Classical intracranial chondrosarcoma: A case report

Extra-skeletal intracranial mesenchymal chondrosarcoma: systematic-literature review

BACKGROUND

Intracranial mesenchymal chondrosarcoma (IMC) is a rare malignant tumor in pediatric population. IMC can present as extra- or intra-axial lesion in pediatric patients, though the former is commoner causing raised intracranial pressure (ICP). Radiological diagnosis is a challenge in these cases, as is it difficult to differentiate these from other extra-axial neoplasms due to the wide differential diagnosis in pediatric population. We aim to systematically review the literature and present a rare case of extraskeletal intracranial mesenchymal chondrosarcoma treated with safe maximal resection.

METHODS

A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed and Scopus databases were queried using the search terms, "primary intracranial chondrosarcoma", "extraskeletal mesenchymal chondrosarcoma", "mesenchymal chondrosarcoma" and "pediatric". Presentation, surgical management and outcome of a 15-year-old male with an extraskeletal IMC are also described.

RESULTS

The search yielded 25 articles which met the inclusion criteria. These published records consisted of 33 IMC cases with mean age at presentation of 9.81 ± 5.2 years (range 2 months to 18 years). Frontal region was the commonest locations (11, 33.3%). Most common presentation was headache (14, 42.4%). All patients underwent surgical intervention: gross total resection (20, 60.6%), subtotal resection (9, 27.3%) and no extent mentioned (4, 12.1%). No adjuvant therapy was received in 15 patients (45.5%). On latest follow-up, 11 patients (33.3%) are on remission, 5 patients (15.2%) are symptom free, 3 patients (9.1%) had recurrence, 2 patients (6.1%) had metastasis and 9 patients (27.3%) expired.

CONCLUSION

IMC is a rare entity in pediatric population with imaging findings which are non-characteristic leading to its diagnostic challenge. It can masquerade as other extra-axial intracranial neoplasm (meningioma or hemangiopericytoma). Combination of clinico-radiological and pathological examination can help in accurate diagnosis.  Safe Maximal resection followed by radiotherapy is the preferred treatment strategy.

An Unusual Presentation of a Primary Chondrosarcoma of the Cranial Vault

Chondrosarcomas are malignant cartilaginous tumors that usually affect the pelvic bone and long bones. Primary chondrosarcomas of the skull are rare, with the cranial vault being an even more unusual localization. We report a case of a 75-year-old man presenting with headaches and outgrowth of the parietal scalp. CT scan of the head showed an extracranial cystic well-rounded mass originating at the parietal suture and eroding through the adjacent parietal bone. The patient underwent an en bloc surgical resection of the mass, and histological examination confirmed a grade I chondrosarcoma.

A multicenter retrospective analysis of clinical outcomes of intracranial chondrosarcoma in 26 patients

Intracranial chondrosarcoma is a rare tumor with limited reports. We reviewed the clinical outcomes, imaging findings, and pathological characteristics at three centers to improve the diagnosis and treatment of intracranial chondrosarcoma. We retrospectively analyzed 26 patients with intracranial chondrosarcoma who had undergone surgical treatment at Tangdu Hospital of Air Force Military Medical University, Mianyang Central Hospital, and Nanchong Central Hospital from January 2010 to July 2022. Clinical manifestations, imaging features, surgical treatment, prognosis, and overall survival (OS) were analyzed. All 26 chondrosarcomas were located at the skull base. Gross total resection (GTR), subtotal resection (STR), and partial resection (PR) were performed in 14, 10, and 2 cases, respectively. Four cases underwent endoscopic transnasal surgery, while the remaining cases underwent craniotomy. The clinical symptoms were evaluated 1 week after surgery, and 15 cases were relieved to varying degrees. Postoperative complications included pulmonary infection, subcutaneous hydrops, dysphagia and choking, facial numbness, abducens paralysis, and intracranial infection (ICI). Fifteen cases received postoperative adjuvant radiotherapy. Seven cases showed recurrence: two with PR, four with STR, and one with GTR. Six cases received reoperation or radiotherapy after tumor progression, and one untreated patient died 5 months after tumor recurrence. The extent of tumor resection (HR 21.74, 95% CI 1.25-376.6, P = 0.03) and pathological grading (HR 131.99, 95% CI 4.05-4300.5, P = 0.006) were associated with improved OS. We presented our experience in the treatment of intracranial chondrosarcoma at three centers in the past 12 years. Intracranial chondrosarcoma lacked typical imaging features and are difficult to differentiate from other skull base lesions. Maximum extent of tumor resection with minimal injury to neurological function remains the most important treatment strategy. The extent of surgical resection and pathological grading were found to be predictors for OS.

Osteoblastoma in the occipital bone: A case report of a rare tumor in the calvarium

Osteoblastomas infrequently occur in the calvarium, displaying a preference for temporal and frontal bones when it does. We present an unusual case of a large, expansile osteoblastoma in the occipital bone of a 23-year-old man who presented with a nontender lump at the back of his head. Initial computed tomography scan showed a large occipital bone mass, and after additional imaging, a gross total resection was performed. Histopathological examination revealed an osteoblastoma. Although these tumors are benign, overlapping imaging characteristics of lesions affecting the calvarium often present a diagnostic dilemma. This case emphasizes the importance of imaging in the management and work-up of these patients to decrease the risk of complications and assists surgeons in their preoperative planning.

Intracranial Nonskull-Based Chondrosarcoma Arising from the Sagittal Sinus: A Case Report and Review of the Literature

BACKGROUND

Intracranial nonskull-based chondrosarcoma is a very rare malignant tumor. In fact, it is difficult to diagnose because of its atypical radiologic and morphologic features. We report a case of an intracranial parasagittal chondrosarcoma in the left parietal lobe accompanied with significant peritumoral edema (an extremely rare phenomenon for this tumor), with a review of the literature, to clarify aspects in the diagnosis of this rare tumor.

METHODS

A literature search was using PubMed with specific key terms, inclusion criteria, and exclusion criteria. Selected case studies and case series were then compared and summarized them in Table 1. A 59-year-old male patient presented with a history of progressive right hemiparesis and loss of sensation for 45 days.

RESULTS

Magnetic resonance imaging revealed a 2.6 × 2.4 × 2.8-cm mass arising from the superior sagittal sinus in his left parietal lobe. A left parietal parasagittal craniotomy was performed, and a macroscopically complete excision of the tumor was achieved. The patient recovered well postoperatively. Regular follow-up after 6 months revealed that he had almost recovered full strength to his right limbs, and there was no evidence of recurrence. Intracranial parasagittal chondrosarcoma in the parietal lobe is extremely rare.

CONCLUSIONS

Although magnetic resonance imaging was performed, it is sometimes difficult to distinguish intracranial chondrosarcoma from meningioma and glioma, especially when the tumor arises from a nonskull base such as the meninges. Some cases could have significant peritumoral edema, although it is extremely rare. Histologic examination may aid in the diagnosis of this tumor. Neurosurgery is the most effective therapy for these tumors. Postoperative radiotherapy needs to be considered when the tumor is incompletely resected, has atypical histology, or is associated with significant peritumoral edema.

Intracranial dural chondroma in a child-conventional and advanced neuroimaging characteristics and differential diagnosis

Intracranial chondromas are rare tumors, especially in the pediatric population. We describe the conventional and advanced neuroimaging characteristics of this rare convexity dura-based chondroma in a young adolescent. In particular we demonstrate that diffusion-weighted imaging (DWI) facilitates differentiation between a dura-based chondroma and the more frequent classical meningioma. Chondromas are typically DWI hypointense with high apparent diffusion coefficient (ADC) values while meningiomas are typically DWI hyperintense with low ADC values. We also discuss the relevant additional differential diagnoses of dura based focal lesions for the pediatric population as well as the diagnostic significance of additional imaging modalities, including computed tomography, magnetic resonance imaging and cerebral angiography.