Indian Journal of Pathology and Microbiology

CASE REPORT
Year
: 2010  |  Volume : 53  |  Issue : 1  |  Page : 117--118

Meningeal chondroma in a young female


Niraj Kumari1, Rabi Narayan Sahu2, Narendra Krishnani1,  
1 Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
2 Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India

Correspondence Address:
Narendra Krishnani
Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP
India

Abstract

Meningeal chondroma is a rare intracranial neoplasm. It is usually diagnosed clinically as meningioma. Histologically it may have a differential diagnosis of chordoid meningioma, a malignant lesion, and needs radiotherapy. A chondroma is a benign lesion where surgical removal is the treatment. A 20-year-old female presented with symptoms of space occupying lesion which was clinically and radiologically considered meningioma. On histopathology, the lesion turned out to be a chondroma. Meningeal chondroma is a benign lesion for which surgical removal is the curative treatment. No further treatment in the form of radiation is required.



How to cite this article:
Kumari N, Sahu RN, Krishnani N. Meningeal chondroma in a young female.Indian J Pathol Microbiol 2010;53:117-118


How to cite this URL:
Kumari N, Sahu RN, Krishnani N. Meningeal chondroma in a young female. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Sep 25 ];53:117-118
Available from: http://www.ijpmonline.org/text.asp?2010/53/1/117/59199


Full Text

 Introduction



Intracranial chondroma is a rare benign intracranial neoplasm that usually occurs in young adults. Skull base is the common site of occurrence, however, rarely can it arise from dural convexity or the falx. [1],[2],[3],[4],[5],[6] The patients present with symptoms of raised intracranial pressure, seizures and focal neurological deficits. [1],[6],[7] These tumors commonly occur as isolated lesions, however, sometimes they may be associated with syndromes like Olliers enchondromatosis or Maffuci's syndrome. [8] We report a case of intracranial chondroma because of its rarity - it was clinically diagnosed as meningioma.

 Case Report



A 20-year-old female presented with five months of progressive headache and vomiting. On examination, there was no neurological deficit except for the presence of bilateral papilledema on fundoscopy. Imaging on Computed Tomography (CT) scan showed a left fronto-parietal large extra-axial lesion measuring 13x7x6cm that was predominantly isodense with areas of hypodensity surrounding edema and midline shift. magnetic resonance imaging (MRI) revealed hypo intense lesion on T1 and hyper intense lesion on T2 with heterogenous post-contrast enhancement [Figure 1]. The patient's hemogram and viral serology including HbsAg, human immunodeficiency virus (HIV) and anti hepatitis C virus (HCV) were negative. Left fronto-parietal parasaggital craniotomy performed and tumor was excised completely. Intraoperatively, the tumor was extra-parenchymal pinkish-white, firm, lobulated and poorly vascular attached to falx posteriorly. Per-operatively the mass was located in left frontal parasagittal region with attachment to sagittal sinus posteriorly. It was firm to hard in consistency and avascular having a well defined arachnoidal plane of cleavage.

Grossly, the tumor was homogenous whitish shiny cartilaginous appearance and firm to hard in consistency. Microscopically, the tumor consisted of large round to polygonal cells arranged in lobules having single nucleus in the lacunae and abundant chondromyxoid cytoplasm [Figure 2]. The patient came for follow up three months post-surgery and was apparently well without any neurological deficits.

 Discussion



Intracranial chondroma is an extremely rare intracranial tumor that usually arises from the skull base. It may also arise from the cartilage rest within the dura mater of the convexity or the falx. [6],[9] It may be part of Ollier's multiple enchondromatosis or Maffuci's syndrome. Chondromas comprise less than 0.3% of intracranial tumors. [1],[6] The various theories that have been proposed for the genesis of intracranial chondromas are metaplasia of meningeal fibroblasts and perivascular meningeal tissue, traumatic or inflammatory cartilaginous activation of fibroblasts and growth of aberrant embryonal cartilaginous rests in the duramater. Clinically, chondromas present as meningiomas and imaging studies show a well defined mass of variable density due to different degrees of calcification with minimum to moderate contrast enhancement. In the present case there were areas of hypo density within largely isodense appearance on CT scan, however, no calcification was seen within the tumor despite multiple sampling. The tumor had a cartilaginous appearance on gross examination. Histologically, the tumor was composed of benign chondrocytes. No mitosis or multinucleation was noted. Chordoid meningiomas may mimic meningeal chondromas but in contrast to chondromas which show exclusively chondrocytes, the chordoid meningiomas show at least some evidence of conventional meningioma and cords of large cells in a myxomatous background. In the present case despite multiple sampling no evidence of meningioma was found.

Chondromas are benign lesions that do not require post-resection radiation whereas chordoid meningiomas are WHO grade II (atypical meningioma) which require radiation and close follow-up. They have a tendency to recur. As the clinical and radiological diagnosis mimics meningioma, a histological examination is a must to differentiate chondromas from meningiomas. Complete tumor resection, including its dural attachment, is the treatment of choice. At present, long-term prognosis is favorable and radiation therapy is not recommended for residual tumors or inoperable patients due to risk of malignant conversion post-radiation.

References

1Colpan, E, Attar A, Erekul S, Arasil E. Convexity dural chondroma: a case report and review of the literature. J Clin Neurosci 2003;10:06-8.
2De Coene B, Gilliam C, Grandin C, Nisolle JF, Trigaux JP, Landou JB. Unusual location of an intracranial condroma. Am J Neuroradiol 1997;18:573-5.
3Ishibashi H, Matsuno H, Nagata S, Onitsuka H, Fukui M. Posterior fossa chondroma arising from the tentorium: A case report. Surg Neurol 1999;52:604-6.
4Luzardo-Small G, Mendez-Martinez O, Cardozo- Duran J. Cavitated (cystic) falcne condroma: case report. Br J Neurosurg 1999;13:426-8.
5Mapstone TB, Wongmongkolrit T, Roessman U, Ratcheson RA. Intradural chondroma: A case report and review of the literature. Neurosurgery 1983;12:111-4.
6Nakayama M, Nagayama T, Hirano H, Oyoshi T, Kuratsu J. Giant chondroma arising from the dura mater of the convexity. J Neurosurg 2001;94:331-4.
7Lacerte D, Gagne F, Copty M. Intracranial chondroma. Report of two cases and review of the literature. Can J Neurol Sci 1996;23:132-7.
8Ghogawala Z, Moore M, Strand R, Kupsky WJ, Scott RM. Clival chondroma in child with Ollier's disease: case report. Pediatr Neurosurg 1991;1:53-6.
9Erdogan S, Zorludemir S, Erman T, Akgul E, Ergin M, Ildan F, et al. Chondromas of the falx cerebri and dural convexity: report of two cases and review of the literature. J Neurooncol. 2006;80:21-5.