with sciatica, in two cases signs and symptoms of cord compression, one case of cauda syndrome, while in four cases no clinical details are reported. Among the six cases presenting with sciatica, four were chondromas (in all cases the L4 level was involved), and one osteochondroma, while in one case the histopathologic diagnosis was not reported.

CONCLUSION

Computed tomography is important and indispensable for preoperative diagnosis, giving a precise indication of tumor extent and location and its relationship to the adjacent structures; while MRI is helpful in detecting patterns related to histologic malignancy. It is important to examine the whole tumor histologically because it is known that there may be small areas that show signs of malignancy; thus is more likely in chondromas than osteochondromas.

Chondromas of the spine: report of two cases and review of the literature

We report two cases of vertebral chondroma presenting with spinal cord compression. In one case there was ultimate malignant transformation.

Chondroma of the cervical spine

Chondroma is a benign cartilaginous tumor and rarely seen as a spinal cord tumor. The authors report a case of cervical chondroma with cord compression signs. After the total surgical removal of the lesion neurological recovery was seen, but one year later recurrence occurred with no sarcomatous transformation.