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Chondroma

CLINICAL HISTORY:
This 22-year old female patient complained one year ago of sudden diplopia. Now she notes a progressive paresis of the right side of the body with paresthesias and problems with swallowing.

NEUROLOGICAL EXAMINATION reveals a tendency to fall to the right. The uvula deviates to the right with a curtain sign. Horizontal diplopia is present due to bilateral VI nerve palsy. The right corner of the mouth is drooping. The right leg and the right arm show paresis and hypotonia.

NON-CONTRAST CT (IMAGES 1 AND 2): A huge retroclival mass is seen with substantial posterior extension. The periphery of the mass is calcified, while in the center some punctate calcifications are present. The center of the mass is hypodense. There is severe compression of the brainstem.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): A huge retroclival mass is seen, with an irregular outline. The mass displays an overall hyperintense signal, but with a peripheral hypointense character due to calcifications. Substantial dilatation of the lateral ventricles is noted.

b) SAGITTAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 5): The mass appears to be in broad contact with the clivus just beneath the dorsum sellae. Significant posterior displacement and compression of the brainstemn is again noted. The floor of the third ventricle is markedly elevated (arrowheads).

c) TRANSAXIAL T1-WEIGHTED (520/15/1) SPIN-ECHO SEQUENCES (IMAGE 6): The mass is overall hypointense.

d) TRANSAXIAL (IMAGES 7 AND 8), CORONAL (IMAGE 9) AND SAGITTAL (IMAGES 10 AND 11) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The enhancement of the tumor is intense, but quite inhomogeneous. Within the tumor several areas with less enhancement can be seen. Elevation of the third ventricle and the marked compression and displacement of the brainstem can again be appreciated. Broad implantation on the clivus (arrowheads).

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS includes chondroma and chordoma. A meningioma of the clivus is very unlikely.

SURGICAL FINDINGS: Surgery was performed via the subtemporal transtentorial approach. The brainstem was considerably displaced posteriorly. The tumor capsule was tightly adherent to the brainstem. The contents of the tumor were partly slimy, partly hard and partly crumbly. The vascularity was considerable. Only a partial resection could be achieved.

ANATOMOPATHOLOGY: Chondroma

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Chondrosarcomas of the skull base

 

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Fig. 1

Chondroma, Fig. 1
Chondroma, Fig. 2
Chondroma, Fig. 3
Chondroma, Fig. 4
Chondroma, Fig. 5
Chondroma, Fig. 6
Chondroma, Fig. 7
Chondroma, Fig. 8
Chondroma, Fig. 9
Chondroma, Fig. 10
Chondroma, Fig. 11